There’s no need to panic, however surveillance needs to be maintained, say experts

By Mohd Naushad Khan

The number of Monkeypox cases increased to 13 after very recently a Nigerian national was tested positive. On the face of it, the numbers may be too small, but it is definitely a wake-up call for India because WHO has already declared Monkeypox as a global emergency.

When the memory of deadly Covid-19 pandemic gradually started to fade out from our conscious and sub-conscious minds, the emergence Monkeypox virus has once again started to remind the horror, trauma and tragic story of the pandemic.     

Experts have already started to compare the threat of Covid-19 with that of Monkeypox, the danger foreseen and are also contemplating on how the lessons learnt from Covid-19 pandemic can help India fight the spread of deadly new virus. 

It is still not clear how it is going to spread and how dangerous it would be in terms of its impact. Therefore, India needs to set up a data-based monitoring system in order to provide information for policymakers and healthcare industry about where the Monkeypox virus would spread faster in near future and how to streamline the response mechanism accordingly. Experts believe that the lessons learnt from the pandemic will help India fight Monkeypox in an effective way.

According to Prof. Suptendra Nath Sarbadhikari, a Health Informatics Educationist specialising on Digital Health Standards, and presently Professor and Head, Digital Health Research at Santiniketan Medical College, West Bengal, who is also included in the Roster (of Experts) for Digital Health of the World Health Organisation (WHO), “Monkeypox is quite different from CONVID 19. Nevertheless, the lessons learnt during the COVID 19 pandemic will be useful to us. It is good that the ICMR has brought out an Expression of Interest (EOI) on Collaboration for development of In-Vitro Diagnostic (IVD) Kits and Vaccine candidate against Monkeypox Virus (MPXV).

“They are inviting kit manufacturers for joint collaboration in the following two categories – i. Development of vaccine candidate against Monkeypox disease, and, ii. Development of diagnostic kits for diagnosis of Monkeypox virus infection. The NCDC (National Centre for Disease Control) has also notified Interim Advisory for IDSP SSUs in view of Monkeypox cases reported from a few countries. Hopefully, we’d be able to overcome this emergent disease successfully.”

Seyed Ehtesham Hasnain, Former Member (2004-14), Scientific Advisory Council to the Prime Minister of India (SAC-PM), Vice Chancellor, Jamia Hamdard and First Director, Centre for DNA Fingerprinting & Diagnostics (CDFD), Hyderabad, said, “There are very few similarities between monkeypox virus and SARS-CoV-2. India has shown and demonstrated its strength in being able to manage and, to a large extent, control COVID-19 pandemic. With the record 2 billion doses of COVID-19 vaccine shots already given in India, there is no competitor globally for India in this respect. As of now and also very unlikely in the future, that monkeypox virus will cause the same impact as COVID-19. A typical member of Poxviridae family, monkeypox virus usually causes morbidity and has a very low case fatality ratio (<1%) unlike SARS CoV-2. With a low R-value (a measure of reproduction and person to person infection), this virus is also not as transmissive as CoV-2.” 

Dr Hasnain added, “With no definitive vaccine available for mass use (the vaccine developed for the pox virus is the only one that can be used), it is also very unlikely that emergency care vaccine will be developed along the lines of COVID-19. The ICMR-NIV lab in Pune has already purified this virus from a patient and a whole virus vaccine can be developed on the patterns of COVID-19 done earlier by Hyderabad based Bharath Biotech India Limited. The other good part is also that unlike SARS-CoV-2 this virus infects a limited number of organs, skin lesions appear mostly around genital regions.” 

“Surveillance however needs to be maintained and that is relatively easy compared to COVID-19 as infected persons develop skin lesions in about a week’s time which becomes easy to identify and isolate infected persons and check further transmission. Although transmitted mostly through sexual route, air borne transmission being one of the modes of infection, wearing of masks will be desirable. With less than half a dozen cases reported from India so far, there is no need to worry and implement the kinds of measures India took to fight COVID-19 in terms of diagnostics or rapid development and delivery of vaccines. At this point of time there is certainly no need to panic given the existing infrastructure and more importantly the political resolve the Government of India has to fight such infections,” said Hasnain.

“The mechanisms and processes fine-tuned during the ongoing pandemic can help shape response against newer outbreaks, provided the systems have incorporated and prioritised strengthening the public health systems. From COVID-19 response, the system should have incorporated how to destigmatise and reduce discrimination. The stigma can stem from the disease itself, geography or social economic inequalities,” said Giridhara R Babu, professor and head- life Course Epidemiology, The Public Health Foundation of India (PHFI) who has also worked with World Health Organisation and All India Institute of Medical Sciences, New Delhi.

“Reduced testing, poor access to vaccines and treatments were some of the challenges confronted during COVID-19 response. The learning from scaling up the development, production, and distribution, mechanisms and processes involved therein are key learnings. The world will witness more zoonotic diseases in future. The governments need to prioritise one health agenda with the goal to reduce the suffering and promote health in humans as well as animals,” he said.

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