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RUBY:

From Schwartz Media I’m Ruby Jones this is 7am.

The spread of monkeypox is testing public health officials worldwide.

It’s a virus that is challenging both our ability to get vaccines and medicines to the people who need them the most, as well as the ability of health authorities to send the right message.

So, what is the right health message? And how do we empower communities, after they have been through two years of a COVID-19 pandemic?

Today, science writer Bianca Nogrady, on the origins and challenges of the monkeypox outbreak.

It's Monday, August 22.

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RUBY:

Bianca, we've seen a relatively small number of monkeypox cases so far in Australia, but it won't necessarily stay that way. Doctors around the world are saying that they have seen more people infected than they would have originally imagined when this virus first began to spread. So could you tell me about where we're at with this outbreak and how much further we might have to go?

BIANCA:

Yeah, so in terms of where we're at, I think Australia at last count has about 82 cases. The majority of those are in New South Wales and Victoria. But I think most states have now recorded at least one case of monkeypox. Globally we're now looking at more than 27,000 infections over the course of just a couple of months. And obviously it's been declared a public health emergency of international concern by the WHO, which is really an indication of how seriously everybody is taking this.

Archival tape - Nine News

“It's the highest alarm the World Health Organisation can sound.”

Archival tape - Dr Tedros

“The global monkeypox outbreak represents a public health emergency of international concern.”

Archival tape - The 7:30 Report

“Monkeypox spreads mainly through skin to skin contact or touching contaminated objects and occasionally through breathing in droplets from an infected person.”

Archival tape - ABC News

“The world has again been placed on the highest alert.”

BIANCA:

But in terms of where it's going to go, our experience with COVID tells us that it's very difficult to predict how infectious diseases will behave in a pandemic context. But it's generally a pretty mild, self-limiting illness, which means that it will just go away by itself. But unfortunately for some people, and it's not clear how many people do get quite severe disease, and particularly if they get lesions in sort of the rectal area, inside the mouth, around the anus, they can be incredibly painful. They can make eating very difficult. And so for some people, they actually need to be hospitalised for pain relief. So it isn't as mild as I think has long been thought with this disease, there is the potential for it to really knock people around for a good two to four weeks. And I think the combination of that with the fact that we now have so many cases around the world is why organisations like the WHO are being very careful and really trying to stay on top of this.

RUBY:

Yeah because if we've learnt anything from the COVID pandemic it’s that we shouldn't necessarily think that we know how things are going to play out or what might happen next with any kind of infectious disease. But can we talk a bit about how it is that monkeypox has spread in the way that it has? What do we know about how the original outbreak has reached the kinds of numbers that we're seeing now?

BIANCA:

Well, some of it is just bad luck. It's bad timing in the sense that this is an endemic infectious disease in some parts of West and Central Africa. It's been known in humans since around the 1970s and in animals for longer than that. And it's sort of, I guess, bubbled along for quite a few decades, you know, these kind of little outbreaks that then die off.

But then since 2017 there's been a much bigger outbreak in Nigeria. And so they've seen several hundred cases there.

And what seems to have happened is that at some point there has been a transmission outside Nigeria which has happened before, you know, these cases have been reported elsewhere in the world over the last few decades, but they're generally quite isolated and they don't result in outbreaks.

But where the bad luck comes in is that this sort of transmission to other countries has coincided with the Northern Hemisphere summer, everybody's been outdoors, everybody's been mingling.
And also, you know, it's an opportunity for everyone to catch up on a lot of socialising, which we haven't been able to do when the pandemic has been at its worst.

It's also coincided with these massive gay pride celebrations around the world, which have also really been stymied for many, many years.

Archival tape - Fox News

“Thousands of people gathering today, closing out Pride Month with the city's first in-person pride parade since before the pandemic.”

BIANCA:

They're particularly joyous this time and that's meant a lot of mingling. That's meant a lot of people getting on and being happy and doing what humans do when they've been locked up in the dark for so long.

And unfortunately, that timing of those events has meant that it's been a lot easier for this infection to spread than, for example, if it occurred in the middle of winter when people were at home, there wasn't so much interacting and partying going on.

RUBY:

Right, okay so as people moved out of the pandemic, and started to think that it might be safe once again to go out in large crowds and to enjoy themselves, monkeypox was able to get a foothold I guess. So who did health providers start to see presenting with the virus?

BIANCA:

What we've seen so far is the vast majority, so 99% of infections, are in men and around 94% of those who have reported infection, report having recent sexual or close intimate contact with men. And that's something that does seem to emerge out of a lot of the pride festivals.

What we know is that while the disease can be spread by droplets, so that’s something we’re familiar with in terms of coughing or sneezing, that’s much less likely than spread by close skin to skin contact. So, you know the disease has these lesions, they’re pustular, they crust over and those lesions contain it but they’re really the main method of spread. And so it's skin to skin contact, it's those lesions coming in contact with somebody else and that's really how this disease is spreading.

But what we do need to be really careful about is to point out that this is not a sexually transmitted disease. And the reason we need to be careful about that is that once you label something as a sexually transmitted disease that comes with a whole lot of societal baggage, that makes it very difficult to then actually address the situation in a rational, calm way. We really need to make sure that we don't stigmatise this condition, that we don't judge anybody for having it, for participating in the joyous activities that may have led to them being infected. Because what happens then is that people don't come forward to get testing because they're worried about being judged. And that makes it much more difficult to get a lid on it, to treat people and help them manage it when they do have the infection.

RUBY:

Well, how do we do that – because it’s easier said than done – so how do health authorities make sure that they are sending the right message?

BIANCA:

One concept that I really like is, which Associate Professor Jennifer Power - who's a public health sociologist - talks about is this idea of sex-positive messaging around monkeypox. And it's about recognising, you know, that sex culture is important. It's part of gay culture and any public health messaging to do with a disease that does have the risk of being transmitted during sex really needs to acknowledge that sex is actually part not just of queer culture, but of life. You know, sex and pleasure is part of being human. It's part of connection. And so any kind of messaging that says, look, just don't have sex or abstain or, you know, it's just really ignorant of how humans are.

So it's you know, this is relevant not just to the queer community, it's relevant to everybody. And so really, the messaging is about, you know, how do we reduce the spread of this infection in a way that also acknowledges that these are fundamental parts of being human. And vaccines I guess are the great hope at this point because that then does just eliminate the risk of transmission.

RUBY:

We'll be back in a moment.

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RUBY:

Bianca, we’ve been talking about the health response to monkeypox. But I want to go back because you said something interesting earlier and that is that this disease, monkeypox, has actually been around for a long time, since the 70s. And since then, there have been some small and localised outbreaks of monkeypox. So why is it then that this particular outbreak is global?

BIANCA:

So one of the reasons, or I think possibly the most logical explanation, is actually to do with smallpox. So, monkeypox is from the same group of viruses that include smallpox. And smallpox is really the stuff of nightmares for anybody working in infectious diseases, in bioterrorism. That's really the stuff that wakes them up in a cold sweat, because smallpox was a terrible, terrible disease. It killed so many people, it was incredibly disfiguring. And the fact that we managed to eradicate it entirely with vaccines is one of the greatest public health achievements that we've ever had globally. And that smallpox vaccine also offers protection against monkeypox. But because we eradicated smallpox, that vaccination programme ceased in most parts of the world in around the 1980s. So anybody born after 1980, is not vaccinated against smallpox. There's also the possibility that people who were originally vaccinated against smallpox, they may have lost some of that immunity over time. We don't know how long that immunity lasts. And so essentially what that's meant is that we now have a global population that hasn't got that high level of immunity to smallpox and therefore to monkeypox. And so, it's not that it would have been inevitable, but certainly it makes it a lot less difficult for any of these othor pox viruses to gain traction, whereas now, most of us, myself included, have no protection against either smallpox or monkeypox.

RUBY:

And so what is the situation with vaccines, do we have enough of them and can we get them to the people who need them?

BIANCA:

Well, it is tricky. I mean, pretty much every government that can afford to has got a stockpile of smallpox vaccine. We do still have that vaccine or there's two smallpox vaccines. So the older one was ACAM2000, and that does exist in the Australian vaccine stockpile. But the problem with that vaccine is it's a live attenuated vaccine. So it means that it can't be given to anybody who's immunocompromised because there is a risk that it might have potential side effects. So it can't be given to pregnant people, for example, as well. It also requires quite specialist training to administer it, it’s not just a straightforward vaccine, like, for example, the COVID vaccine and it does have a very rare, but there is still a possible risk, of some severe side effects. So we've got that vaccine, but we'd like to not have to use that. There's another more recent vaccine called JYNNEOS and that has far fewer, associated with much lower risk of side effects. It can be used in people who are immunocompromised, so that also means people with HIV and with pregnant people. But we didn't have any of that in Australia and we've just recently got a shipment through. And so I believe that vaccine has just in the last two weeks been started to be rolled out in Victoria and I think New South Wales. So we don't have large quantities of vaccines at this point, which is why it's really important that those are used judiciously and focused on the people who are most likely to encounter monkeypox and people who have been exposed to it.

RUBY:

And Bianca just finally, everyone has spent the last few years in this kind of relentless cycle of health warning after health warning. And then along comes monkeypox and we have this new threat that we have to contend with but everyone is exhausted and depleted and our resources are low. So, I wonder how important you think it is that we remain vigilant and we remain capable of responding to these kinds of threats, not just monkeypox, but other possible outbreaks in the future? Because we know that our resources are low, I mean, we hear this all the time from health authorities.

BIANCA:

Yeah, it's a massive concern. And it's also worth remembering that even though it feels like COVID has come out of the blue, I mean, we've had the previous SARS epidemic, which didn't quite get to pandemic levels. We've had MERS, which was Middle Eastern Respiratory Syndrome, which was associated with camels. We've had Ebola, which nearly became a global outbreak. I mean, these zoonotic diseases are always there. And, you know, the concern is that we'll start to see more of them, particularly as humans encroach more and more into wild places, because so many of these diseases are able to cross into humans because of people encountering infected animals in the wild. And, you know, obviously, we've seen that with SARS-CoV-2. All the evidence now really points to its origins in terms of its spread from animals to humans in, you know, a market selling live animals. But similarly, this, you know, influenza all the time, all of the different influenza viruses tend to come from either pigs or chickens. So this is a constant feature of us all sharing this planet.

I mean, we're still in the middle of this pandemic. I don't think we're anywhere near this finishing in any way. I mean, obviously we're seeing the kind of, hopefully we're seeing what looks like a drop off of the latest Omicron variant and certainly crossing our fingers that that's the case. But there will always be more of these viruses, I mean, there's probably millions and millions of viruses out there in the wild that have the potential to infect humans. And hopefully what we do take away from our experience with COVID and with monkeypox is a much more robust public health response, but also a much more robust community response and understanding of community responsibility, understanding of how we can still be human safely and be with each other safely so that we can avoid, hopefully, a pandemic of the scale that we're currently still wrestling with.

RUBY:

Bianca, thank you so much for your time.

BIANCA:

Thank you.

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RUBY:

Also in the news today…

An overhaul of funding for disability employment services will see eight major service providers essentially shutdown because the federal government will no longer fund them.

Funding to almost half of the country’s services will be cut back because of poor performance. The funding decisions follow a review of the services after the Disability Royal Commission heard evidence some of the services were not achieving long-term outcomes for clients.

And NSW Police conducted 4,400 strip searches between July 2020 and May of this year, including on children as young as 13.

The data, which was obtained by the Redfern Legal Service also showed Indigenous people made up 10% of those strip searched, despite only being three and a half per cent of the NSW population.

I’m Ruby Jones this is 7am, see you tomorrow.

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