Call for ‘urgent action’ to counter threat of monkeypox

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Leading health advocates are calling for bolder action against monkeypox, saying New Zealand could face the same failures as other countries if the government doesn’t act now.

A five-page letter was sent to Prime Minister Jacinda Ardern, with a range of government ministers and health officials copied, including Health Minister Andrew Little, Associate Health Minister Ayesha Verrall and senior Health New Zealand and Maori officials. Health Authority.

It calls for “urgent action to prepare for and prevent the escalation of the MPX [monkeypox] case in Aotearoa, New Zealand,” and is signed by Chief Executive of the Burnett Foundation (formerly the NZ Aids Foundation), Joe Rich, President of the New Zealand Sexual Health Society, Anne Robertson, and Senior Health Researcher sexual, Peter Saxton.

“We must act now,” they wrote. “The rapid spread of MPX indicates a failure of public health strategies that were implemented early overseas.”

They want a dedicated monkeypox response team; a prioritized vaccination plan; better public health communication, without stigma; and support for self-isolation.

Rich told RNZ the organization had worked constructively with the government on a response, but was concerned about the similarity of current plans to those of countries in the northern hemisphere.

“What we’re seeing right now is that in the northern hemisphere the approaches that they’ve been using to try to control monkeypox haven’t worked and the [case] the numbers are increasing.”

Since early May, more than 18,000 cases have been confirmed or suspected in more than 70 countries outside of those where the virus was usually endemic.

In New Zealand, three cases have been confirmed – two of which have recovered. The Ministry of Health considers the risk to public health to be low to moderate, but with a high risk that more cases will be imported.

Rich said a post-exposure vaccine approach, known as ring vaccination, “isn’t going to cut it” and instead should be preventative and used as the primary tool instead of relying on research and contact testing.

“It’s not a criticism,” he said. “It just means we have the advantage…of being able to know what works or doesn’t work in other countries.”

University of Auckland associate professor Peter Saxton said buying pre-exposure vaccines was necessary so New Zealand could “stay ahead of the virus, rather than chasing a infection that we see moving rapidly among most at-risk communities overseas.”

He feared infections would soon start to be missed and the virus “start to spread locally”.

“We still have a short window of opportunity to act before monkeypox becomes established.”

The Department of Health said it was “working with Pharmac to ensure access to third-generation smallpox vaccines that can be considered for the targeted prevention of monkeypox.”

RNZ understands that health officials and manufacturers are discussing a possible timeline for delivery of a vaccine, as well as antiretroviral treatments.

“I’m worried enough to be honest with you”

Gay, bisexual and other men who have sex with men (MSM) have been disproportionately affected by the current global epidemic, but anyone can be infected with monkeypox.

The Department of Health said the risk of transmission was “considerably lower” than Covid-19 or measles, “given that it requires very close contact”.

It could be transmitted from person to person through close contact with broken skin, body fluids, respiratory droplets and contaminated materials such as bedding, but it was unlikely to be a sexually transmitted infection.

Dr Massimo Giola, a member of the executive of the New Zealand Sexual Health Society, said the country needed to act “before we have a major problem on our hands”.

Dr Giola is gay and studied infectious diseases in Italy in the 1990s, “at the height of the AIDS pandemic”. The current monkeypox outbreak made him feel like he was reliving those times, but in “fast forward” and he wanted to see a stronger response to the outbreak.

He said he understands why some MSM “feel threatened.”

“I’m worried enough to be honest with you.”

There were challenges creating a stigma-free response, Giola said.

Specifically, officials had to carefully juggle acknowledging the disproportionate rate at which the MSM community was affected without stoking the homophobia the outbreak had stoked online, including people calling monkey pox a “gay disease” or thinking that it only affected the MSM community, he said.

The struggle of this was already showing in the patients he was seeing. Giola had started talking to patients who asked the HIV prevention drug PrEP if they knew about monkeypox and where to find information.

“Always, always, always the question I get is, ‘when are we going to get the vaccine?’ So people are very aware that there is a vaccine and they absolutely want to have access to it.”

“Leadership, bold action” needed

Rich of the Burnett Foundation said they weren’t trying to cause panic, but officials had to be “very careful” to get the right answer.

“We know from our experience with Covid that we have unique opportunities in New Zealand to learn from the rest of the world.”

Similarities to the response to the Covid-19 pandemic were mentioned in the letter to Ardern.

“As with Covid-19, an effective response to MPX requires leadership, bold action and comprehensive resources at a level commensurate with the threat of this new global public health emergency.”

RNZ asked the Department of Health a series of specific questions about the concerns raised in the letter.

They went unanswered, but acting director of public health Harriette Carr said the department “acknowledges the concerns raised in this letter”.

Carr also said public health advice had been developed from “the early stages of the current global outbreak” for the general public and medical professionals.

RNZ has also approached the offices of the Prime Minister, Minister of Health and Associate Minister of Health for comment.

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