Monkeypox makes pandemic solidarity pledges hollow

The author is a scientific commentator

The lack of international solidarity revealed by the pandemic, particularly after wealthy countries cornered Covid-19 vaccines, has led to cries of “never again”. Never again should vital data and samples be withheld during an outbreak; never again should the global south be abandoned by the global north in search of money, medicine and vaccines.

In light of the current monkeypox epidemic, those promises now seem hollow. High-income countries are once again scrambling for vaccines that African countries have little access to, even though the disease has existed in central and western Africa for decades. Monkeypox is suspected in 70 deaths in Africa this year, while no deaths have been reported among the more than 4,000 cases recorded outside the continent. “The place to start any vaccination should be Africa and nowhere else,” said Ahmed Ogwell, acting director of the Africa Centers for Disease Control and Prevention.

The lofty ideal of global health as a public good is once again wavering in the face of national interests. The fragmented response is not just a problem in controlling monkeypox. It also signals problems for the global pandemic treaty being drafted, designed to more tightly bind countries to act for the collective good.

An advisory group that met at the World Health Organization last week decided not to label monkeypox a public health emergency of international concern. Gregg Gonsalves, an epidemiologist at Yale University, said it was “a big mistake”, given that containment has failed so far.

Perhaps the panel felt that suddenly acknowledging an outbreak that has been bubbling in Nigeria since 2017 would send the wrong signal. Still, the WHO may change tack if the disease worsens, moves to different groups (currently most cases are in men who have sex with men), or establishes itself in animal populations outside of Africa, widening the endemic footprint of the virus.

Emerging science is already hinting at something unusual: Preliminary research published last week suggests the virus is moving faster than expected. And the epidemic, which so far affects 48 countries, is not going away. The UK alone has recorded more than 900 cases as of June 27. Spain and Germany are also seeing high numbers of cases. At a pandemic preparedness conference I attended in Brussels last week, few scientists were prepared to rule out a monkeypox pandemic.

A big theme of the conference, focusing on respiratory viruses, was to ensure that the mistakes of Covid-19, such as late reporting of cases and poor messaging, are not repeated. One of the proposed remedies is the WHO Pandemic Preparedness Treaty, sometimes referred to as the Global Pandemic Treaty. The treaty would legally bind signatories to practices such as timely data sharing. A “zero draft” will be released in August. The treaty is already the subject of false claims that claim it will strip states of their sovereignty and mandate the imprisonment of the unvaccinated. The real obstacles are more prosaic: since the WHO is a technical rather than a legal agency, could it enforce treaty obligations?

But for Mark Eccleston-Turner, an expert in global health law at King’s College London, the treaty could fail because it is a “neocolonial” instrument designed to crystallize, rather than erase, the power imbalance between the Nations. Early versions, he says, appear to be forcing low- and middle-income countries to quickly share samples and data, giving other countries time to close borders and stockpile drugs, vaccines and protective equipment – but without devoting equitable access to these drugs and vaccines in return.

“The fundamental problem with our system, and the problem that the treaty currently entrenches,” Eccleston-Turner tells me, “is that samples, data and information from PRFIs [low- and middle-income countries] are public goods and should be shared for the good of humanity, while vaccines and other medical countermeasures are private goods to be hoarded and accessed first by the wealthiest in the world.

The fact that monkeypox vaccines are only now being hastily purchased strengthens his argument.

Treaties are legal instruments designed to bind and protect all parties. But a remedy should not make a patient’s situation worse. Without careful drafting, a pandemic treaty risks protecting high-income countries without binding them, and binding low- and middle-income countries without protecting them.

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