Following the lead of the World Health Organization (WHO), CDP will be “removing the distinction between endemic and non-endemic countries, reporting on countries together where possible, to reflect the unified response that is needed,” except in reference to historical information.
For several months, cases of monkeypox have been climbing globally. When CDP first started tracking it on May 23, 2022, there were less than 100 cases confirmed in several non-endemic countries. The U.S. had only one confirmed case and two suspected cases.
According to TIME Magazine: “Monkeypox was first identified in the 1950s. Prior to the current outbreak, it was endemic to parts of western and central Africa, with cases often linked to exposure to infected animals. The current outbreak is unusual in its scale, global reach, and spread from person to person. Experts are still trying to figure out why that is, but possible explanations include viral mutations, declining use of the smallpox vaccine, and shifts in human behavior.” The first human case appeared in the 1970s.
The 2022 outbreak has been traced to several mid-spring gatherings (mostly circuit parties and raves) for men within the LGBTQIA+ community in Europe. These were followed by Pride celebrations across the world, and the June/July surges are attributed to those events.
(Photo: Monkeypox vaccination site in Toronto, Canada. Photo credit: TJ Cutland)
Monkeypox is part of the orthopoxvirus genus. While similar to smallpox, it is usually less severe but can cause rashes, fever, headaches, muscle and backaches and swollen lymph nodes. Unlike the Congo Basin strain, which has a 10% fatality rate, the West Africa strain that is spreading now has a 1% fatality rate. There have been 51 deaths in 2022: the highest numbers are in Nigeria (7), Brazil (5) and Ghana (4).
However, according to the Centers for Disease Control and Prevention (CDC), “people with weakened immune systems, children under 8 years of age, people with a history of eczema, and people who are pregnant or breastfeeding may be more likely to get seriously ill or die. Although the West African type is rarely fatal, symptoms can be extremely painful, and people might have permanent scarring resulting from the rash.”
There has been a report of the virus living on surfaces, meaning direct human-to-human contact may not be required. However, it is a very weak virus and normal household disinfecting cleaners can eliminate it. Additionally, a case in France of human-to-dog transmission has been reported.
What we’re watching: Weekly disaster update, October 11
What we’re watching: Weekly disaster update, October 3
What we’re watching: Weekly disaster update, September 26
What we’re watching: Weekly disaster update, September 19
What we’re watching: Weekly disaster update, August 29
- According to WHO, “This is the first time that cases and sustained chains of transmission have been reported in countries without direct or immediate epidemiological links to areas of West or Central Africa.”
- With the exception of those regions, the majority of cases (87.9%) are occurring among men who have sex with men, including gay and bisexual men.
- Overall, the severity is quite low. While extremely painful, most cases are being managed without hospitalization and only 28 deaths have been reported.
- Anyone can catch monkeypox, although the majority of cases currently have been linked to sexual transmission.
- It is uncertain whether monkeypox can be eradicated in non-endemic countries, although some researchers think it is likely to become endemic in more places.
By the numbers
As of Nov. 16, 2022, there are 79,665 global cases occurring in 110 countries across all six of WHO’s regions. The highest number of cases have been found in the U.S. (28,999), followed by Brazil (9,637), Spain (7,392), France (4,102), the United Kingdom (3,710) and Germany (3,671). These six countries, together with Peru, Colombia, Mexico and Canada, represent 86.2% of cases. The rate of transmission has slowed dramatically over the past couple of months in most places; for example, Germany only increased by 20 cases in the past month.
Overall, the new cases have decreased by 16% between Nov. 7 to Nov. 13, compared to the previous week. According to WHO, as of Nov. 16, 2022, 18 countries reported an increase in their cases. The highest increase reported was from Brazil. There are 65 countries that have not reported any cases in the past 21 days. The Region of the Americas had 89.9% of the cases in the past four weeks and the European Region had 6.6% of the cases.
U.S. public health emergency
Given the high rate of monkeypox within the U.S., the Biden administration declared monkeypox a public health emergency on Aug. 4. This allowed Health and Human Services (HHS) to access funds and hire new staff.
As of Nov. 16, monkeypox has been found in every state across the U.S. New cases have fallen about 47% from the peak in August. The highest overall number is in California (5,547) with New York state (4,144) ranking second.
The first U.S. death was confirmed in California on Sept. 12. The death of a man in Ohio was announced on Sept. 29. A severely immunocompromised individual in Texas’ Harris County with monkeypox died in late August, although the role the virus played in the death is still unconfirmed and being investigated.
A disproportionate number of people in the U.S. contracting monkeypox are Black and Hispanic men. As of Oct. 30, 34.32% of cases are Black or African-American and 21.9% are Hispanic or Latino, compared to 30.77% white. By comparison, 59.3% of people in the U.S. are white (non-Hispanic), 13.6% are Black and 18.9% are Latino.
Men who have sex with men (MSM)
Like HIV in the 1980s, the majority of cases in this outbreak to date are among men who have sex with men (including gay and bisexual men) and their close associates. The term MSM has been used to capture this as not all individuals engaging in same-gender sexual encounters identify as gay or bisexual.
Nonetheless, this association has resulted in a form of “gay panic” and an opportunity for those opposed to LGBTIA+ rights to seize on the disease as a moral failure.
WHO has analyzed and traced a number of the cases. They have reported (as of Nov. 16):
- “96.9% of cases with available data are male, the median age is 34 years.
- Males between 18-44 years old continue to be disproportionately affected by this outbreak as they account for 79.7% of cases.
- Among cases with known data on sexual orientation, 86.2% identified as MSM. Of those identified as MSM, 5.1% were identified as bisexual men. For women, the available data shows that 86% are heterosexual.
- Among those with known HIV status, 49.7% were HIV-positive. Note that information on HIV status is not available for the majority of cases, and for those for which it is available, it is likely to be skewed towards those reporting positive HIV results.
- 914 cases were reported to be health workers. However, most were infected in the community and further investigation is ongoing to determine whether the remaining infection was due to occupational exposure.
- Of all reported types of transmission, a sexual encounter was reported most commonly, with 71.5% of all reported transmission events. [This is a decrease from earlier in the outbreak when the rate was over 90%.]
- Of all settings in which cases were likely exposed, the most common was in party settings with sexual contacts, 58.8% of all likely exposure categories.”
Children and discrimination
According to a WHO analysis, 560 cases were found in children under 18 (1.2%), and of these, 149 were children ages 0-4 (0.3%). As of Nov. 9, there have been over 577 cases of monkeypox detected in children and youth under 20 across the U.S. This includes: 18 children aged 0 to 5, nine aged 6 to 10, 11 aged 11 to 15 and 539 cases in people aged 16 to 20. There were concerns that return to school and daycares could increase the spread. Of the 412 cases reported among people aged 0-17 in the Region of the Americas, 26 were reported in a school setting.
According to the CDC, while monkeypox can be spread through sexual contact, it is not the only mode of transmission. Anyone can get monkeypox if they have close personal contact with someone who has symptoms of monkeypox. Household transmission such as shared towels, clothing and bed linens is seen as the primary cause for cases in children. Despite this, homophobic opponents of equal rights are pointing to infections in children and CDC Director Rachelle Walensky’s describing children as “risk-adjacent” as proof of pedophilia, even though monkeypox is not considered to be a sexually transmitted disease (STD) (and even if it was an STD, household transmission is possible through activities of daily living).
Critique of the name
Due to increasing criticism of the name “monkeypox” to describe the virus, especially within the U.S., actions have been taken to rename the virus.
According to the New York Times, “Public health researchers say the term evokes racist stereotypes, reinforces offensive tropes about Africa and abets stigmatization that can prevent people from seeking care.”
The virus will be renamed by the International Committee on the Taxonomy of Viruses (ICTV) while the disease will be renamed by the WHO. This is similar to the concerns when SARS-CoV-2/COVID-19 was first discovered, and it was referred to as the “Wuhan virus” or the “Chinese virus.”
In addition, the WHO spoke out in August about people in Brazil attacking and killing monkeys, worried that they were carriers of the disease. “Monkeypox virus is in a number of different animals. The only reason it got named monkeypox is this virus was first identified in a group of monkeys.”
According to the Los Angeles Times, the name is already being changed in discussions. “The California Department of Public Health is referring to it as MPX — pronounced “M-P-X” or “em-pox” — as it waits for the WHO to pick a new name. Officials in Oregon, Vermont, New Jersey and elsewhere have gone with hMPXV. Some LGBTQ community organizations in Canada use Mpox.”
The WHO is holding an open process to rename the disease the virus causes. In the meantime, the variants have been reclassified as Clade I (previously The Congo Basin variant) and Clade II (previously West African variant). There are two sub-clades (or sub-variants) Clade IIa and Clade IIb. It is Clade IIb that is currently circulating.
According to the WHO, “A global expert group decided on the new naming convention ‘as part of ongoing efforts to align the names of the monkeypox disease, virus, and variants—or clades—with current best practices.’”
Two meetings of the International Health Regulation Emergency Committee (IHR Emergency Committee) were held – one in June and one in July – to determine whether WHO should declare monkeypox a public health emergency of international concern (PHEIC). In June, the IHR Emergency Committee felt there was not enough evidence to make such a declaration and in July, the committee could not reach a consensus. As a result, Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO, made the decision to break the deadlock and declared monkeypox as a PHEIC. This has been done for several diseases, the most recent in January 2020 for COVID-19.
CNBC states, “The rare designation means the WHO now views the outbreak as a significant enough threat to global health that a coordinated international response is needed to prevent the virus from spreading further and potentially escalating into a pandemic. Although the declaration does not impose requirements on national governments, it serves as an urgent call for action. The WHO can only issue guidance and recommendations to its member states, not mandates. Member states are required to report events that pose a threat to global health.
Vaccines, testing and treatment
As with many viruses, vaccines and testing are the key to reducing transmission and preventing mutations. While there are several vaccine and testing clinics, and information hotlines across the country, they are limited to primarily urban areas. Additionally, tests, vaccine supplies and human and other resources are limited.
Work with your local public health entities to increase capacity to test, treat and vaccinate while also supporting vaccine and test production. The primary focus should be on community clinics in partnership with local organizations. Use the Find a Community Health Center tool in the U.S. to find a clinic near you.
The extensive outreach by community health clinics and HIV/AIDS or LGBTQIA+ organizations in the U.S., Canada and other countries has been instrumental in reducing the spread of the virus. University of South Florida College of Public associate professor Jill Roberts said, “The community that largely was affected was very responsible … If that had not been the case, we would have definitely seen a lot of spread well beyond the men who have sex with men population and into other populations.”
Supporting LGBTQIA+ and HIV/AIDS organizations
As mentioned, this virus is still primarily affecting men who have sex with men. They are the population most at-risk and therefore were the initial population for vaccines. However, most LGBTQIA+ organizations are underfunded. HIV/AIDS organizations have the skills and experience needed to lead a response to this crisis, but they too lack funding. According to Funders Concerned About AIDS, HIV patient advocacy funding has been flat for almost a decade and may be declining. CEO of Community Access National Network, Jen Laws, says, “This is the equivalent of underinvesting in public health infrastructure from the patient advocacy perspective – we cannot prioritize the experiences of patients, their wellbeing, and ultimately inform public policy without these supports.”
Best practices to reach a marginalized population include using members of that community and familiar organizations to convey critical messaging. Support capacity-building and opportunities for education and outreach. Given the homophobia that has become evident, there is a need to also support the overall capacity of these organizations to help their communities with emotional health.
One of the best techniques to reduce Ebola outbreaks has been the use of contact tracing. An effective and vigorous contact tracing program could also help reduce the spread of monkeypox, given the long incubation period.
If people are informed of their exposure early, they can isolate, monitor their symptoms, get tested and access vaccines without waiting for the disease to progress. Contact tracing programs, often used in public health for infectious diseases, need to be stood up or expanded. Because of the currently affected population, contract tracing should be done by or in conjunction with organizations that work with the LGBTQIA+ population.
There is a need for advocacy to support the increased roll-out of vaccines, testing and treatment, as well as federally-funded public health campaigns. Support LGBTQIA+ and HIV advocacy organizations, which insert patient voices, inform public policy, educate patients and often perform the capacity-building activities service organizations rely upon.
In addition to government advocacy, there is a need for patient navigators who can help advocate on behalf of patients who may also be facing additional health complications from HIV, AIDS or other illnesses. The immense pain that comes with monkeypox requires sufficient pain management and emotional support programs.
Overall, there is going to be a need for counseling and other emotional support initiatives. For many MSM, this virus could be a reminder of the losses throughout the HIV/AIDS pandemic. For others, their ongoing battles with HIV or AIDS will be aggravated by monkeypox and may create additional trauma.
As with COVID-19, people who have been exposed or infected are required to quarantine or isolate. Monkeypox, however, has a much longer incubation period meaning people are off work for weeks at a time. This can have a significant impact on employment and puts housing, food and other living costs in jeopardy. Similarly, programs to support lost income are important to enable proper precautions and compliance with public health measures.
Because of the global nature of the virus, two CDP funds are available to respond to the outbreak: CDP Global Recovery Fund will provide support internationally and CDP Disaster Recovery Fund will provide support in the United States and its territories. CDP is also tracking organizations that are responding. We are in contact with and can grant to organizations that are not 501(c)3 entities.
If you are a responding NGO, please send updates on how you are working in this crisis to email@example.com.
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More ways to help
Philanthropic contributions to monkeypox have been low with only two major grants issued by pharmaceutical companies. A recent Chronicle of Philanthropy article, featuring an interview with CDP director of learning and partnerships, Tanya Gulliver-Garcia states, “That smaller scale of giving is in stark contrast to the billions of dollars in funding foundations and corporations gave in the early days of Covid-19. By May 2020, grant makers in the United States had given $6 billion in response to the coronavirus spread, according to data from Candid.”
Grantmakers in Health, in partnership with Funders Concerned About AIDS and Funders for LGBTQ Issues, hosted a webinar for funders in September to discuss philanthropic needs.
As with most disasters, cash donations are recommended by disaster experts as they allow for on-the-ground agencies to direct funds to the greatest area of need, support economic recovery and ensure donation management does not detract from disaster recovery needs.
CDP has also created a list of suggestions for foundations to consider related to disaster giving. These include:
- Take the long view: Even while focusing on immediate needs, remember that it will take some time for the full range of needs to emerge. Be patient in planning for disaster funding. Recovery will take a long time, and funding will be needed throughout.
- Recognize there are places private philanthropy can help that government agencies might not: Private funders have opportunities to develop innovative solutions to help prevent or mitigate future disasters that the government cannot execute.
- All funders are disaster philanthropists: Even if your organization does not work in a particular geographic area or fund immediate relief efforts, you can look for ways to tie disaster funding into your existing mission. If you focus on education, health, children or vulnerable populations, disasters present prime opportunities for funding.
- Ask the experts: If you are considering supporting an organization that is positioned to work in an affected area, do some research. CDP can provide resources and guidance about organizations working in affected communities.
LGBTQ+ Communities and Disasters
Lesbian, gay, bisexual, transgender and queer (LGBTQ+) communities experience the impacts of disasters differently than heterosexual and cisgender individuals.
Pandemics and Infectious Diseases
A pandemic is the sustained transmission of an infectious disease across a wide area of one country or across international borders. Pandemics may be either naturally occurring or the result of human intervention through genetic engineering or biological warfare.
People with Disabilities
When a disaster hits, the lack of inclusion in disaster preparedness – combined with adverse socioeconomic outcomes – creates increased risk and problems for people with disabilities. Disasters also increase the disparities between people with disabilities and others in their community, making it more likely they will be disproportionately negatively impacted during the disaster and afterward.