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Monkeypox Global Outbreak

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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.

A New England Journal of Medicine study looking at the first several hundred cases found “528 infections diagnosed between April 27 and June 24, 2022, at 43 sites in 16 countries. Overall, 98% of the persons with infection were gay or bisexual men, 75% were White, and 41% had human immunodeficiency virus infection; the median age was 38 years. Transmission was suspected to have occurred through sexual activity in 95% of the persons with infection.”

(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 11 deaths in 2022: one in the Southeast Asia region, two each in the European region and region of the Americas, and six in the African region.

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.”

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Key facts
  • 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 (98.3%) 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 the need for hospitalization and only five deaths have been reported.
  • Anyone can catch monkeypox, although the majority of cases currently have been linked to sexual transmission.
By the numbers

As of Aug. 12, 2022, there are 31,799 global cases occurring in 89 countries across all six of WHO’s regions. The highest number of cases have been found in the U.S. (9,491), followed by Spain (5,162), Germany (2,982), the United Kingdom (2,914), France (2,423) and Brazil (2,131). The cases are growing quickly.

According to WHO, as of Aug. 14, 2022, three countries reported their first case over the past seven days, while 27 countries reported an increase in their cases. The highest increase reported was from the U.S. There are 17 countries that have not reported any cases in the past 21 days.

In California, researchers monitoring wastewater for the presence of COVID-19 added monkeypox to their analysis in June. It was present in almost every analysis. “[They] confirmed the presence of genetic material from the monkeypox virus — but not the live virus — at every wastewater treatment site except for the University of California, Davis. The most frequent occurrence of the viral material …. occurred at two wastewater treatment plants in San Francisco, as well as in San Jose, which serves about 1.5 million people.”

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:

  • “98.7% of cases with available data are male, the median age is 36 years.
  • Males between 18-44 years old continue to be disproportionately affected by this outbreak as they account for 76.9% of cases.
  • Among cases with known data on sexual orientation, 97.2% identified as MSM. Of those identified as MSM, 0.7% were identified as bisexual men.
  • Among those with known HIV status 39% 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.
  • 386 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 91.1% of all reported transmission events.
  • Of all settings in which cases were likely exposed, the most common was in party settings with sexual contacts, 65.5% of all likely exposure categories.”.”
Children and discrimination

According to a WHO analysis, 103 cases were found in children under 18 (0.5%), and of these, 26 were children ages 0-4 (0.1%).

There have been five cases of monkeypox detected in children within the U.S. including two in California, two in Indiana and one in Washington, DC. The first U.S. case in a pregnant person has also been reported. There are concerns that return to school and daycares could increase the spread.

In an interview on July 22, with the Washington Post, CDC Director Rachelle Walensky said, “We have seen now two cases that have occurred in children. Both of those children are traced back to individuals who come from the men who have sex with men community — the gay men community … And so, when we have seen those cases in children, they have generally been what I call ‘adjacent’ to the community most at risk.”

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. Despite this, homophobic opponents of equal rights are pointing to the children’s infection and Walensky’s describing them 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

There is increasing criticism of the name “monkeypox” to describe the virus, especially within the U.S.

NPR reported that Dr. Ifeanyi Nsofor, a global health equity advocate and senior New Voices fellow at the Aspen Institute, said “Monkeypox should be renamed for two major reasons … First, there is a long history of referring to Blacks as monkeys. Therefore, ‘monkeypox’ is racist and stigmatizes Blacks. Second, ‘monkeypox’ gives a wrong impression that the disease is only transmitted by monkeys. This is wrong.”

Connecticut commissioner of public health Manisha Juthani echoed his concerns, saying, “Any naming of an infectious pathogen or clinical syndrome that implicates a nationality, ethnicity, region, or animal can be stigmatizing and harmful to the implicated group.”

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.”

The International Committee on the Taxonomy of Viruses is looking for a new name for the virus, but previously said it may still include the word monkey.

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.’”

WHO declaration

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.

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 allows Health and Human Services (HHS) to access funds and hire new staff.

According to HHS, the announcement is just one part of the overall strategy. “The strategy includes significantly scaling the production and availability of vaccines, expanding testing capacity and making testing more convenient, reducing burdens in accessing treatments, and conducting robust outreach to stakeholders and members of the LGBTQI+ communities.”

As of Aug. 13, monkeypox has been found in every state except Wyoming. The highest rate is in Washington, DC, and the highest overall number is in New York City.

A number of states, cities and counties have declared monkeypox to be a state of emergency and/or a public health emergency including California, Illinois, New York state, New York City, Dallas, Austin, Los Angeles and San Francisco.

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.

Supporting LGBTIA+ 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 should be 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.

Given the high levels of misinformation about monkeypox, GLAAD has asked all social media platforms to follow Twitter’s lead in redirecting viewers to HHS’s monkeypox website.

Contact tracing

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.

Advocacy

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.

Emotional support

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.

Livelihood support

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.

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Philanthropic contributions

If you would like to make a donation to the CDP Global Recovery Fund or the CDP Disaster Recovery Fund, please contact development.

(Photo: Colorized transmission electron micrograph of monkeypox virus particles (gold) cultivated and purified from cell culture. Credit: NIAID via Flickr; CC BY 2.0)

Recovery updates

If you are a responding NGO, please send updates on how you are working in this crisis to tanya.gulliver-garcia@disasterphilanthropy.org.

We welcome the republication of our content. Please credit the Center for Disaster Philanthropy.

Donor recommendations

If you are a donor looking for recommendations on how to help in this crisis, please email regine.webster@disasterphilanthropy.org.

More ways to help

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.

Resources

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LGBTQ+ Communities and Disasters

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

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

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.