Stop maligning our public health response measures to epidemics

First, epidemics are generally costly to manage and control—both in terms of lives lost, time expended and the socio-economic loss that assails some of the restrictions needed to interrupt transmission and bring them to an end, especially when there are
no effective medical countermeasures to deploy. Second, advances in research have made it possible to manipulate and adapt bugs with lesser virulence, to create those that carry catastrophic effects.

Truth is that we live in a part of the world that is blessed with diversity in flora and fauna alike. The Great Lakes region of East Africa carries perhaps the largest size of coverage by natural forests and lakes, comparable only to the Amazon. These most unexplored, virgin spaces also carry disease pathogens, some that we do not know about. Activities that assail economic and urban development, such as mining, logging, expansion of human settlements such as those we have witnessed over the past 30 years in the region, have brought us more in contact with these virgin ecosystems.

What were historically considered virgin, explored ecosystems are increasing being encroached on. At the same time, the bugs and their natural animal hosts are under pressure to survive. Therefore, they mutate and become better adapted to live in other hosts, inclusive of man. Trouble reigns when well-adapted bug finds its way, in a largely naive human population, with no pre-existing body immunity to fight off the same.

The outbreak of mpox (previously monkeypox) disease that started in the gold mining area of Kamituga, South Kivu Province, DRC fits well in the above narrative. The mpox virus (MPXV) was first identified in 1970 in the DRC as a cause of human disease
very closely similar to smallpox.
Since then, DRC has experienced several remote outbreaks of mpox disease that were effectively controlled by the authorities there. Little known to us, these repeated outbreaks also forced or trained the virus to better adapt, to live in humans.

 Therefore, when the clade 1b mutant emerged (from its ancestor now denoted 1a); we imagined it’s the usual same old story. Only this time, this virus is smarter, better adapted for humans, easily transmissible including through sex, and more virulent or severe in its disease-causing abilities. As such, while everyone imagined the same would burnout naturally, instead, sustained transmission continued and expanded to over regions in the province, spilling over to neighbouring countries. 

Increased human traffic across borders, did not help. Exposed and infected yet still unaware truck and sex workers who ply the roads across borders spread the infection. Finding a largely naive young population unlike the elders who got vaccinated ( majority now above 65 years) against smallpox during the 1965 to 1973-80 eradication programme; the disease is spreading like a wildfire. And since it also spreads via casual contact inclusively of touching infected inanimate objects like door handles, etc; there is no foresight as to how far this will go.

Therefore, just like the HIV epidemic started among the at-high risk group of men who have sex with men (MSM) and eventually become a heterosexually transmitted disease; we have seen the epidemiology of mpox disease shift, with the 2022-to-2023 global outbreak caused by the Clade 2b variant of West Africa mostly affecting MSM, and now the Clade 1b lineage spreading via heterosexual contact. What’s worrying is that, once people are infected, they may spread it through casual contact such as shaking hands, hugging, sharing a bed, clothings, touching the same surfaces, etc.

This should make us all more worried, and serious about our resolve to contain this disease. Rather than go about promoting our acumen at spinning facts or threatening the authorities not to impose harsh measures to contain the outbreak; we should work together to bring it under control.

Authored by Misaki Wayengera MD, PhD Chair—MoH Ministerial Scientific Advisory Committee on Epidemics