Takshashila Issue Brief - The Rise of Monkeypox in India
Monkeypox is an emerging threat to India’s health security. The virus which was first discovered to cause disease in humans in 1970, had been limited to the African continent with a few sporadic, but limited outbreaks in the rest of the world.
However, today it is spreading relatively rapidly. India has so far reported 9 cases with 1 death. More than 80 non-endemic countries around the world have reported over 30,000 cases. This is the first large outbreak outside of endemic areas. In July 2022, the World Health Organisation (WHO) declared monkeypox as a “Public Health Emergency of International Concern”.
Why the Sudden Rise?
Although monkeypox has afflicted humans for more than 50 years, such a large outbreak has never been seen before. One of the major factors in the rise has been the decline in immunity conferred by global smallpox vaccinations. Smallpox vaccine is estimated to provide around 85% immunity against monkeypox. In the 1980s, after the successful elimination of smallpox, countries around the world stopped giving out smallpox vaccination.
Another possible reason for this global outbreak could be certain mutations in the virus that have created novel ways for the virus to escape immunity and spread to humans. A rise in detection of the cases could also be due to the widespread use of molecular diagnostics based on RT-PCR in the wake of the COVID-19 pandemic. Tests for detection of the COVID-19 virus as well as the monkeypox virus are done using RT-PCR.
Possible Future Scenarios
Our current understanding of monkeypox hints that while its spread may not be as dramatic as COVID-19, the disease could still cause significant damage to the population. Compared to COVID-19, monkeypox is less infectious and cannot spread efficiently without close contact.
The fatality rate in resource deficient endemic countries has been found to be ranging from 3–6%. Currently, the fatality rate is quite low with 10 deaths reported in 30,000 cases worldwide.
The A.2 strain of Monkepox is currently being detected in India and it has not been linked to any other major clusters. There is paucity of research which compares the B.1 strain (the one responsible for the outbreak in Europe) to A.2 regarding severity or infectivity.
What Can Governments Do?
At this stage of the outbreak, the government can take the following measures:
1. Ring Vaccination
Vaccination is given to all close contacts of a suspected or a confirmed case. This will help contain the virus before it spreads uncontrollably. For this pre-existing smallpox vaccination can be used. Smallpox vaccination is found to be effective for treatment of the disease if given in early stages.
India has a large vaccination manufacturing base. We should take advantage of this and start manufacturing smallpox vaccines till the time we get vaccines for monkeypox.
2. Diagnostics
We should also improve our testing capacity to diagnose the disease and detect cases before they spread. An important part of this is educating healthcare workers about the disease and making sure they are able to utilise our diagnostic capability optimally.
3. Information and Education Campaigns
Making information widely available about the virus to the general public is imperative. Information and education campaigns help in stopping the spread of infectious diseases.
Monkeypox is unlikely to spread as widely as COVID-19 and become a pandemic. However, if the monkeypox infects a significant proportion of India’s population, we recommend a restriction of public activities. This can be calibrated to the spread of the virus, and the damage it causes. We had recommended a similar strategy for COVID-19.
We also propose an Indian National Epidemic Intelligence Service to monitor the spread of Monkeypox and other diseases. This would allow us to assess the threat from infectious diseases from an Indian viewpoint.
Complied by Harshit Kukreja, with inputs from Shambhavi Naik. August 10, 2022.
Selected Reading:
Takshashila Discussion Document - A National Epidemic Intelligence Service for India by Ruturaj Gowaikar and Shambhavi Naik
Takshashila Issue Paper - Tackling New COVID-19 Variants by By Harshit Kukreja , Priyal Lyncia D’Almeida, Ruturaj Gowaikar and Shambhavi Naik
Takshashila Policy Advisory - COVID-19: Towards a National Reopening Strategy for India by Takshashila Working Group
IPPR Journal Article - A COVID-19 Vaccine Deployment Strategy for India — The Takshashila Institution by Shambhavi Naik, Ameya Paleja, Mihir Mahajan, Narayan Ramachandran, Sunila Dixit, Rahul Matthan, Nitin Pai and Pranay Kotasthane
What Can We Do to Ensure Monkeypox Doesn't Become Next Covid by Harshit Kukreja and Mahek Nankani
India Should Get Battle-Ready as Monkeypox Cases Explode in US, UK, Other Non-African Countries by Harshit Kukreja and Mahek Nankani
COVID-19 Vaccine Deployment in India: Lessons We Need to Learn From the Past by Shambhavi Naik
