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Monkeypox spreads in West, baffling African scientists

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Monkeypox spreads in West, baffling African scientists

As more cases of monkeypox are detected in Europe and North America, some scientists who have monitored numerous outbreaks in Africa say they are baffled by the unusual disease’s spread in the West.

Cases of the smallpox-related disease haven’t previously been seen among people with no links to central and West Africa. But in the past week, Britain, Spain, Portugal, Italy, U.S., Sweden and Canada all reported infections, mostly in young men who hadn’t previously traveled to Africa.

France, Germany, Belgium and Australia confirmed their first cases of monkeypox on Friday.

“I’m stunned by this. Every day I wake up and there are more countries infected,” said Oyewale Tomori, a virologist who formerly headed the Nigerian Academy of Science and who sits on several World Health Organization advisory boards.

“This is not the kind of spread we’ve seen in West Africa, so there may be something new happening in the West,” he said.

One of the theories British health officials are exploring is whether the disease is being sexually transmitted. Health officials have asked doctors and nurses to be on alert for potential cases, but said the risk to the general population is low.

Outbreaks in Nigeria, which reports about 3,000 monkeypox cases a year, are usually in rural areas, where people have close contact with infected rats and squirrels, according to Tomori. He said the disease is not spread very easily and that many cases are likely missed.

“Unless the person ends up in an advanced health centre, they don’t attract the attention of the surveillance system,” he said.

Tomori hoped the appearance of monkeypox cases across Europe and other Western countries would further scientific understanding of the disease.

The World Health Organization’s lead on emergency response, Dr. Ibrahima Soce Fall, acknowledged this week that there were still “so many unknowns in terms of the dynamics of transmission, the clinical features (and) the epidemiology.”

British officials have so far reported nine cases of monkeypox, noting that the most recent cases have all been in young men who had no history of travel to Africa and were gay, bisexual, or had sex with men.

Authorities in Spain and Portugal also said their cases were in young men who mostly had sex with other men and said those cases were picked up when the men turned up with lesions at sexual health clinics.

Experts have stressed they do not know if the disease is being spread through sex, or other close contact related to sex.

“This is not something we’ve seen in Nigeria,” virologist Tomori said. He said viruses that hadn’t initially been known to transmit via sex, like Ebola, were later proven to do so after bigger epidemics showed different patterns of spread.

The same could be true of monkeypox, Tomori said. “We would have to go back through our records to see if this might have happened, like between a husband and wife,” he said.

In Germany, Health Minister Karl Lauterbach said the government was confident the outbreak could be contained. He said the virus was being sequenced to see if there were any genetic changes that might have made it more infectious.

Scientists said that while it’s possible the outbreak’s first patient caught the disease while in Africa, what’s happening now is exceptional.

“We’ve never seen anything like what’s happening in Europe,” Christian Happi, director of the African Centre of Excellence for Genomics of Infectious Diseases, said. “We haven’t seen anything to say that the transmission patterns of monkeypox have been changing in Africa, so if something different is happening in Europe, then Europe needs to investigate that.”

Happi also pointed out that the suspension of smallpox vaccination campaigns after the disease was eradicated in 1980 might inadvertently be helping monkeypox spread. Smallpox vaccines also protect against monkeypox, but mass immunization was stopped decades ago.

“Aside from people in west and Central Africa who may have some immunity to monkeypox from past exposure, not having any smallpox vaccination means nobody has any kind of immunity to monkeypox,” Happi said.

Shabir Mahdi, a professor of vaccinology at the University of Witwatersrand in Johannesburg, said a detailed investigation of the outbreak in Europe, including determining who the first patients were, was now critical.

“We need to really understand how this first started and why the virus is now gaining traction,” he said. “In Africa, there have been very controlled and infrequent outbreaks of monkeypox. If that’s now changing, we really need to understand why.”

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Lagos Govt Unveils New Guidelines On Safe, Lawful Abortions

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Lagos Govt Unveils New Guidelines On Safe, Lawful Abortions

The Lagos State government says its Ministry of Health has developed a set of policies on safe termination of pregnancy.

Tagged “Lagos State Guidelines on Safe Termination of Pregnancy for Legal Indications,” the 40-page policy document sets out guidelines for safe termination of pregnancy within the ambit of the criminal law of the state.

Dr Olusegun Ogboye, who is the Permanent Secretary of the ministry, presented and launched the document at a stakeholders’ engagement held on Tuesday in Lagos.

He explained that the policy document was produced following the need to provide evidence-based data and information for health workers in public and private sectors who have the requisite skills and training necessary to provide safe terminations to reduce preventable deaths.

The permanent secretary added that while therapeutic termination of pregnancy was permissible under the law, the absence of clear guidelines has stalled the effective implementation at appropriate levels of care, resulting in preventable deaths.

“In 2011, the Lagos State House of Assembly updated the criminal code, providing for abortion to save the life and protect the physical health of the woman,” he said. “While physical health is covered under the Lagos legal framework, services conforming to the law have not been available in Lagos State health sector.

“This document provides information on relevant laws applicable in Lagos State while providing standards and best practices with regards to legal indications, pre and post-procedure care, methods, and monitoring. I must state here that this document has undergone wide consultation with relevant technical stakeholders within the legal and health service context in the state.”

Ogboye explained that the process to develop the guidelines commenced in 2018 with the Safe Engage project led by the ministry and hosted by the Society for Obstetricians and Gynaecologists of Nigeria (SOGON), with support from the Population Reference Bureau (PRB).

He added that stakeholders in the health sector worked with key opinion leaders in Lagos and the south-west region to develop a tailored advocacy tool for terminations within the legal context.

The permanent secretary pointed out that the advocacy messages on the Safe Engage project focused on two immediate outcomes, including ensuring that safe abortion services were available within legal indications in Lagos and domesticating the Violence Against Persons Prohibition Act, supporting women to terminate a pregnancy caused by rape or incest.

“To guide the implementation, one of the follow-up recommendations of the project was the adaptation of the National Standards and Guidelines for Safe Termination of Pregnancy within Legal Indications within the Lagos State context,” he said.

“The Federal Ministry of Health had developed and disseminated the national guidelines on safe termination of pregnancy which highlights the compendium of conditions and circumstances under which termination of pregnancy could be instituted.

“The guideline was intended to build the capacity of health professionals to identify pregnancies for which legal termination could be instituted.”

Others who spoke at the event include the Country Director of Marie Stopes International Organisation Nigeria (MSION), Emmanuel Ajah; the Vice-Chancellor of the University of Medical Sciences, Otukpo, Professor Innocent Ujah; and a Professor of Law at the University of Lagos, Ayodele Atsenuwa.

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Covid Vaccines Saved 20 Million Lives In First Year – Study

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Covid Vaccines Saved 20 Million Lives In First Year – Study

Covid vaccines prevented nearly 20 million deaths in the first year after they were introduced, according to the first large modelling study on the topic released Friday.

The study, published in The Lancet Infectious Diseases, is based on data from 185 countries and territories collected from December 8, 2020 to December 8, 2021.

It is the first attempt to estimate the number of deaths prevented directly and indirectly as a result of Covid-19 vaccinations.

It found that 19.8 million deaths were prevented out of a potential 31.4 million deaths that would have occurred if no vaccines were available.

It was a 63 percent reduction, the study found.

The study used official figures — or estimates when official data was not available — for deaths from Covid, as well as total excess deaths from each country.

Excess mortality is the difference between the total number of people who died from all causes and the number of deaths expected based on past data.

These analyses were compared with a hypothetical alternative scenario in which no vaccine was administered.

The model accounted for variation in vaccination rates across countries, as well as differences in vaccine effectiveness based on the types of vaccines known to have been primarily used in each country.

China was not included in the study because of its large population and strict containment measures, which would have skewed the results, it said.

The study found that high- and middle-income countries accounted for the largest number of deaths averted, 12.2 million out of 19.8 million, reflecting inequalities in access to vaccines worldwide.

Nearly 600,000 additional deaths could have been prevented if the World Health Organization’s (WHO) goal of vaccinating 40 percent of each country’s population by the end of 2021 had been met, it concluded.

“Millions of lives have probably been saved by making vaccines available to people around the world,” said lead study author Oliver Watson of Imperial College London.

“We could have done more,” he said.

Covid has officially killed more than 6.3 million people globally, according to the WHO.

But the organisation said last month the real number could be as high as 15 million when all direct and indirect causes are accounted for.

The figures are extremely sensitive due to how they reflect on the handling of the crisis by authorities around the world.

The virus is on the rise again in some places, including in Europe, which is seeing a warm-weather resurgence blamed in part on Omicron subvariants.

AFP

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WHO considers declaring monkeypox a global health emergency

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WHO considers declaring monkeypox a global health emergency

As the World Health Organization convenes its emergency committee Thursday to consider if the spiraling outbreak of monkeypox warrants being declared a global emergency, some experts say WHO’s decision to act only after the disease spilled into the West could entrench the grotesque inequities that arose between rich and poor countries during the coronavirus pandemic.

Declaring monkeypox to be a global emergency would mean the U.N. health agency considers the outbreak to be an “extraordinary event” and that the disease is at risk of spreading across even more borders. It would also give monkeypox the same distinction as the COVID-19 pandemic and the ongoing effort to eradicate polio.

Many scientists doubt any such declaration would help to curb the epidemic, since the developed countries recording the most recent cases are already moving quickly to shut it down.

Last week, WHO Director-General Tedros Adhanom Ghebreyesus described the recent monkeypox epidemic identified in more than 40 countries, mostly in Europe, as “unusual and concerning.” Monkeypox has sickened people for decades in central and west Africa, where one version of the disease kills up to 10% of people. In the epidemic beyond Africa so far, no deaths have been reported.

“If WHO was really worried about monkeypox spread, they could have convened their emergency committee years ago when it reemerged in Nigeria in 2017 and no one knew why we suddenly had hundreds of cases,” said Oyewale Tomori, a Nigerian virologist who sits on several WHO advisory groups. “It is a bit curious that WHO only called their experts when the disease showed up in white countries,” he said.

Until last month, monkeypox had not caused sizeable outbreaks beyond Africa. Scientists haven’t found any major genetic changes in the virus and a leading adviser to WHO said last month the surge of cases in Europe was likely tied to sexual activity among gay and bisexual men at two raves in Spain and Belgium.

To date, the U.S. Centers for Disease Control and Prevention has confirmed more than 3,300 cases of monkeypox in 42 countries where the virus hasn’t been typically seen. More than 80% of cases are in Europe. Meanwhile, Africa has already seen more than 1,400 cases this year, including 62 deaths.

David Fidler, a senior fellow in global health at the Council on Foreign Relations, said WHO’s newfound attention to monkeypox amid its spread beyond Africa could inadvertently worsen the divide between rich and poor countries seen during COVID-19.

“There may be legitimate reasons why WHO only raised the alarm when monkeypox spread to rich countries, but to poor countries, that looks like a double standard,” Fidler said. He said the global community was still struggling to ensure the world’s poor were vaccinated against the coronavirus and that it was unclear if Africans even wanted monkeypox vaccines, given competing priorities like malaria and HIV.

“Unless African governments specifically ask for vaccines, it might be a bit patronizing to send them because it’s in the West’s interest to stop monkeypox from being exported,” Fidler said.

WHO has also proposed creating a vaccine-sharing mechanism to help affected countries, which could see doses go to rich countries like Britain, which has the biggest monkeypox outbreak beyond Africa — and recently widened its use of vaccines.

To date, the vast majority of cases in Europe have been in men who are gay or bisexual, or other men who have sex with men, but scientists warn anyone in close contact with an infected person or their clothing or bedsheets is at risk of infection, regardless of their sexual orientation. People with monkeypox often experience symptoms like fever, body aches and a rash; most recover within weeks without needing medical care.

Even if WHO announces monkeypox is a global emergency, it’s unclear what impact that might have.

In January 2020, WHO declared that COVID-19 was an international emergency. But few countries took notice until March, when the organization described it as a pandemic, weeks after many other authorities did so. WHO was later slammed for its multiple missteps throughout the pandemic, which some experts said might be prompting a quicker monkeypox response.

“After COVID, WHO does not want to be the last to declare monkeypox an emergency,” said Amanda Glassman, executive vice president at the Center for Global Development. “This may not rise to the level of a COVID-like emergency, but it is still a public health emergency that needs to be addressed.”

Salim Abdool Karim, an epidemiologist and vice chancellor at the University of KwaZulu-Natal in South Africa, said WHO and others should be doing more to stop monkeypox in Africa and elsewhere, but wasn’t convinced that a global emergency declaration would help.

“There is this misplaced idea that Africa is this poor, helpless continent, when in fact, we do know how to deal with epidemics,” said Abdool Karim. He said that stopping the outbreak ultimately depends on things like surveillance, isolating patients and public education.

“Maybe they need vaccines in Europe to stop monkeypox, but here, we have been able to control it with very simple measures,” he said.

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