The rise in monkeypox cases in India may not be of much concern yet—Delhi reported the ninth case in the country on Wednesday—but the quick spread in some European nations and the US underscore the need for countries to have a multi-dimensional control and prevention strategy. For perspective, of the 26,208 active cases reported so far, 25,864 are in 80 countries that have not historically reported monkeypox cases, suggesting the situation could become critical if early measures are not taken. To that end, the Centre’s decision to set up a task force to examine the need to vaccinate close contacts of positive cases, and to consult experts on updating existing guidelines for management of cases are important first steps. The health ministry has also told Parliament that the country has initiated strict surveillance and contact tracking to control spread.
Globally, as of August 1, there were just 16.4 million doses of the only vaccine approved anywhere against the monkeypox virus, while there are two other candidates. All three were developed as second-/third-generation vaccines against smallpox (which is from the same family of viruses as monkeypox ), and one is approved for use against monkey pox in the US. The other two could soon get approval. This means as cases grow in Europe, the US and Canada, the rich nations’ scramble for access could become a major hurdle for the rest of the world in rolling out control measures. Against this backdrop, the Indian Council of Medical Research isolating the virus from cases in the country and floating expressions of interest for vaccine-development and diagnostic kits should help build necessary resources quickly to contain large-scale spread. Even as work on monkeypox vaccine development takes off, the country will need to build a stock of the smallpox vaccines. India took the decision to stop vaccinating against smallpox in the 1980s, given that smallpox had been eradicated.
Given how the World Health Organization has warned that the window to prevent monkeypox from becoming endemic outside Africa is closing fast, it will be crucial to mount efforts on vaccination, diagnosis, treatment and isolation. State governments must remain on alert and create capacity to treat and isolate cases—Delhi has directed at least three private hospitals to create facilities to isolate and treat confirmed and suspected cases. As for vaccination, the Centre must quickly formalise a strategy as the US and France have already done. It’s a good sign that the task force on monkeypox has already started talks with potential vaccine manufacturing partners. Adar Poonawalla, CEO of the Serum Institute of India, has confirmed that his facilities are being primed for vaccine production even as the need for a new shot is being assessed. Preparation measures would also need to assess safety and efficacy of existing antivirals—scientists affiliated with the US Center for Disease Control, Food and Drug Administration, and National Institutes of Health have already called for randomised control trials to assess the potential (or lack thereof) of tecovirimat, a drug developed to fight smallpox, writing in the New England Journal of Medicine. India must also examine the soundness and necessity of such an approach. If there is one learning from the Covid-19 jolt, it is that nations can’t afford to take the foot off the pedal on contagion preparedness.