Mpox Outbreak: Return of Lockdown?

the World Health Organization last week declared empx a global Public Health Emergency that's its highest form of alert empx the virus formerly known as monkey pox is spreading quickly around the world following a summer outbreak in Africa impx is not the new Co well that's a relief the who says empx is not going to hit the world in the same way as covid however it is still calling it a global Health Emergency as the number of cases rise and of course it's worried also so about a new more virent strain people around the world have a lot of questions about this virus and we're going to be putting some of those to our panel of scientists and doctors including can it be contained how dangerous is it and will there be a need for lockdowns or other restrictions but first let's have a look at how empo is being reported in the media the World Health Organization has declared a global Public Health Emergency following an outbreak of a new strain of the empo virus in Africa a new variant of the disease with its distinctive rash has emerged in central Africa The Strain is more Mortal so in other words uh causes more uh percentage of deaths it's also more transmissible it spreads more easily from person to person detected in 13 African nations including Kenya Rwanda and Uganda this is the second time in 2 years that the who has declared epox a global Health Emergency Sweden's public health agency says it has recorded the first case of a contagious new variant of empo outside the African continent more cases of the dangerous variant are likely to be found in Europe in the coming days it's clear that a coordinated International response is essential to stop these outbreaks and save lives we do not recommend uh closure of borders we do not want to see closure of borders impo is a viruses very closely related to small pox and the chickenpox and so it's very contagious monkey pox is a zoonotic disease this means it can spread from non-human animals to people it starts with flu like symptoms and ends with this this is what MX which used to be called monkey pox can do it's transmitted by near contact and we have not that much information of how transmittable it is most people can contract it through very close and prolonged contact with an infected individual with direct contact and sexual contact those are the primary modes of transmission having just had Co and now getting monkey pox how do you compare the two I was much sicker with monkey pox okay let's bring in our panel now and we have two infectious disease experts with us Dr Samir eled in Canada and Dr amsh Adalia in the United States welcome to both of you Amish if I may start with you this virus is not easily transmitted isible so then what makes it a global Health Emergency just because it's not as easily transmissible as co9 does not mean that it can't be a disruptive force in countries in which it is spreading and what what's different about this is we've got a more contagious probably more dangerous strain that's spreading unchecked in the DRC with spread to neighboring countries countries who have never reported empo cases and what this Public Health Emergency will do is galvanize the world to get resources to the source of empo to be able to vaccinate populations to be able to diagnose populations there to reduce the risk in the whole continent on the whole continent of Africa as well as for the rest of the world because there is a threat of importation of disease as people travel out of that outbreak region so this really is about making sure that empo ceases to be a threat to Africa and and to the world even if it's not going to be a covid level threat or a pandemic flu level threat and Dr elai do you think it was the right decision to declare this a global Health Emergency yes I do believe it was the correct decision actually aox has been neglected for many decades and we've seen already from 2022 to 2023 with the clay 2 virus how it was spread outside of the of the African continent but in Africa itself it's certainly the number of cases this year exceed everything from last year and you know for the last 20 years aox has infected thousands of people uh since 2005 actually it's been you know thousands of cases every year and so with this more transmissible strain with the neighboring countries of Africa that have never had empo before as well as the case in Sweden there's a case in Thailand currently being investigated we won't know if it's clayed 1B or not until Friday but I do believe it's the correct decision and Dr Adalia do you think the World Health Organization should have made a similar announcement before uh when it was just contained within the continent of Africa I do think that this required a lot of attention in Africa at least since the mid 2000s when cases were spiraling out of control in the DRC in places like Nigeria and which seated the prior outbreak that we had in 2022 you know as as the other guests has said this has been a disease that's been on the radar of infectious disease experts for a long time but has been neglected until it caused this outbreak so I do think that we should have been much more aggressive with controlling this virus at its source at least uh up to 10 years ago uh when people started to think about this becoming something different that it was changing its modes of transmission that it was becoming sexually transmitted and we had vaccines we had counter measures that could have been deployed earlier uh it's only now that we're actually seeing vaccination occurring on the continent of Africa and I think that really speaks to the fact that it it takes there's a lot of inactivity and inaction and reactivity when it comes to infectious disease outbreak but what we need is actually proactive steps and I think this Public Health Emergency declaration is the first time we've seen them being proactive um but it could have come earlier because this has been going on for some time in the DRC and do you have any suspicion why the who was dragging its feet I don't know that they were dragging their their feet but it is a bureaucratic process this requires consensus amongst multiple different individuals on the emergency committee sometimes countries themselves are reticent to have a public health emergency declared within their own Borders or affecting their borders because of the stigma attached to that so there's a lot of considerations that go into these declarations that are outside kind of the realm of infectious disease and epidemiology we saw that with covid we've seen that with ebola we've seen it when declarations are declared when they're not declared it's not you know as an on or off switch it's not an easy process and that's what happens kind of when politics and international relations get bound up in what really is a scientific issue it's not a question of the wh thinking oh well it's only Africa let's not worry too much but now it's reached Sweden and Pakistan we need to ring the bell I think that there is definitely much more impetus to declare a public health emergency when something spreads to the Western World to more developed countries that's always been the case that that's when people start to take action or take notice because people often think of certain countries in Africa as places where infectious diseases kind of Thrive and that's always been the case and I think that's the wrong way to look at it because in diseases and one continent affect everybody in all the other continents okay um Dr elide Dr adal there mentioned vaccinations uh in fact there is no vaccination against empo itself is that correct but they but they found that small poox vaccination is 85% effective yeah so there there are three commercially available uh preparations of of empo vaccine actually three brand names um and uh the one used in Europe is immune the one used in inex and the one used in Canada is imune and genius is the one in the United States uh these vaccines are essentially vaccines made against small poox uh and crossreact to the uh empx virus and Amish we've received a number of questions from our viewers uh quite simple ones which I think though do need to be addressed and they uh Chief amongst them are can it be contained how dangerous is it if you contracted and uh will there be a need for lockdowns and any other restrictions so yes this can be contained we had outbreaks for example in the United States where we had over 35,000 cases with the other clay of empo and that was contained we have countermeasures as you've just heard about there are vaccines that are highly effective the key to containment is diagnosing cases isolating them vaccinating individuals that are in the atrisk population but this isn't the same thing as covid-19 which was a virus not known to humans before 2019 for which there were no countermeasures we have countermeasures and this doesn't spread in the manner of co9 or influenza so that's not something that would require major mitigation measures like you mentioned lockdowns that those aren't anywhere you know even on the in the realm of possibility when it comes to a virus that's spread through intimate close contact like aox and when you come when it comes to co you know you have to keep also in mind that those lockdowns only occurred because there was Major inaction by governments that's not the way you you want to handle an infectious disease that's a a last resort when you've basically used up all your other resources so although the people are really triggered by the idea of lockdowns because of what happened during Co you have to realize that's not you know anywhere in the first pages of any kind of playbook for an infectious disease and it certainly wouldn't apply to a virus that spreads in the manner of empo for which we have vaccines and countermeasures and Dr El on the question of how dangerous is it um what is the mortality rate and how effective are the treatments available well the mortality rate for Cay one in general is much higher than for clay 2 the mortality rate for clay 2 is is around 3% to uh it's less than 1% but uh for clay for Cay one and and we don't know about U clay B outside of Africa of course because we only have the um Swedish case but in Africa the mortality rate is is approximately uh 7% roughly and so you know that of course that's that's very concerning the the difference between Cade 1 a which has been around for decades and Cade 1B which is this new strain is that claymon B has a propensity to transmit between person to person it's not considered to be a clay that was acquired from animals whereas Cay 1A is U known for being transmitted from animals to humans and also as well there has been some human uh to human transmission but uh the concern is with the human to human transmission of clay subcl 1 1B uh with that mortality rate of about 7% there's obviously a range of numbers quoted uh that's the concern of course and most of the people who are dying are young children these are people that have never been vaccinated against smallpox people who are uh over the age of of 55 people who were born before 1970 are perhaps protected from previous small poox vaccination if they received it so and a quick question for you both uh Dr El let's start with you um there are questions why uh African countries themselves haven't uh prepared themselves for such an outbreak um given that it is endemic in in some countries in in central Africa and in West Africa uh could those countries have done more to prepare I guess one of the challenges in Africa and other you know developing nations is is access to resources and U infrastructure of the Healthcare System certainly uh I I believe the African CDC and and other organizations have worked tirelessly to uh contain infectious diseases outbreaks not just for empo but also if you look at Ebola and many other diseases that originate on the African continent uh I don't think it's it's a lack of effort I think it's a lack of resources and a lack of international support Amish this is something that's been a perennial problem is that trying to make Africa resilient to the Infectious Disease threats that that arise there and that's been part for example during the Obama Administration the global Health security agenda was meant to increase the infrastructure in Africa and we've seen with Africa CDC being developed some efforts to try and do that but when you think about a country like the DRC how it is plagued with conflict in authoritarian governments and Civil Wars you know empo is probably far down on their list of threats to their their country and their National Security so it's often hard for countries like this to be able to even develop the infrastructure or or Public Health apparatus to deal with it but this has to be something that is is created there because this is not going to be the last infectious disease outbreak that they that they face and I think the whole world depends on uh this being uh the world itself being resilient in all all of its corners and I think this is a major priority to develop that capacity in Africa Dr Amish adala and Dr samier elsaed thank you both very much much appreciate it but it seems clear that empo is not the next covid but the wh is still concerned about another pandemic coming along in the future the question is has the world learned how best to handle it remember last time each country took a rather different approach last time concerns over a virus went Global two starkly different approaches were put into effect State enforced lockdowns and public L her immunity in other words letting a significant portion of the population get the virus becoming immune in the process Sweden opted for herd immunity avoided a societal shutdown and asked vulnerable citizens to sh Shield themselves if they felt it necessary very large Gatherings were limited according to the World Health organization's data Sweden's excess death rate over that period was 56 people per 100,000 Spain's excess death rate was 111 people per 100,000 that's double Spain enforced one of the strictest lockdowns in Europe ordering most of their 47 million residents to remain at home except to buy food or medicine or walk the dog giving more freedom to pets than those under 14 who were confined for over 6 weeks in their first lockdown Sweden allowed people to keep their freedom and still the death rate remained lower than many countries with extreme governmental restrictions lessons have been hard to learn because of the different ways data was cated both during and after the covid pandemic the UK employed a policy of recording any death within 28 days of a positive test as being caused by covid even PM Boris Johnson was dubious of the figures he says I must say I've been slightly rocked by some of the data on covid fatalities the median age is 82 to 81 for men 85 for women that's above life expectancy so get Co and live longer the wh is a long way down the road of planning for the next Global emergency its pandemic treaty is centered around private business and political interests leaving it hard for some to believe Global health is their only motivation the idea behind the treaty is to create a new system of pandemic management under the who's Authority and make it binding under international law member states would be obliged to give up 20% of pandemic related Health Products to other countries and would be prevented from stockpiling supplies it was this issue and concerns over intellectual property rights and sanctions that prevented the treaty being signed in May earlier this year you know you give away power to people that can make huge decisions over your life you can't vote for you can't hold to account in debate and you can't actually vote to remove so if the government decided on another lockdown how would the general public react we sent our producers onto the Streets of London to find out just wondering people's opinions on if there were to be another lockdown would you comply with it no why is that we went through this once in the us and we're not going to comply don't trust the government basically so theoretically if the UK government was to lock down again what would you comply with it absolutely not those are the only circumstances I would form a revolutionary yeah movements I would die on the on the barricades for freedom and liberty never again I couldn't bear it we would yeah it would be awful I think that was what we needed so I think the lockdown gave them some time but um I don't know if we'll be able to do that again um I think it affected us a lot and it affected our economy a lot as well so I'm not sure absolutely because it would be law legal it would be the law so therefore you need to do what the law requires you to do although that hasn't always followed for our politicians it should certainly follow for us I don't think I would I don't think I probably not so if the government locked down the country would you listen I don't think so no one's going to listen to them it's just a game there is no Co nothing they they the government they just make out of their hand they just make the people to stay at home they show their power that's I think that's what they're doing if the government hypothetically was to lock down again would you comply with that no why is that because it's a bioweapon just like the last one I think that if the populist voted whether that was a short or from home vote whether they were in favor of as a majority in favor of locking it down again if something happened I think that that would be a democratic solution to probably a difficult problem okay let's bring in Anthony Hinton now a former NHS surgeon here in Britain and we also have Rodney roie a microbiologist in the United States He also used to work with the Center for Disease Control welcome to the program both of you uh Tony Hinton if I may start with you uh quite a lot of skepticism there amongst our Vox pops uh about the efficacy of lockdowns do you think they have a good reason to feel that way well we've just been through a pandemic and we had a huge worldwide experiment with lots of countries doing different things and what I would say is that we should be looking at which countries did best and did best in the long term particularly in terms of overall mortality and the country that did best is Sweden now Sweden had almost zero lockdown I visited Sweden twice in the Autumn of 2020 to see for myself they didn't have um groups of more than 500 people so Cinemas and theaters were closed but otherwise everything was normal there was no masking uh shops were open um restaurants bars um it was very normal and I think we should learn from that um so there's no evidence that lockdowns saved a single person but there's a lot of evidence that lockdowns have caused huge problems Children's Mental Health the economy uh Health in general missed cancer diagnosis you could go on Rodney Roy your response yeah I I mean I tend to agree with that statement with just some caveats I think it's difficult to take one country um such as Sweden or Spain or even other countries and compare them to a very large Continental Country like the United States uh including just differences in how people's belief systems work how they actually follow these types of Public Health measures But ultimately I do think um we have some absolutely important lessons to consider uh for example perhaps different countries can approach this in a way that makes more sense from a very honest and accurate science communication standpoint uh my my perspective is that we did a really poor job in the first one to three months we also have to remember we had a novel agent that we didn't know a lot about and so I think we didn't really do a good job of communicating that we would learn in real time and that we would adjust on the Fly and I really think that was part of you know the global problem including in the United States Antony Hinton let's move on to the wh which wants a global pandemic treaty uh what are the upsides and downsides of that well if the who had been in charge of pandemic responses uh in the last two to four years every country would have done the same we wouldn't have differences to look at now and see which was the best way forward Rodney Roy would you be in favor of the United States signing up to a global pandemic treaty uh drawn up by The Who I think only in the sense uh that we are globally communicating and working towards the best solution and best information I don't you know I can't speak for the United States government of course but certainly I think that we would want to be communicating and want to be working with uh everyone across the Global Spectrum to decide best evidence best practices and so forth including again communication come in Tony I would absolutely agree with that really one of the big problems at the start of this pandemic is there anyone that raised anything that wasn't in the government or the medic hierarchy narrative was censored and vilified um thrown off Twitter um one good thing that's come out of the UK's Co inquiry is the suggestion that there should be so-called red teams to advise government to look at what government is doing and come up with contrary advice to test out the advice they're getting rather than just having these um yes people surrounding the Poli politicians just a quick question um Rodney about the CDC and its uh conduct during the the last pandemic do you think there were lessons for for them to learn early on I think what the American public didn't realize and and and those of us who have been there or even worked in State Health departments understand this the CDC is not built to be a corporate Reference Lab that will crank out tens to hundreds of thousands of results so I think one of the lessons that the CDC and the public needs to learn is that we must move quickly again accurate Diagnostics I'm a medical laboratorian you can't identify any changes in a virus or any other pathogen without accurate testing accurate surveillance and it needs to be as rapidly and and as accurate in as real time as possible what's a battle I'm I'm really working at here in the US as a science person is to get that trust back and it's going to be a difficult process because some of these mistakes in communication just a final question for both of you just rounding this off this program about empo Tony Hinton are you troubled by any aspect of how the who or indeed the media have covered empo so far well empo has been tried to be Ted up to be the next pandemic and it was tried again two years ago and they've tried the same thing with bird flu I'm not quite sure why they keep doing that um even if we look at Africa where the vast majority of these empx or monkey pox cases arise there are much more important things clean water malnutrition malaria TB are all more of an issue than empo then what is your suspicion why they're doing that I've no idea Rodney same question yeah I believe impo is is not the next pandemic uh concerned I do believe we should watch all pathogens that are you know changing and and becoming different in how they might infect different populations but I do believe that we have a much broader concern and I'm going to go back to this idea of asking the right questions and determining the true as best as we can the true dangers that may come out of different countries different places different regions and we have to get better at looking at surges in hospitals we have to get better at security questions around certain events and what's happening on the ground that takes a broad a fully funded effort at looking at better communication systems both in the electronic health records understanding what's happening on the ground it's really difficult to follow a a global organization whether it's w CDC or even a regional type of of system that doesn't really understand what might be happening on the ground so I'm always I'm always for better communication better data and and other topics that we've discussed prior Rodney roie and Anthony Hinton thank you both very much for your contributions today much appreciated and thank you at home and on your phones for watching if you want to see this episode or any of our previous episodes do go to our Channel on YouTube just type in Nexus trt World till next week then goodbye