AN expert has warned that Scotland may struggle to cope with an increase in demand for sexual health services if the mpox outbreak spreads to the UK.
On Wednesday, the World Health Organisation (WHO) declared a public health emergency of international concern – its highest level of alert – due to the spread of the mpox disease in Africa.
At least 450 people have died as a result of the initial outbreak in the Democratic Republic of Congo (DRC).
However, it has now been confirmed in 13 African countries with WHO director-general Tedros Adhanom Ghebreyesus stating it is “something that should concern us all”.
A previous outbreak in 2022-23 resulted in more than 3000 confirmed cases in the UK, with a total of 97 in Scotland.
The previous outbreak of the virus in 2022-23 was of a less transmissible variant, while the current variation, which has circulated in the DRC for years, is far more infectious.
The disease is easily spread via sexual contact with the previous UK outbreak largely impacting men who have sex with men.
But Jaime Garcia-Iglesias, a chancellor’s fellow at the University of Edinburgh’s Centre for Biomedicine, Self and Society (Usher Institute), said sexual health services would struggle to meet demand if another wave of the disease reared its head in the UK.
“Currently, the key concern is that the current clade being spread is not clade II (which caused the 2022-23 outbreak) but clade I, which is more transmissible and causes more severe infection,” he said.
“There are some outbreaks supposedly linked to men who have sex with men, but there is no reliable data.
“In any case, it is likely that if the current mpox outbreak spreads outside of Africa, we’ll see a change in its dynamics, as we saw in the previous outbreak.
“In the 2022-23 outbreak in the UK, we learned many things.
“That sexual health services, which are already at breaking point due to underfunding, struggled to meet the increase in demand and properly support people with mpox.
“There has not been a comprehensive revamping and funding of sexual health services since, so we’ll likely see similar situations where clinics simply cannot meet the demand.
“We also learned that involving communities (such as charities, community leaders, etc.) was key to developing effective messages, essentially meeting people where they are, providing information that was timely, accurate, and relevant.
“While we saw some of this happen in the mpox outbreak, there is still a lot of work to do to implement a sustained strategy to engage with communities.”
Men who have sex with men in Scotland were able to receive an mpox vaccine during the previous outbreak, although this was for the clade II strain of the virus and was not available to all of those attending sexual health clinics throughout the country.
However, the US Department of Health and Human Services states that “those who have already had clade II mpox or are fully vaccinated against mpox are expected to be protected against severe illness from clade I mpox".
Yet Garcia-Iglesias stressed that it was important people completed the full vaccine course, which requires two separate doses taken between two and three months apart.
He also warned that official health advice from bodies such as the NHS would struggle to control the narrative against misinformation and disinformation being spread on social media.
Now that @WHO has declared a new #mpox international emergency: What did we we learn during the 22-23 outbreak? Our team in the UK researched how to work with communities and communicate information. Report here: https://t.co/YhmXKBMLti A thread 🧵 https://t.co/dS8Zwx93JH pic.twitter.com/1jZxDLVoDZ
— Jaime Garcia-Iglesias (@JGarciaIglesias) August 14, 2024
“The 2022-23 outbreak was characterized by the relevance of social media: it was key to share information and awareness, but also became a space where misinformation and disinformation thrived,” he said.
“Back then, government and NHS bodies did not have the social media following or knowledge that was required to use them effectively, so it was up to individual people to share information. This led to a lot of inequality. We haven’t seen any changes on this.
“While there was an mpox vaccination campaign, there have been no sustained opportunistic [vaccinating people when they attend clinic for other things] or preventive program, which means that there remain many communities who haven’t been vaccinated or have only had one shot. This is an issue of equity.”
He added that public experts largely expected another outbreak of mpox and called for more investment to combat infectious diseases impacting populations in Africa before they reached Western countries.
Garcia-Iglesias said: “In many ways, we knew this would come. Countries from the Global North only cared about mpox, which had been endemic in Central and Western Africa for decades, when it started circulating in their countries.
“They did not invest in providing diagnostic tools, prevention, or treatment in the African continent.
“It was a matter of time until this happened. And, as with many other infectious diseases, it will continue to happen.”
