Monkeypox makes pledges of pandemic solidarity look hollow

The writer is a science commentator

The lack of international solidarity exposed by the pandemic, particularly after rich countries hogged Covid-19 vaccines, led to cries of “never again”. Never again should vital data and samples be held back in an outbreak; never again should the global south be abandoned by the global north in the quest for money, drugs and vaccines.

In the light of the current monkeypox outbreak, those pledges now look hollow. High-income countries are once again scrambling for vaccines to which African countries have had little access, even though the disease has existed in central and west Africa for decades. Monkeypox is suspected in 70 deaths in Africa this year, while there have been no reported fatalities among the 4,000-plus cases recorded outside the continent. “The place to start any vaccination should be Africa and not elsewhere,” said Ahmed Ogwell, acting head of the Africa Centres for Disease Control and Prevention.

The lofty ideal of global health as a public good is again faltering in the face of national interests. The fragmented response is not just a problem for controlling monkeypox. It also signals trouble for the global pandemic treaty that is currently being drafted, designed to bind countries more tightly to acting for the collective good.

An advisory panel that met at the World Health Organization last week decided against labelling monkeypox a public health emergency of international concern. Gregg Gonsalves, an epidemiologist at Yale University, said it was “a big mistake”, given that containment is so far failing.

Perhaps the panel felt that suddenly acknowledging an epidemic that has been bubbling away in Nigeria since 2017 would give the wrong signal. Still, the WHO may switch tack if the disease becomes more severe, moves into different groups (currently, most cases are in men who have sex with men), or becomes established in animal populations outside Africa, expanding the virus’s endemic footprint.

The emerging science already hints at something unusual: preliminary research published last week suggests the virus is evolving faster than expected. And the outbreak, affecting 48 countries so far, is not fizzling out. The UK alone has notched up more than 900 cases as of June 27. Spain and Germany are also seeing high case numbers. At a pandemic preparedness conference I attended in Brussels last week, few scientists were prepared to rule out a monkeypox pandemic.

A big theme of the conference, focused on respiratory viruses, was ensuring that the mistakes of Covid-19, such as delayed reporting of cases and poor messaging, are not repeated. One proposed remedy is the WHO pandemic preparedness treaty, sometimes called a global pandemic treaty. The treaty would legally bind signatories to such practices as timely data-sharing. A “zero draft” will come out in August. The treaty is already the subject of false claims that claim it will strip states of sovereignty and mandate imprisonment for the unvaccinated. The real obstacles are more prosaic: since the WHO is a technical agency rather than a legal one, could it enforce treaty obligations?

But for Mark Eccleston-Turner, an expert on global health law at King’s College London, the treaty may fail because it is a “neocolonial” instrument designed to crystallise, rather than erase, the power imbalance between nations. Early versions, he says, seem to force low and middle-income countries to promptly share samples and data, giving other countries time to close borders and stockpile drugs, vaccines and protective equipment — but without enshrining equitable access to those drugs and vaccines in return.

“The fundamental problem with our system, and the problem that the treaty currently entrenches,” Eccleston-Turner tells me, “is that the samples, data and information of LMICs [low- and middle-income countries] are public goods and must be shared for the good of humanity, while vaccines and other medical countermeasures are private goods to be hoarded and accessed by the world’s wealthiest first.”

That monkeypox vaccines are only now being hastily procured bolsters his point.

Treaties are legal instruments designed to both bind and protect all parties. But a remedy should not leave a patient worse off. Without careful scripting, a pandemic treaty risks protecting high-income countries without binding them, and binding low and middle-income countries without protecting them.