Africa’s scientists know about monkeypox, but they are being ignored

Voices of continent’s specialists ‘notably absent from discourse’ on disease outbreak

● As the number of monkeypox cases rises across the globe, African researchers are lobbying for the continent’s experience and expertise in this and other diseases to receive the attention it deserves.

Flying the flag high for the continent is Wanda Markotter, a professor from the University of Pretoria (UP) who is co-chair of a new entity formed by the World Health Organisation (WHO).

Markotter, a virologist, is director of the Centre for Viral Zoonoses in the department of medical virology at UP.

Fresh from a trip to Limpopo where she assesses pathogens in bats from caves, she spoke to the Sunday Times about the crucial gaps in understanding monkeypox.

Together with a German scientist, she now leads the newly formed One Health expert panel for the WHO. It looks at human health systemically, understanding it in the context of food, animals, the environment and ecosystems.

Her first bugbear is the lack of funding for finding out exactly where monkeypox comes from so it can be controlled.

There are more than 6,000 cases globally — the largest outbreak on record — while in SA the National Institute for Communicable Diseases (NICD) has confirmed two cases.

Europe is the epicentre of the outbreak, recording more than 80% of cases.

The WHO will this month meet a second time, after the first gathering in June, to assess whether the outbreak is a “public health emergency of international concern” (PHEIC).

There were more than 12,000 monkeypox cases during the Covid-19 pandemic in central and West Africa but, Markotter said, “as soon as it started spreading to more countries through travel, all of a sudden everybody noticed. We know it is linked to an animal source but we are still not exactly sure what animal source and there should have been more funding to understand the origin of it.

“We know it is zoonotic [spread from animals to humans] but we don’t yet know the exact pathway.”

She said clinicians are reporting on what they are seeing with the disease, but more resources need to go into “investigating properly where it’s coming from so we can control it and prevent spread across the world”.

She said Covid-19 taught the importance of keeping a watchful eye on the spread of a disease, but monkeypox is not airborne and “you need to be in really close physical contact with someone to get it”.

According to Aula Abbara from Doctors Without Borders, the “global inattention to infectious disease science done in Africa” is concerning, and “the unexpected, unprecedented and unusual nature of this outbreak in Europe and the Americas has spurred scientific, political and media attention”.

Monkeypox has been known to cause human disease for more than 50 years and is historically reported in at least 10 countries in west and central Africa, she said, with more than 1,000 incidents reported in the Democratic Republic of the Congo in the first three months of 2022 alone.

Writing in The Lancet, she said specialists in African countries have “decades of experience managing such outbreaks, often with little support, and have repeatedly warned of the potential for monkeypox’s globalisation and the need for affordable tools and improved surveillance”.

In spite of vast expertise, the voices of specialists in Africa are “notably absent from the current discourse” and “many have struggled for years to raise awareness, publish their findings, or attract funding to study this disease”.

WHO director-general Tedros Adhanom Ghebreyesus said this week: “On monkeypox, I continue to be concerned by the scale and spread of the virus across the world and we now have more than 6,000 cases recorded in 58 countries.”

He said “testing remains a challenge” and it is “highly probable that a significant number of cases are not being picked up”.

This underreporting echoes the crisis of Covid-19 and, according to professor of bioinformatics Tulio de Oliveira, who became a household name for discovering variants during the pandemic, so does this inattention to African expertise.

He said “praise and recognition of scientists in Africa are not common on the global stage” and “typically researchers in Africa have to produce at least twice as much to get less than half the respect of researchers from high-income countries”.

An example he cites is the discovery of the Ebola virus in 1976, which was credited to European scientists when much of the work had been done by African scientists.

“This kind of scientific discrimination against researchers from low-income and middle-income countries is widespread. It is time to enter a new global phase.”

He called for better investment in science in these countries so that the world is better prepared to deal with future epidemics and pandemics.

This kind of scientific discrimination against researchers from lowincome and middleincome countries is widespread. It is time to enter a new global phase

Bioinformatics

Prof Tulio de Oliveira