The outbreak of the monkeypox virus in Australia, occurring alongside the global Covid-19 pandemic, has alarmed many health authorities, but the New South Wales chief health officer, Dr Kerry Chant, said she felt “confident” the rare disease was being managed.
Four months after the first case was detected in NSW in May, just four cases of monkeypox were identified in Australia in the fortnight to 28 September. There had been a total of 136 monkeypox cases in Australia, despite countries such as the UK, US and Spain reporting thousands each.
By the time cases emerged in Australia it was apparent from contact-tracing efforts overseas that the majority of infections were in men who had sex with men.
In NSW, Chant said the government had worked closely with doctors and health promotion organisations, such as Acon, which specialise in HIV prevention and providing sexual health support to the LGBTQ+ community.
She said she was “cautiously optimistic” the outbreak was now well contained in Australia, attributing the success to the response by gay and bisexual men, and the organisations and workers who support them.
“We’ve got to use the vaccines that will be coming in greater quantities in the coming weeks to further reduce risk,” she said.
Gay and bisexual men lead way in managing sexual health
Matthew Vaughan, Acon’s acting director of HIV and sexual health, said when he first heard about the monkeypox outbreak, and that gay and bisexual people were most affected, he could not help but think of the legacy that HIV has had on gay and bisexual men.
“The idea that monkeypox could do the same thing, and make people hesitant around their relationships and their connections, along with the concern that this may wrongly be labelled as a disease of gay and bisexual men, meant we were very quick to work with the NSW government to proactively get accurate messaging out there,” he said.
While in most countries the virus was predominantly affecting gay, bisexual and other men who have sex with men – about 98% of cases have occurred within this community – it can be contracted by anyone. The virus can spread through respiratory droplets via coughing and sneezing, and through contact with contaminated surfaces, but it is most easily spread through prolonged close contact with an infected person. About 95% of infections have occurred through sexual contact.
“Anybody can get monkeypox, it’s not something that’s specific to gay and bisexual men, though it is being passed to those networks,” Vaughan said.
“But a large part of the reason why cases are being so quickly detected and prevented is because gay and bisexual men have a very good relationship with their sexual healthcare provider, they get regular check-ups and testing. There is also very low rates of vaccine hesitancy among those communities.”
Acon held community forums to answer questions about the virus, posted questions and answers on social media, distributed factsheets and linked up with sexual health service providers to promote testing and vaccination.
“We’re vaccinating to prevent an outbreak rather than just being reactive where cases occur,” Vaughan said.
“I think that’s a very different response to what we’ve seen in the UK or the US, due in a large part because of community organisations working with the government, and the positive response from the community to those messages.”
Victoria’s chief health officer, Prof Brett Sutton, wrote that the “responsiveness and engagement” of the LQBTQ+ community meant Victoria has had no monkeypox cases “for a few weeks now, having had significantly early growth in cases”.
“Those pillars of a public health response work,” he wrote. “Case isolation, contact tracing and early testing through close engagement with at-risk community.”
Other countries need help
The federal health minister, Mark Butler, agreed monkeypox cases were stabilising across the country, despite being declared a “disease of national significance” on 28 July.
He said acquiring the more sophisticated vaccine, named Jynneos, had also played a significant role.
“Australia was one of the few countries to gain access to the third-generation monkeypox vaccine,” he said.
Prior to the outbreak, Australia only had access to a vaccine known as ACAM2000, which is unsuitable for immunocompromised and pregnant people, and carries the risk of side effects. Jynneos has been recommended globally as the preferred vaccine, as it can be administered to the immunocompromised.
This has placed enormous strain on supply.
In a blog post for the Infectious Diseases Society of America, Dr Dimie Ogoina, a Nigerian infectious diseases physician, wrote: “Nigeria, like other affected African countries, has yet to receive a single dose of monkeypox therapeutics or vaccines, even for clinical trials.”
However, Australia was unable to share or donate its supplies of the vaccine due to contractual limitations, a federal government spokesperson said.
Ongoing Australian supply is uncertain, but crucial
Currently, Australia has no vaccine to spare.
Heath Paynter, the deputy CEO of the Australian Federation of Aids Organisations, said until every eligible person had received two vaccine doses and ongoing vaccine supply was secured, it was much too early to celebrate our success.
“We still have a massive vaccine shortage, and we’ve pretty much exhausted our supplies,” Paynter said.
“Australia has got a very big order of vaccines placed, but there’s no timeframe on when the next tranche is going to arrive. If that was delayed considerably, and we had an outbreak in the meantime, we could be in trouble.”
Only 22,000 vials out of 450,000 ordered had arrived, he said.
“We expect 78,000 will arrive in the next month but we have no guarantee. We need those vaccines asap as people are travelling, they will be travelling to hotspots, and the majority of those vaccinated in Australia have only had one dose.”
A single dose offered about 60% protection against infection, whereas two doses offered about 85% protection, he said. The Jynneos vaccine was produced by a small Danish company, Bavarian Nordic, which controlled the global supply.
“The supply issue is a major issue that I would argue rests with the World Health Organization and the European Union. That Danish company needs to sign a voluntary licensing agreement with a larger vaccine manufacturer and allow them to mass-produce it so there is supply security.”
In the meantime, Paynter said: “You couldn’t find a more health literate and vigilant community than gay and bisexual men”.