We need to talk about Mpox
And this week's podcast is a PROJECT 2025 Deep Dive
Dear Friend of Global Health Conversations,
I hope that you are enjoying a peaceful evening or start to your week. I have always conceptualised this newsletter as a ‘match’ striking effort for what I consider to be important conversations. And hopefully, by talking about these topics, candle by candle (or match by match) we can have broader, richer, interdisciplinary conversations. I hope I can do so this fortnight with both Mpox & Project 2025.
For my part, I had an absolutely lovely fortnight. Busy bits, some tougher bits and a nice weekend both celebrating a close friend’s birthday and catching up with my mum’s friends in her absence. ☺️ I have also hit over one month with my favourite piece of wearable tech - The Oura Ring. From a young age, I loved to read. I would stay up reading into the wee hours well after bedtime, in the dark, with a trickle of moonlight. I wasn’t too slick and my parents busted me on more than one occasion. Reminding me of the potential negative effects of reading in the dark and sleeping late. I was a ‘just one more chapter’ at night and ‘just 5 more minutes’ in the morning kind of kid.
So imagine my surprise all these years later learning through the data collected that my ideal sleeping time is in fact somewhere between 01:00 - 02:00 AM based on when I have the highest quality sleep measured by sleep latency, blood oxygen saturation and heart rate variability. It turns out I sleep particularly well when I sleep at the right time for me. This is not a total endorsement of the product - I have always had my apprehensions about data sharing and privacy in this regard. But I have enjoyed learning the insights.
A lot of important, relevant updates have emerged this fortnight: Updates on the resuming INB negotiations towards the pandemic accord, new research showing that nearly 75% of HIV positive people will also be living with a chronic disease by 2035 and two important updates on the J&J Tuberculosis Bedaquilline saga from India and South Africa. But this fortnight I have decided to really focus in on Mpox.
In addition, I did a mega detective level deep dive on PROJECT 2025, The American Presidential Transition Project in which I broke down ALL the impacts on healthcare, public health and drug regulation. The document is pretty dystopian and literally 902 pages long. So if you’re interested in the tl;dr version, here’s mine: PURE DYSTOPIA: Project 2025’s Impact on Healthcare, Women's Health and Regulation (You can listen to me grow progressively more exasperated as I go along)
This is what I’m listening to; this is a documentary I watched this week (and needed a vpn for) and I’m currently preparing a list of my past months in books that I’ll share with you next fortnight if you’re interested. 🙂
Thanks for reading and for being here, Friend. It means a lot to me.
Warm wishes,
Christiana
This Fortnight’s Episode: Project 2025’s Impact on Healthcare, Women's Health and Regulation
In this fortnight's episode, we explore Project 2025's proposed policies, which could dramatically impact health, women’s health and safety. The plan includes lifetime caps on Medicaid, reducing coverage for millions, and increased out-of-pocket costs for Medicare recipients. It threatens reproductive rights and seeks to curtail the CDC's public health role, potentially weakening responses to health crises. Basically, an anti-epidemic preparedness vision and plan. The changes could result in higher healthcare costs and reduced access to essential services for women and vulnerable populations
Everything you need to know right now about Mpox
Humanity has met yet another moment wherein we need to confront the loss of human life through a public health crisis with echoes of the HIV epidemic decades ago. So what are we going to do? How are we going to deal with it? Unlike the case of HIV, we have known about this virus since 1958 and yet there are no targeted therapeutics for its treatment. The best we have is the smallpox vaccine which was found in the 1980s to confer a good level of resistance and recent studies (1;2) have reasserted its relative efficacy. But there are still no treatments. Moreover, internationally, most people are not vaccinated for smallpox.
Smallpox was declared eradicated in 1977 after almost 30 years of no ‘natural’ outbreaks of the virus. By 1972, vaccination for smallpox had largely ceased, globally. Today, most people born after 1972 have not received a smallpox vaccination. As a result, the smallpox vaccine is being used as prevention for at-risk groups and as post-exposure prophylaxis for people very recently exposed to Mpox without symptoms.
I really wanted to hone in and talk about the Mpox Virus (MPXV) - formerly known as the monkeypox virus. Particularly the new and more severe clade (Economist). Last fortnight I pointed out that 384 people have died in the DRC alone.
New deadlier Clade of Mpox - Clade I
Clade I of the Mpox virus, endemic in the Congo Basin, is known for its higher virulence and mortality rates compared to Clade II. The Democratic Republic of Congo (DRC) has been significantly impacted, with over 11,000 cases reported this year and now 443 deaths, predominantly affecting children. That is a staggering 59 additional deaths from Mpox since we last spoke a fortnight ago, Friend. In the DRC alone.
The new Clade Ib, identified in the densely populated mining town of Kamituga, South Kivu, shows increased transmissibility, particularly through sexual contact, raising concerns about its potential to spread beyond the region
How is Mpox spread and contracted
Mpox is primarily transmitted through direct contact with the bodily fluids or lesions of infected individuals or animals, contaminated materials, or via respiratory droplets during prolonged face-to-face contact.
Animal-to-human transmission occurs through bites or scratches from infected animals or handling infected animal products.
Human-to-human transmission can occur through close physical contact, including sexual contact, making certain populations more vulnerable such as men who have sex with men (MSM) and sex workers.
There is also vertical transmission - pregnant women can pass the virus to the foetus, leading to congenital Mpox.
I recently had an interesting philosophical chat that reminded me of a term that I know but have never had occasion to use. The term is SWERF. It stands for ‘sex worker exclusionary radical feminism’. From a public health perspective, I strongly feel that there is no room for being sex-worker exclusionary neither in our advocacy or in our interventions. Professionals in this field are as entitled to their opinions about sex work, its legality or lack thereof in different contexts, gay communities and men who have sex with men, etc. as any other professionals are. But it is our duty to ensure that the different groups across society, as part of the public, are adequately caught and catered to by our public health interventions. This includes other marginalised groups such as those living in poverty, black people or those in hard to reach regions. I will always advocate for women. And I hope that going forward, as this rapidly spreading virus is addressed, we will not be too polite, too squeamish or too shy to address the incredible and outsized effect that it has on certain patient bases - like sex workers in Africa specifically.
On Friday in the United States, in acknowledgement of the seriousness of Mpox as an endemic disease threat, the county of San Diego announced that they would be offering free vaccination (smallpox vax) against Mpox at the Pride parade. This is a great intervention. And I hope that similar interventions globally will consider female sex-workers too - a very vulnerable demographic for Mpox infection.
Virology and Pathogenesis
Mpox is caused by what was known as the ‘Monkeypox’ virus (MPXV), a member of the Orthopoxvirus genus, which also includes the variola virus (the causative agent of smallpox). MPXV is a large, double-stranded DNA virus with a complex structure. It encodes numerous proteins that modulate host immune responses, contributing to its pathogenicity and ability to evade immune detection. Upon entry into the host, MPXV infects macrophages and dendritic cells, spreading through the lymphatic system and bloodstream. The virus primarily targets the skin, respiratory tract, and lymphoid organs, leading to the characteristic rash and systemic symptoms.
Mpox in Africa
It is worth noting that South Africa is almost 3000 km away from the DRC. This is almost double the distance from London to Moscow. South Africa is also known for diligent and rapid genomic sequencing and disease surveillance.
Mpox has been found in South Africa as I mentioned last fortnight. South Africa remains on high alert as it reports new cases of Mpox: 22 confirmed infections and three deaths since May 2024. The Department of Health continues to urge public vigilance and adherence to preventive measures, including vaccination and contact tracing.
It can only be inferred, therefore, that there are cases of Mpox in other countries within central and Southern Africa that are largely yet unreported. As it is, there is precious little about Mpox in the news by way of updates. And I worry that this virus might follow the path of HIV just a few decades ago. Contact tracing, testing, and reporting is absolutely vital for understanding the gravity of the disease and its transmission.
Cases of Mpox were also found this fortnight to be increasing in the Goma region of DRC. The Goma region, located near the borders of Rwanda and Uganda, is one of the world’s major hubs for economic activity, particularly mining. It is critical to basically all of our technological advancement - almost all of the world’s coltan (used in computers and smartphones) and cobalt is found here among many other natural resources It attracts a large, transient population, including workers from neighbouring countries, which contributes to the region's economic significance. This mobility also facilitates the spread of infectious diseases like Mpox.
Mpox Consortium and efforts of African Scientists
African scientists have been and continue to be at the forefront of Mpox research and response. The establishment of an Mpox Research Consortium (MpoxReC) is a significant step toward consolidating efforts across the continent. The consortium aims to enhance disease surveillance, research capacity, and community engagement to mitigate recurring Mpox epidemics. But this virus is spreading fast and resources need to be mobilised to save human lives.
Mpox represents a growing public health challenge with significant implications for health security. As the world becomes increasingly interconnected, the lessons learned from Mpox outbreaks underscore the importance of preparedness and rapid response to emerging infectious threats. Let’s talk about it, let’s take it seriously.
Community transmission has sadly become a reality. Let’s not wait until it’s too late.
(Some Mpox resources from the past fortnight: South African Dept. of Health, Nature: New push for mpox research funding, GAVI: Meet the African Scientists fighting the spread of Mpox, Reuters: 25 cases in GOMA (I have more - always contactable in response to this e-mail.))
Behind the scenes:
My team played well but Spain played better. Unpacking some lovely bits and pieces. Trying to record in a new space. Celebrating a dear friend becoming a tricenarian. Being happy.
Recent Episodes: In case you missed them! 💃🏾
Recent Episodes: In case you missed them! 💃🏾
Episode 21: Philippines: Twelve Minute Health System Summary
In this mini solo episode, we take a high level look at Philippines' health system. In under twelve minutes, we take an overview of the health system dynamic, payer mechanisms and the fiscal policies the nation has employed to boost health expenditure 6-fold! We delve into the multifaceted nature of the ongoing epidemiological transition from communicable to non-communicable diseases.
Episode 20: The Profitability of Skinny - How Semaglutides made Novo Nordisk Europe's most profitable company
In this episode, we explore the economics of thinness and the phenomenal rise of GLP-1 receptor agonists in the weight loss market. Novo Nordisk, the Danish pharmaceutical company behind Ozempic and Wegovy, has become Europe's most profitable company, surpassing even the luxury giant LVMH. We delve into the social and economic capital associated with thinness, examining how societal attitudes toward body image drive the profitability of weight loss drugs.
Episode 19: Drug Licensing and the Pandemic Accord
In this episode, we look at Colombia's recent move in issuing its first compulsory license. The country challenged ViiV Healthcare's monopoly on their patented drug, dolutegravir, an HIV therapeutic, in an attempt to open doors for affordable generic versions and thus improve accessibility & affordability.
Episode 17: PART 1: Dental Dialogue: Prioritising Oral Health in Public Health (ft. Ema Prohić)
Ema and I discuss oral health as a public health issue. Discussing system challenges, incentivisation and disincentivasation, dental caries as the most common infectious disease, bacteria and the use of antibiotics. We also discuss a public health project that I led back in 2020 with the Ministry of Health Qatar and PHCC wherein she focussed on integrating oral health into a primary care program. Ema is a doctor of dental medicine from Croatia, currently undertaking her specialization in orthodontics and facial orthopedics in Barcelona as well as working in the UK in several dental practices as an NHS and private practitioner.
That’s all, folks! :) Much love,
Christiana