An uncertain threat

The World Health Organisation (WHO) declared the global monkeypox outbreak a Public Health Emergency of International Concern (PHEIC) — a step preceding the declaration of any outbreak as a pandemic. Theoretically, the world may be standing at the cusp of another pandemic, even as COVID-19 pandemic has not receded completely. Monkeypox has been a known phenomenon for over decades but its spread was largely limited to a select African region. The year 2022, however, stands out as an exception as it witnessed widespread detection of cases in countries that had never reported such a thing in the past. Against this background, the declaration of monkeypox as PHIEC is not at all surprising, and is indeed a rational move. As the WHO puts it, PHEIC is an extraordinary event, which constitutes a "public health risk to other States through the international spread" and requires a "coordinated international response" in tackling. In a span of around three months from May, monkeypox has spread its tentacles from 47 countries to over 70 countries across six WHO regions, with the threat particularly being more pronounced in Europe and America. Even countries in the Asian continent — including India — have reported multiple cases. Until now, the Indian state of Kerala has reported three cases in a span of two weeks. Several national and state-level authorities have issued their guidelines for keeping the situation in control. What is required further is a coordinated international response and cogency in Intra-country responses. The COVID-19 pandemic had brought with it extraordinary chaos and panic; the same needs to be avoided in the case of monkeypox. The fallouts of the delay in recognising and taking the threat of COVID-19 seriously in the early months of 2020 may not be forgotten for decades and a century to come. Monkeypox virus is comparatively less transmissible than the coronavirus. The real cause of concern however is the vast grey area that its global outbreak has left behind it. Three months after the cases started picking up in May, many aspects of the virus remain in the realm of the unknown. Though the genesis of monkeypox virus is originally traced to zoonotic spillover from the rodents of Amazon Forest in Africa, its abrupt spread globally is inexplicable yet. Its transmission is known to take place through physical contact, air droplets and through clothing materials but why it is spreading particularly among homosexual men is still answered through theories and speculation, and not concrete findings. As long as these questions are unanswered, threats will keep looming large across the globe. Our fight against the Covid-19 pandemic grew stronger only when scientists and virologists started coming up with answers. For monkeypox — which is just one step away from being declared as a pandemic — answers are still lacking. In such a circumstance, the most prudent thing will be to make optimum use of the information we have at hand. At the same time, there is a pressing need to rule out any scope of misinformation which feeds on uncertainty, anxiety and fear. Based on the limited information we have, various agencies have come up with guidelines that need to be followed strictly. The WHO guidelines direct countries to step up surveillance, spread awareness on the pandemic, and ensure that at-risk groups aren't stigmatised. Additionally, the Union Health Ministry has also issued guidelines, mostly for international passengers, to avert the possible spread of the virus. Meanwhile, the Kerala government has also come up with a detailed SOP to deal with the issue. Apart from the guidelines, the Indian Council of Medical Research (ICMR) has trained 15 research and diagnostic laboratories across the country for early detection of the virus. It is very important that instructions at all levels — state, national and international — are coherent. People should also exercise extreme caution by following the guidelines strictly. It needs to be understood that the definition of basic hygiene has evolved over time, and its importance is greater today than ever before.