Monkeypox has been spreading globally in recent months with 75 countries reporting cases. However, while the WHO has issued the highest level of alert, this does not mean that monkeypox is highly contagious or necessarily fatal, he says Kerry Bowmanassistant professor in the department of family and community medicine at the Temerty School of Medicine and the School of the Environment at the School of Arts & Sciences. “It doesn’t mean we’re dealing with a situation like COVID-19,” Bowman says. “[But] I think it’s a good decision. It has been in Africa for some time and is now emerging in new parts of the world.” A joint research effort by the university and partner hospitals – including University Health Network, Sunnybrook Research Institute and Unity Health Toronto – is underway to study the global epidemic of monkeypox. The team’s findings will help inform the public health response to the outbreak in Canada and support efforts in other countries where the virus is endemic. U of T News recently spoke with Bowman about the WHO’s designation of monkeypox as a global health emergency, how this may change the international response to the outbreak, and what can be done to address the rise in zoonotic diseases in general. What does the WHO designation mean? This means that we have an alarming disease that is spreading worldwide. There is no question about it. It does not necessarily mean that this is highly contagious or that it is extremely deadly. You may recall that the WHO did this for Zika, which may not have had implications for many of us. So it doesn’t mean we’re dealing with another situation like COVID-19. The WHO was quite divided on whether it was necessary to activate the highest level of alert. But I think it’s a good decision. It has been in Africa for quite some time and is now emerging in new parts of the world. How might the global response to monkeypox change with this new characterization? What it could mean in the future is travel warnings and restrictions. People coming from countries with a high prevalence of monkeypox, which is the United States and parts of the European Union right now, could be subject to higher screening at airports. If a person is unwell and officials suspect it is monkeypox, they could order quarantine or containment. I emphasize the word “could” in this scenario. I hope it will encourage countries like Canada to step up to tackle monkeypox before it really takes hold – to lead the way in vaccinating and providing vaccination. From a public health perspective, it’s important to make sure this can be contained before it becomes something that’s endemic here. What more could be done to reduce the risk of transmission? Access to vaccines and education is huge. At this point, it should be readily available and people should decide for themselves whether they want it or not. The other concern I have is that until very recently our leaders have been opaque about how much vaccine we have, what our vaccine status is, and what our plans are with it. Democracy and public health should never be opaque. You really need to let the public know what we are dealing with. Right now, it is unclear what our vaccine supplies are and whether we have enough for the long term. It’s still a very slow, inconsistent process to get vaccinated. One thing I think we’re ignoring globally is: where do all these horrible diseases come from? Monkeypox, without a doubt, has an environmental and climate change component. It is not the only factor, but it is clearly a contributing factor. We continue to not look at the causes of zoonotic diseases – diseases that come from animals, just like this one. Can you expand on that? There is a connection related to climate change and biodiversity loss that we are simply unaware of. What is happening is that as more and more forests are cut down and climate changes in Africa and other tropical regions, there are more non-human species moving around and being hunted. The interaction between animals and humans is increasing as there is both environmental degradation and habitat loss. We are opening up more areas of what was once virgin forest and exposing people to these viruses. The number of zoonotic diseases that are increasing is significant. How can we deal with this? In the early days of the COVID-19 pandemic, we had some awareness of this – but almost nothing is being done to prevent more of these diseases from occurring. It’s a real shortcoming of Western medicine that we have these firewalls where we don’t get through anything environmental. It’s the way we organized ourselves – our choice. We need much more of a ‘One Health’ approach. One Health and planetary health is something that looks at how all these systems – human, non-human and biodiversity – work together. In national and global planning, we should consider the consequences of massive deforestation in equatorial regions. We should also look at the health and well-being of ecosystems in Canada and the health of animals. For human health to flourish, we must look through the lens of our environmental parameters.
