As health authorities in Europe and elsewhere roll out vaccines and drugs to stamp out the biggest monkeypox outbreak beyond Africa, some doctors acknowledge an ugly reality: The resources to slow the disease’s spread have long been available, just not to the Africans who have dealt with it for decades.

Countries including Britain, Spain, Portugal, Italy, Switzerland, the United States, Israel and Australia have reported more than 500 monkeypox cases, many apparently tied to sexual activity at two recent raves in Europe. No deaths have been reported.

Authorities in numerous European countries and the U.S. are offering to immunize people and considering the use of antivirals. On Thursday, the World Health Organization will convene a special meeting to discuss monkeypox research priorities and related issues.

Meanwhile, the African continent has reported about three times as many cases this year.

There have been more than 1,400 monkeypox cases and 63 deaths in four countries where the disease is endemic — Cameroon, Central African Republic, Congo and Nigeria — according to the Africa Centers for Disease Control and Prevention. So far, sequencing has not yet shown any direct link to the outbreak outside Africa, health officials say.

Monkeypox is in the same family of viruses as smallpox, and smallpox vaccines are estimated to be about 85% effective against monkeypox, according to WHO.

Since identifying cases earlier this month, Britain has vaccinated more than 1,000 people at risk of contracting the virus and bought 20,000 more doses. European Union officials are in talks to buy more smallpox vaccine from Bavarian Nordic, the maker of the only such vaccine licensed in Europe.

U.S. government officials have released about 700 doses of vaccine to states where cases were reported.

Such measures aren’t routinely employed in Africa.

Dr. Adesola Yinka-Ogunleye, who leads Nigeria’s monkeypox working group, said there are currently no vaccines or antivirals being used against monkeypox in her country. People suspected of having monkeypox are isolated and treated conservatively, while their contacts are monitored, she said.

Generally, Africa has only had “small stockpiles” of smallpox vaccine to offer health workers when monkeypox outbreaks happen, said Ahmed Ogwell, acting director of the Africa CDC.

Limited vaccine supply and competing health priorities have meant that immunization against monkeypox hasn’t been widely pursued in Africa, said Dr. Jimmy Whitworth, a professor of international public health at the London School of Hygiene and Tropical Medicine.

“It’s a bit uncomfortable that we have a different attitude to the kinds of resources we deploy depending on where cases are,” he said. “It exposes a moral failing when those interventions aren’t available for the millions of people in Africa who need them.”

WHO has 31 million doses of smallpox vaccines, mostly kept in donor countries and intended as a rapid response to any re-emergence of the disease, which was declared eradicated in 1980.

Doses from the U.N. health agency’s stockpile have never been released for any monkeypox outbreaks in central or western Africa.

Dr. Mike Ryan, WHO’s emergencies chief, said the agency was considering allowing rich countries to use the smallpox vaccines to try to limit the spread of monkeypox. WHO manages similar mechanisms to help poor countries get vaccines for diseases like yellow fever and meningitis, but such efforts have not been previously used for countries that can otherwise afford shots.

Oyewale Tomori, a Nigerian virologist who sits on several WHO advisory boards, said releasing smallpox vaccines from the agency’s stockpile to stop monkeypox from becoming endemic in richer countries might be warranted, but he noted a discrepancy in WHO’s strategy.

“A similar approach should have been adopted a long time ago to deal with the situation in Africa,” he said. “This is another example of where some countries are more equal than others.”

Some doctors pointed out that stalled efforts to understand monkeypox were now complicating efforts to treat patients. Most people experience symptoms including fever, chills and fatigue. But those with more serious disease often develop a rash on their face or hands that spreads elsewhere.

Dr. Hugh Adler and colleagues recently published a paper suggesting the antiviral drug tecovirimat could help fight monkeypox. The drug, approved in the U.S. to treat smallpox, was used in seven people infected with monkeypox in the U.K. from 2018 to 2021, but more details are needed for regulatory approval.

“If we had thought about getting this data before, we wouldn’t be in this situation now where we have a potential treatment without enough evidence,” said Adler, a research fellow at the Liverpool School of Tropical Medicine.

Many diseases only attracted significant money after infecting people from rich countries, he noted.

For example, it was only after the catastrophic Ebola outbreak in West Africa in 2014-2016 — when several Americans were sickened by the disease among the more than 28,000 cases in Africa — that authorities finally sped up the research and protocols to license an Ebola vaccine, capping a decades-long effort.

At a press briefing on Wednesday, WHO’s Ryan said the agency was worried about the continued spread of monkeypox in rich countries and was evaluating how it could help stem the disease’s transmission there.

“I certainly didn’t hear that same level of concern over the last five or 10 years,” he said, referring to the repeated epidemics of monkeypox in Africa, when thousands of people in the continent’s central and western parts were sickened by the disease.

Jay Chudi, a development expert who lives in the Nigerian state of Enugu, which has reported monkeypox cases since 2017, hopes the increased attention might finally help address the problem. But he nevertheless lamented that it took infections in rich countries for it to seem possible.

“You would think the new cases are deadlier and more dangerous than what we have in Africa,” he said. “We are now seeing it can end once and for all, but because it is no longer just in Africa. It’s now everybody is worried.”
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In the spring of 2020, as COVID-19 spread throughout the world in ways not fully understood, the United States faced a critical shortage of protective masks. 

Dozens of manufacturing startups attempted to meet the demand for what was then a confusing array of grades and types — N95, KN95, full-face respirators.  

Now, after a short respite from many COVID-19 precautions, the U.S. is weeks into a new surge in cases that may foreshadow a greater one this fall, and those same small companies that make masks are hurting.  

John Bielamowicz is a co-founder of United States Mask. The Fort Worth, Texas, company is among those struggling.  

Bielamowicz launched his mask-making mission after reading social media posts about medical professionals not having N95 masks in the pandemic’s terrifying early months. It was caregivers like them who had helped his family in 2016, when his son Matthew was born missing 80% of his diaphragm on the left side. 

Bielamowicz and his business partner ​David Baillargeon put their commercial real estate business on hold to start the mask company. 

“This was our way of paying it back … for the gift that they gave us for sending us home with our son,” Bielamowicz told VOA Mandarin in a virtual interview. “It was a debt that I never thought that I’d be able to pay back.” 

The partners began reading and experimenting in February 2020, and by late October of that year, their N95 masks carried a National Institute for Occupational Safety and Health certification. At its peak in early 2021, the company produced millions of N95 masks a month and employed close to 50 people. 

“For me and my family, this was a mission, and we were going to do it or fail trying,” Bielamowicz said. “And we didn’t fail. We did it.”  

Masks and jobs

The American Mask Manufacturers Association (AMMA) represents small companies that started making masks during the pandemic.  

“During the pandemic, we created just over 8,000 new manufacturing jobs. And this was at a time where most businesses were laying people off or furloughing people,” Lloyd Armbrust, president of the association, told VOA in a virtual interview.  

But attitudes toward mask wearing have varied widely across the U.S. since 2020, and on April 18, a federal judge in Florida voided the national mask mandate covering airplanes and other public transportation. This came a day before the Biden administration said it would no longer enforce a U.S. mask mandate.  

Armbrust American, Armbrust’s mask company in Pflugerville, Texas, staggered from the twin blows.  

“That day, we saw our online sales be cut at half or even more,” said Armbrust, who added that he and other mask-makers had already been competing with cheap masks from China before the one-two punch.  

China and masks 

According to research published last year by the Peterson Institute for International Economics, a Washington-based think tank, 72% of the masks and respirators imported by the U.S. in 2019 came from China. 

When the coronavirus that causes COVID-19 was first identified in humans in Wuhan, China, in late 2019, U.S. imports of protective masks from China plunged. 

When China resumed exporting government-subsidized masks in 2020, it attempted to create “a monopoly within the PPE (personal protective equipment) market,” the AMMA charged, and manufacturers such as Armbrust American found themselves in difficulty. 

“Our raw material costs me about $0.015 per mask,” Armbrust said. “And yet China can deliver it to the United States for less than $0.01. They say that they’re more efficient, but how is that possible when the cost of their finished products is cheaper than I buy the raw materials for? It’s just not possible. The answer is, the Chinese government is subsidizing it because they don’t want to lose this business.”  

In response to VOA Mandarin questions about China’s mask exports to the U.S., Liu Pengyu, the spokesman for the Chinese embassy in Washington, said, “I would like to point out that as a market economy, China has earnestly fulfilled its WTO (World Trade Organization) commitments and abides by multilateral economic and trade rules. Chinese merchandise is cheap and good because of the good supply chain, sufficient competition and economies of scale, not non-market behavior.” 

“I can be very competitive, but I can’t be competitive against the whole government. … In 2021, we laid off about 70% of our staff,” Armbrust said. 

Bielamowicz’s United States Mask laid off people as well. 

“It was the worst day of my career,” he said.   

An uncertain future 

Nationwide, the AMMA, which peaked with almost 30 members in 2021, now includes fewer than 10 enterprises still producing masks. 

Facing masks’ uncertain future, Armbrust American shifted to producing home air filters. 

Bielamowicz has been traveling to Washington to lobby the federal government. 

“We’re asking for free competition,” Bielamowicz said. “We know the free market works.” 

That said, Armbrust hopes the government can subsidize small companies that make masks, as it does farmers, to preserve production capability so that when the next pandemic hits, small producers can jump back into mask making. 

“If I could just have a base,” Armbrust said, “… where I could mothball these machines and … I could afford to pay the rent for the space instead of actually shutting it down and scrapping the machines, that would be another solution.”  
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