The monkeypox outbreak is an alert on global health inequities

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Source: This post is based on the following articles

What monkeypox alarm tells us about global health inequality” published in The Livemint on 18th Jul 22.

How India can keep the monkeypox threat at bay: Precautionary vaccines for healthcare workers, disease surveillance and communication are essential” published in The Times of India on 17th Jul 22.

Syllabus: GS2 – Issues related to health

Relevance: Monkeypox outbreak and related issues

Context: Despite causing deaths and being regularly reported from endemic African countries, Monkeypox got global attention only when high-income countries got affected.

The total number of suspected cases reported by the Democratic Republic of Congo in 2022 alone are manifold more than any other country affected by the ongoing outbreak.

Unfortunately, this phenomenon is not an isolated story of its kind.

Reasons for global outbreak

This is the first time that such a large number of monkeypox cases have been detected in non-endemic countries.

It could partially be attributed to a) decrease in immunity provided by smallpox vaccination, b) increase in RT-PCR testing post Covid pandemic and c) increased global travel.

One of the other possible reasons could be new mutations in the virus, although preliminary supporting data is weak.

What are the global health inequities?

Disproportionate attention to diseases affecting developed countries: There are a number of diseases in low- and middle-income countries that affect a large proportion of their populations, but get disproportionately less attention from the global community.

This is a challenge recognized as the ‘10/90 gap

– It states that diseases and health problems that constitute roughly 10% of the global disease burden but affect people mostly in rich countries receive 90% of the overall health research attention and funding.

However, health problems that constitute 90% of the world’s burden of disease but affect mainly low- and lower-middle income countries get merely 10% of the attention and funds.

Example: A specific example is a group of about 17 diseases, which include leprosy, Lymphatic filariasis and rabies, collectively called ‘neglected tropical diseases’ or NTDs. These diseases have long been a major health problem in low and low-middle income (LMIC) countries, but have not received sufficient/commensurate attention in health policies and financial allocations for years.

Inequity in the availability of potentially effective therapies and vaccines: A drug used to treat smallpox, Tecovirimat, was approved in the US earlier in 2022 for the treatment of monkeypox. There are three second and third generation smallpox vaccines, a few of which have been approved for use against monkeypox, including most recently MVA-BN, approved in 2019.

However, the US and some countries in Europe have almost exclusive access to Tecovirimat and smallpox vaccines, while these are hardly available in the endemic countries in Africa.

Way forward


Outbreaks and epidemics are going to be the unfortunate reality of the future. The only way to respond is with more, better and stronger global collaboration.


Improving disease detection and surveillance capabilities is of utmost importance. This includes ramping up RT-PCR testing capacity and making testing more accessible.

An important part in this is educating healthcare workers vis-à-vis monkeypox symptoms, testing and treatment.

Using ring vaccination: In this, the vaccine is given to contacts of all suspected or confirmed cases. Smallpox vaccines can be used like this until monkeypox vaccines are readily available for all. Smallpox vaccines are highly effective in prevention and if given early even in treatment of monkeypox disease.

Utilise India’s large vaccine-manufacturing base for making smallpox and monkeypox vaccines available for all.

Public health emergencies can be better tackled with appropriate communication messages. Implementing effective risk communication messages should be made a priority, starting with informing the citizens about how the virus spreads and what they can do to protect themselves.

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