Surge of Mpox: What is India Doing While History Repeats Itself | Gouri Sankar Nag

The emergence of new health epidemics, particularly in the context of the COVID-19 pandemic and subsequent outbreaks such as Monkeypox, reflects a continuous spectre of Non-traditional Security threats with the complex interplay of factors that distinguish these phenomena from historical epidemics.

First, the rapid spread of COVID-19 is largely attributed to unprecedented levels of global travel and trade due to closer integration of the world economy [1]. The more the degree of interconnectedness of the world the more likelihood of the spread of pathogens across borders. Today this reality is unavoidable, hence the risk is enhanced. Unlike past epidemics, which were often localized due to geographic barriers, modern transportation allows for the swift movement of people across continents, facilitating transmission of the virus.

Second, the response to COVID-19 created a humongous war-like emergency that involved coordinated efforts at local, national, and international levels, including widespread testing, contact tracing, and vaccination campaigns that utilized mRNA technology [2] —an innovation not seen in previous epidemics.
Third, the pandemic exposed existing health disparities exacerbated by socioeconomic factors. Vulnerable populations in the less-developed countries faced higher risks due to limited access to healthcare resources and often depended on humanitarian assistance from either advanced countries or the WHO.

Now when we witness an uptick in cases of Monkeypox, a pertinent question arises, that is how far India is battle-ready to cope with the eventuality of the impending crisis. India under Modi proclaims herself as “Viswaguru†but the status can be confirmed by concrete action. According to a government source, P K Mishra, principal secretary to the prime minister, convened a high-level meeting recently to assess the country’s preparedness for Mpox. According to the current assessment, the risk of a large outbreak with sustained transmission is low [3]. But can we be complacent? It is because there exists key differences between Monkeypox and historical epidemics:

First, while Monkeypox is primarily transmitted through close contact with infected individuals or animals (zoonotic transmission), its recent spread among networks linked to sexual activity indicates evolving patterns that differ from traditional modes seen in past outbreaks like smallpox or measles.

Second, unlike COVID-19 where no prior immunity existed before the outbreak began, many individuals have some level of immunity against smallpox due to historical vaccination programmes; however, this immunity does not fully protect against Mpox.

Third, the COVID-19 pandemic heightened our awareness and also led to quicker public health responses. However, due to a lack of experience as well as cautious and sensitive planning, it caused tremendous hardship when the nationwide lockdown in India was announced on short notice. The question is why are we still biding time or feeling complacent. Earlier we ran with limited capabilities but now why are not we alert enough to act proactively to make use of advancements in disease surveillance technologies for faster identification and tracking of outbreaks at different entry points such as border-check posts, and airports of course with Standard Operating Procedure. Simultaneously we also need to develop potential vaccines or treatments tailored for Indian demographics.

Besides there are so many dos and time is so short because we can’t ignore the aspect of collaboration with the WHO that has declared Mpox a public health emergency, with over 99,000 cases recorded since 2022. The World Health Organization (WHO) labelled Mpox a Public Health Emergency of International Concern (PHEIC) on August 14, 2024. According to a news release by the WHO, its Director-General Dr Tedros Adhanom Ghebreyesus has determined that the upsurge of mpox in the Democratic Republic of the Congo (DRC) and a growing number of countries in and around central sub-Saharan Africa constitutes a public health emergency of international concern (PHEIC) under the International Health Regulations (2005) (IHR). [4] Dr Tedros was emphatic in affirming that “It is time to act decisively to prevent history from repeating itself.â€

Currently, India must keep a vigil on the situation and its Diasporas in African states where the rapid spread of a new virus strain of Mpox—clade 1b was suspected to be spreading mainly through sexual networks, and its detection in countries neighbouring the DRC like Burundi, Kenya, Rwanda and Uganda. Already to scale up preparatory measures WHO has urged Emergency Use Listing to enable partners including Gavi and UNICEF to procure vaccines for distribution.

Such health advisories from WHO are of crucial importance for countries like India because already in India, a total of 30 cases have been detected since 2022 with the most recent case reported in March 2024. [5] Many Asian countries from Pakistan to Indonesia have either called for heightened monitoring and protective measures or introduced stringent health screening protocols for foreign visitors and travellers.

In fact, it is not enough that we make contact tracing or simply make provision for health checkups for suspected symptoms and necessary admission to isolation wards in hospitals. Those exposed to Mpox may need to quarantine according to local regulations which means local governments in the states should be alerted. It is also advisable to consider medical evacuation insurance and even economic packages as victims may be from poor households with their families having only a few earning members. The government should consider legal changes to make healthcare providers accountable for the onus of testing and treatment.

Finally, what we need in the current age of Infodemic, is to combat the spread of fake but plausible narratives that certain epidemics may be deliberately spread by revisionist powers to disrupt liberal democratic orders or challenge Western hegemony. It may be deliberate propaganda to complicate the international response mechanism because there is currently no conclusive evidence supporting claims that specific powers are deliberately creating or spreading epidemics with malicious intent against liberal democracies. On the contrary, such narratives intend to make some states as villain while what is needed is collective volition in sharing information, updating data database to capture the newer developments and follow best practices in managing outbreaks.

(Author: Gouri Sankar Nag, Professor, Department of Political Science,, Sidho-Kanho-Birsha University, West Bengal, India)