KINSHASA, Congo - Scientists are warning that discrimination against gay and bisexual men in Africa could exacerbate the ongoing monkeypox outbreak in Congo. The World Health Organization (WHO) reported in November that monkeypox, also known as mpox, was being transmitted through sexual contact in Congo, a significant departure from previous flare-ups that primarily affected individuals in contact with infected animals.

While mpox has been present in parts of central and west Africa for decades, it was not until 2022 that the virus was documented to spread through sex. Disturbingly, the majority of the approximately 91,000 people infected worldwide that year were gay or bisexual men.

In Africa, the reluctance to report symptoms could drive the outbreak underground, according to Dimie Ogoina, an infectious diseases specialist at the Niger Delta University in Nigeria. The World Health Organization identified the first sexually transmitted cases of the more severe form of mpox in Congo last spring after a Belgian resident, who identified as a man with sexual relations with other men, arrived in Kinshasa, the Congolese capital. Subsequently, five other individuals who had sexual contact with this man became infected with mpox.

Ogoina emphasizes that sexual transmission of mpox in Africa has been underestimated for years. However, the lack of monitoring makes it challenging to estimate how many mpox cases are linked to sex. Nonetheless, it is noteworthy that most cases in Nigeria involve individuals with no known contact with animals.

In Congo, there have been approximately 13,350 suspected cases of mpox, with 607 deaths reported by the end of November. However, only about 10% of these cases have been confirmed by laboratories, and determining the proportion of infections transmitted through sex remains unclear. According to WHO, around 70% of cases in Congo are reported in children under the age of 15.

During a recent assessment trip by WHO officials to Congo, it was discovered that there was "no awareness" among health workers about the sexual transmission of mpox, leading to missed cases. The organization confirmed sexual transmission of mpox between male partners, as well as through heterosexual transmission, in various parts of the country.

Mpox typically presents symptoms such as fever, skin rash, lesions, and muscle soreness for up to a month. It is primarily spread through close contact, and most individuals recover without requiring medical treatment.

During the major international outbreak in 2022, countries like Canada, Britain, and the U.S. implemented mass vaccination programs targeting gay and bisexual men, who were deemed to be at the highest risk of mpox infection. However, experts believe that replicating such efforts in Africa would be challenging due to reasons including the stigma faced by gay communities.

Dr. Boghuma Titanji, an assistant professor of medicine in infectious diseases at Emory University School of Medicine in Atlanta, predicts that gay and bisexual men, who are most vulnerable to mpox, might hesitate to come forward in a broad immunization program. Dr. Titanji suggests that countries should find ways to provide vaccinations to this population without stigmatizing them.

Congo's National Institute of Biomedical Research has reported clusters of mpox cases linked to sexual transmission in two provinces, a concerning development. However, obtaining enough vaccines for a large-scale program in Congo is challenging due to the lack of licensed vaccines and regulatory issues surrounding the procurement of the Japanese mpox vaccine.

Globally, only one mpox vaccine, manufactured by Denmark's Bavarian Nordic, has been authorized. However, supplies are extremely limited, and their availability would require approval from African countries or WHO. Currently, the vaccine has only been accessible in Congo for research purposes.

Oyewale Tomori, a Nigerian virus expert, suggests that African governments have competing priorities, making it unlikely for them to seek assistance from WHO or donors to secure vaccines. Tomori believes that enhancing monitoring, laboratory networks, and diagnostic supplies would be more beneficial to the continent than vaccines.

Without greater efforts to control mpox outbreaks in Africa, Ogoina warns that the disease may continue to spread to new populations and potentially trigger outbreaks in other countries, resembling the global emergency declared by WHO in the past year. He draws a parallel to the HIV pandemic, which initially affected gay and bisexual men in the global North before spreading to Africa.

Ogoina concludes, "Unless we address these outbreaks in Africa, this virus will keep coming back", highlighting the urgent need to focus on combating the mpox outbreak on the African continent.