Monkeypox remains – along with COVID-19 and polio – one of three global health emergencies identified by the World Health Organisation (WHO).
The WHO declared monkeypox a global health emergency on 23 July after the rapid spread in cases in countries outside of central and west Africa that had never seen the disease before.
From May until late July, more than 16,000 cases were reported across 75 countries.
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Australia also designated monkeypox a national emergency – a “Communicable Disease Incident of National Significance” – to coordinate the monkeypox vaccine rollout and health service provision.
What is the case load in Australia and globally?
Since 1 June, monkeypox – also known as MPX – has been a notifiable disease, requiring mandatory notification under the National Notifiable Diseases Surveillance System.
Of the 140 recorded cases of MPX in Australia, 69 were in Victoria, 54 in NSW, 7 in Western Australia, 5 in Queensland, 3 in the Australian Capital Territory, and 2 in South Australia.
Globally, there are in excess of 73,400 lab confirmed case across 109 countries as of 19 October, . The global case numbers recorded by the US CDC stand at . The death toll is 29.
Cases globally and in Australia hit their peak in July and have since trailed off, but health advocates say the next challenge is the next phase of the vaccine rollout.
A shipment of 78,000 vaccine vials is due in Australia in a fortnight.
The first phase of Australia’s vaccine rollout started in August.
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Caleb Hawk from the Thorne Harbour Health (formerly the Victorian AIDS Council) clinic said it is pleasing to see cases appear to plateau.
But he said work is already underway to prepare for the increased risk of outbreaks with the summer festival season, Christmas and Sydney WorldPride in February next year.
“I don’t think we’re out of the woods yet. We still need to see the rollout of second doses. We’re coming out of winter. And as we go into the festival season, we could see an increase in cases.”
The clinic has administered 5,700 vaccine doses since late August.
Mr Hawk said that has been due to the trust and rapport built between the clinic’s volunteers and patients.
“We actually had volunteers step up in a massive way to help create a hotline and system so we could send out alerts.
“If people go to our website and our monkeypox page, you can register your name and an expression of interest. And then we would send out an SMS to people on that list.”
What progress has been made with the vaccine rollout?
As of 27 October, close to 29,000 (28,227) vaccine doses have been voluntarily reported to the Australian Immunisation Register.
This includes 4,479 Australians who have received two doses.
The Australian Federation of AIDS Organisations (AFAO) said the rollout so far has been a success story and that has been due to the trust and rapport established between sexual health centres and the target group – gay or bisexual men.
The majority – 98 per cent of the cases – recorded globally have been among men who have sex with men.
Heath Paynter, the deputy CEO of AFAO, said health advocates were very aware of the need to avoid stigmatising the community or the disease, which could prevent people seeking help.
“The challenge we had was to avoid the virus being framed as a gay disease – because it is not. Anyone can get monkeypox, ” he said.
“It is just that the current transmission dynamics means that the virus is being transmitted through interconnected networks of gay and bisexual men. We have been able to meet that challenge – and do it successfully.”
He said the increased health literacy of the target population has meant there have been no reports of vaccine wastage or vaccine hesitancy.
“People living with HIV take treatment every day. And many gay men take a pill once a day to prevent HIV infection – known as HIV PrEP. So this is the same demographic.
“We expected the community to take that same level of trust that they have in HIV treatments and apply it to the new threat of monkeypox. And the community has done that.
“We have not seen any evidence or heard any anecdotes of vaccine hesitancy. And we have not heard of any dials or doses going to waste.”
Another delivery of 350,000 vaccine doses is due to arrive in Australia early next year.
Vincent Cornelius is clinical adviser for ASHM, the peak body of health professionals in Australia and New Zealand who work with patients with human immunodeficiency virus (HIV) or sexually transmissible infections.
He said new efficiencies have been achieved in how the vaccine is delivered – into the outer layers of the skin – which means five people, instead of one person, can now receive a dose from a single vaccine vial.
“We’re very keen to try to ensure that we start vaccinating people as early as possible, so that there’s enough time for them to generate immunity and be protected,” he said.
“With five times as many people now able to receive doses – that should be sufficient to adequately cover the community in terms of providing sufficient immunogenicity.”
A spokesperson for the federal health department said forward planning by the new government resulted in Australia securing a supply of the much sought after JYNNEOS vaccine.
“Australia is one of a limited number of countries to secure supplies of this vaccine in 2022 and in doing so, is ensuring the increased safety of vulnerable communities who may be exposed to monkeypox.”
Only two doses of the MPX vaccine – spaced at least 28 days apart – are needed to give lifelong protection from the virus.
The expert panel on vaccines, ATAGI, the new method of administering the vaccine in August.
Vaccination bookings for those eligible can be made in these locations across , , and .
Have we nipped the spread of the disease in the bud?
HIV prevention health service ACON in NSW is working on a national health campaign to encourage more people to get the vaccine once more supply becomes available.
Mr Paynter said there will be an acceleration of the rollout to reach targets by Christmas.
Vincent Cornelius said the rapid spread of the disease from May to July shows vaccine equity needs to be addressed to avoid future outbreaks.
“I think it was a very much a missed opportunity in global health,” he said of the initial response to the disease’s spread outside of Africa.
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“Monkeypox infections have been circulating in central and western Africa for quite some years now, despite the fact that we have an effective vaccine.
“This really goes to illustrate that infectious diseases are not a local issue, infectious diseases are a global issue.
“And as a global health sector, we really need to make sure that we assist all countries, regardless of their levels of resourcing, in addressing infectious diseases, because otherwise it will just come to bite us.”
Mr Hawk from Thorne Harbour Health said he remains “cautiously optimistic” that the early success of the monkeypox vaccine rollout can be maintained and accelerated.
“We’ve had a really amazing initial response with regard to vaccination uptake. I think we just need to follow through and make sure that we continue to see those cases plateau. And as soon as those numbers go down overseas, the risk to us [in Australia] will be lower as well.”
