The threat of Monkeypox in the Philippines: another problematic preparation and management for the healthcare system?

Abstract

The Philippines is still in a tight battle with the coronavirus disease 2019 pandemic since many cases are detected daily. With the continuous spread of another disease worldwide—monkeypox, many Filipinos are alarmed if the country’s healthcare system is prepared enough, especially with the detection of its first case. Learning from the unfortunate experiences of the country during the current pandemic is essential in facing another health crisis. With this, recommendations for a robust healthcare system are proposed centered on: a massive digital information campaign about the disease; training healthcare workers to raise awareness about the virus and its transmission, management, and treatment; an intensified surveillance and detection procedure to monitor cases and execute contact tracing properly; and a persistent procurement of vaccines and drugs for treatment, with a well-designed vaccination program.

On January 30, 2020, the Philippine government’s Department of Health confirmed that a 38-year-old female Chinese patient under investigation tested positive for the novel coronavirus (2019-nCoV) after her laboratory results arrived from the Victorian Infectious Disease Reference Laboratory in Melbourne, Australia. The confirmed case came to the Philippines from Wuhan, China, via Hong Kong last January 21, 2020 [1]. After over a month, there were already 633 suspected coronavirus disease 2019 (COVID-19) cases. After more than 2 years, the total cases climbed to 3,799,334 as of 2022, August 6, and 60,789 deaths [2]. Like other developing countries in Southeast Asia, the Philippines’ healthcare system was unprepared. The first vaccine brand just arrived in the country almost after a year, on March 2021, with the initial 600,000 doses of Sinovac-made “CoronaVac” vaccine donated by China and then followed by more than 480,000 doses of AstraZeneca vaccines from the COVID-19 Vaccines Global Access or COVAX Facility, the international partnership established to ensure equitable distribution of COVID-19 vaccines around the world. Many believed the high casualties would have been avoided if the country’s healthcare system had enough preparation and proper management.

It is important to note that the government’s response to the pandemic is tainted by incompetence and corruption. The full story of the Philippine response to COVID-19 remains to be told, but the incompetence, impunity, and sufferance of integrity will surely be a central part [3]. In addition, the government relied heavily on “draconian” measures where the police and the military were given supreme power to ensure that order was maintained and that all health protocols were followed [4]. Others called the response “medical populism,” characterized by ignoring scientific advice, proffering denials, and blaming others [5]. Some perceived this as an exaggeration, unnecessary, and ineffective. The country’s COVID-19 pandemic is far from over since herd immunity is not yet achieved, and there are still 37,344 active cases. While the good news is that 72,054,011 have been fully vaccinated (66.4%) [6], another global health concern entered the country that has alarmed many since the cases are gradually increasing worldwide—monkeypox.

Monkeypox is an illness caused by the monkeypox virus. It is a zoonotic viral infection that can spread from animals to humans. It can also spread from person to person. The World Health Organization (WHO) declared on 23 July 2022 that the multi-country outbreak of monkeypox is a public health emergency of international concern (PHEIC), which means it constitutes the highest level of global public health alert under the International Health Regulations and can enhance coordination, cooperation, and global solidarity. Fortunately, a vaccine was recently approved for preventing monkeypox. Some countries are recommending vaccination for persons at risk. Many years of research have led to the development of newer and safer vaccines for an eradicated disease called smallpox, which may also be helpful for monkeypox. For its treatment, an antiviral drug called tecovirimat was approved in January 2022 by the European Medicines Agency.

However, the experience with these therapeutics in an outbreak of monkeypox is limited [7]. Investigation of recent monkeypox cases in non-endemic countries indicates potential transmission through sexual contact. It spreads mostly through intimate sexual contact with those who have rashes or open lesions. Even if it is not like COVID-19, which spreads mostly through the air and the symptoms are mild, and the disease is rarely fatal [8], it is still a PHEIC that can affect everyone’s health and livelihood. The first case of monkeypox in the country was detected in a 31-year-old Filipino national who arrived from abroad last 19 July 2022. The patient had previous travel to several European countries with documented monkeypox cases. It is rapidly spreading worldwide, and as of 22 December 2022, there have been 83,424 confirmed cases and 72 deaths worldwide [9]. This worldwide spreading of monkeypox can increase the risk of new cases in the country, given that the Philippines is now open to all international tourists and those citizens who planned to come home after their work overseas. In the latest statistics as of 14 November 2022, the country’s Department of Tourism reported that a total of 2,025,421 visitors arrived and of this number, the majority (73.43%) are foreign tourists, while 538,078 or 26.57% are overseas Filipinos [10]. This data includes those countries where there are many cases of monkeypox. Currently, there were already four reported monkeypox cases in the country. The first three cases have all traveled to countries with documented confirmed cases of monkeypox. The most intriguing case is the fourth one where the patient has no documented history of travel to where there is a monkeypox outbreak. This shows that local transmission has possibly taken place. It is important to note that monkeypox is transmitted to humans through close contact with an infected person or animal, or with material contaminated with the virus. Due to the easing and lifting of COVID-19 restrictions, mass gatherings and other public events are now allowed which can pave way for the transmission of the monkeypox virus in any possible way.

And so, what should be done to battle the possible increased cases of monkeypox in the country? First, since the disease is unknown to Filipinos, the government should prepare a massive information campaign about it. Setting up the official health website or digital information system is important, and it should contain updated data and other essential information regarding the disease. All forms of traditional media like radio, television, newspapers, and various social media platforms must be utilized extensively and responsibly for this campaign. It is important to remember that the country is affected by fake and malicious news cases during the COVID-19 outbreak. This is where close monitoring can play a vital role. If the government cannot make this possible, it can collaborate with private sectors and organizations for a successful campaign. Second, the government and private sectors must prioritize training healthcare workers, such as doctors and nurses, to raise awareness about the virus and its transmission, management, and treatment. Added to this professional enhancement move is checking whether their rights and privileges are appropriately given to avoid another round of massive protests and resignation from the “modern heroes.” Third, there must be an intensified surveillance and detection procedure to monitor cases carefully and execute contact tracing properly. With this, highly-efficient test kits for screening must be used to detect new cases. Also, implementing community-based human quarantine protocols must be anticipated if necessary. Since monkeypox is a zoonotic disease that can spread between animals and people, the quarantine should also include companion/domestic animals. Clinical and epidemiological studies concerning companion animals’ potential role in disease transmission will hopefully be undertaken since it has previously been overlooked [11]. Lastly, the best way to avoid transmission is to vaccinate people at risk who may have been exposed to monkeypox. Since the country does not have available vaccines yet, the government must be very persistent in purchasing the vaccine from abroad. And after securing the vaccines, there must be a well-designed and just vaccination program to avoid health inequalities. It must also double its initiative to ensure that the country will have the available treatment as soon as possible, such as the drugs developed for smallpox as approved by the WHO. A robust healthcare system is characterized by proper collaboration among the government, private sectors, and the public. If every institution in the Philippines does its unselfish role in achieving this noble goal, then there is no reason why COVID-19, monkeypox, or any health crisis can be overcome.