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COVID – 19 and Monkeypox : Why we need agile leadership
THE COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus was first identified in December 2019 in Wuhan, China.
Since the first reported case in mainland China , there have been 600 million COVID 19 cases and 6.5 million people have died so far from the coronavirus COVID-19 outbreak as of August 25, 2022.
On January 30, 2020 , WHO Director General Tedros Adhanom Ghebreyesus declared that the COVID-19 outbreak constitutes a Public Health Emergency of International Concern (PHEIC). A PHEIC is the highest level of alert that the UN health body can give and has been previously attributed to COVID -19, polio, the 2014 outbreak of Ebola, and the spread of the Zika virus in 2016.
After 2 1/2 years, the World Health Organization on July 24 has declared the zoonotic disease the monkeypox, a global outbreak, a public health emergency of international concern (PHEIC) as public health measures taken fail to stem the disease’s spread.
Global health experts are now hoping that the decision will spark a more coordinated international response, further research into the disease, and the ramping up of vaccine production.
More than 40,000 confirmed cases of monkeypox – including a handful of deaths – in over 80 countries where the virus is not endemic have been reported since early May.
Over 35% of the current global case count is in the United States, while the UK has over 3,000 confirmed cases.
According to the World Health Organization (WHO ) , the clinical presentation of monkeypox resembles that of smallpox, a related orthopoxvirus infection which has been eradicated. Smallpox was more easily transmitted and more often fatal as about 30% of patients died.
The last case of naturally acquired smallpox occurred in 1977, and in 1980 smallpox was declared to have been eradicated worldwide after a global campaign of vaccination and containment. It has been 40 or more years since all countries ceased routine smallpox vaccination with vaccinia-based vaccines. As vaccination also protected against monkeypox in west and central Africa, unvaccinated populations are now also more susceptible to monkeypox virus infection.
Monkeypox has been endemic in West Africa for decades, where the illness is usually spread to people by infected wild animals. Until 2022 infections reported in Europe and North America were usually isolated cases linked to travel from Africa or animal trafficking.
This year the monkeypox virus, which is closely related to smallpox and produces similar symptoms, has spread to many countries which had never before reported cases and where the disease is now sustaining itself through human-to-human transmission.
According to the WHO , 98% of infections have been reported in men who have sex with men (MSM) and especially in those with multiple sexual partners. That means that this is an outbreak that can be stopped with the right strategies in the right groups. The disease has various modes of transmission, including skin-to-skin contact, kissing, and the touching of infected materials.
The Philippines’ Department of Health detected this week its 4th monkeypox case a few days ago. The latest case is a 25-year-old Filipino with no documented travel history to or from any country with documented confirmed cases of the disease.
According to Dr. Roentgen Solante, Philippine College of Physicians Vice President and a leading infectious disease specialist, warned there is a possibility that the current strain of monkeypox is mutating faster than expected due to the increase in the number of transmissions across the globe.
Dr. Solante said that while the classic monkeypox virus mutates once every five years, the current global outbreak could hasten its mutation. He said that due to the community transmission, it is normal for a virus to mutate to protect its ability to transmit from one person to the other. At this point, there is a direction in terms of the current outbreak and its mutation is six to 12 times faster than expected.
Thus , a separate National Task Force is urgently needed to nip it in the bud. We should choose our battles wisely and with sense of urgency. Personally speaking, a local transmission is inevitable with the density of our population particularly in urban areas, with increase in our mobility, and with opening of our borders.
Future waves of COVID-19 will be less lethal not because the virus itself has changed to become “milder” but because we will be better able to handle SARS COVID -2 because of immunity from COVID -19 vaccines and infection. Even if you’ve been infected, get vaccinated and boosted. Hybrid immunity (vaccines + infection and recovery) offers increased protection that is longer lasting against COVID reinfection and variants. The national vaccination and booster programs for COVID-19 are extremely challenging. This will need focus and prioritization. Priorities help us understand where to invest our talent, time, and energy.
We also need help from our local medical experts on monkeypox, an equally important medical illness globally. We should act with speed over precision in a crisis situation. The situation is changing by the day — even by the hour. The best leaders quickly process available information, rapidly determine what matters most, and make decisions with conviction. During a crisis, cognitive overload looms; information is incomplete, interests and priorities may clash, and emotions and anxieties run high. Analysis paralysis can easily result, exacerbated by the natural tendency of matrixed organizations to build consensus.
Countries with recently imported cases of monkeypox and those that are seeing human-to-human transmission are being asked to implement a coordinated response to stop transmission and protect vulnerable groups, increase public health surveillance and measures, and strengthen clinical management and infection prevention and control in hospitals and clinics. The WHO will also work with civil society organizations to reduce stigma around the disease, which can deter people from accessing health services.
WHO officials stressed that despite monkeypox meriting the highest level of concern, its epidemiological profile meant that it was not too late for countries to contain it.
WHO is also recommending that countries accelerate research into the use of vaccines, therapeutics, and other tools to combat monkeypox. Scaling up the production of monkeypox vaccines and ensuring that low and middle income countries have access to them must be a main goal if the outbreaks are to be contained. WHO previously announced that it was drawing up a vaccine sharing mechanism for the most affected countries but few details on the scheme have emerged.
How quickly countries can deploy vaccines and other measures to contain monkeypox depends on how relevant and weighty a WHO declaration is perceived by governments, public bodies, and vaccine manufacturers and suppliers, as well as people at risk of monkeypox around the world.
The British scientists behind one of the major therapeutic COVID-19 trials have turned their focus on treatments for monkeypox, a viral disease that has been labeled a global health emergency by the World Health Organization (WHO).
Although there are vaccines developed for the closely related smallpox that can reduce the risk of catching monkeypox, there are currently no treatments that have been proven to help hasten recovery in those who develop the disease.
The response to the COVID outbreak has been slow and this has affected our capacity to bounce back from our economic depression.
We need an agile, competent and honest leader at our health department. Sense of urgency is the most important attribute to succeed. Embrace action, and don’t punish mistakes. Missteps will happen, but our research indicates that failing to act is much worse.
Strong leaders get ahead of changing circumstances. They seek input and information from diverse sources, are not afraid to admit what they don’t know, and bring in outside expertise when needed.
Our current leaders should:
Decide what not to do. Put a hold on large initiatives and expenses, and ruthlessly prioritize. Publicize your “what not to do” choices.
Throw out yesterday’s playbook. The actions that previously drove results may no longer be relevant. The best leaders adjust quickly and develop new plans of action.
Build direct connections to the front line. In triage situations, it’s crucial to have an accurate, current picture of what is happening on the ground. Whether running a supply chain, leading an advocacy, or overseeing a vaccination program, leaders must get situational assessments early and often. One way is to create a network of local leaders and influencers who can speak with deep knowledge about the impact of the crisis and the sentiments of citizens, suppliers, employees, and other stakeholders. Technology can bring the diverse groups together; think about issues that capture issues, solutions, innovations, and best practices. Effective leaders extend their antennae across all the networks in which they operate.
The American horse trainer and a U.S. Racing Hall of Fame inductee, Dr. Wayne Lukas once said “The speed of the leader determines the rate of the pack. “
Agile leadership is key to the success of our healthcare system.
Well , every Filipino should step up as well. Let us make every day count by being socially responsible and relevant. We should engage more stakeholders to achieve our health goals.
Now or never. By Dr. Tony Leachon