The monkeypox outbreak and how disparities in healthcare access contribute to higher mortality rate
By Jo Maline D. Mamangun. Infographics by James Sablay.
While the death rate for those infected with monkeypox in the past was only between 1% to 10%, the World Health Organization (WHO) mentioned in their ‘Questions & Answers’ (Q&A) webpage for the said disease that these percentages may differ in various countries owing to a variety of factors, one of which being access to healthcare.
Based on the latest WHO situation update on the multi-country monkeypox outbreak, there have been 3413 laboratory confirmed cases of the virus since the beginning of 2022, with one fatality recorded as of June 22. These figures came from 50 countries and territories across five WHO Regions.
Meanwhile, the Department of Health (DOH) announced on July 29 the first case of monkeypox in the Philippines, which is a 31-year-old Filipino who arrived in the country last July 19. According to Dr. Beverly Ho of DOH, the case was verified positive by the Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test done on July 28 at their facility. Ho further stated that the patient and its ten close contacts are currently under strict quarantine.
A global health emergency
As the number of monkeypox-infected cases in non-endemic countries rises, WHO Director-General Tedros Adhanom Ghrebeyesus declared the recent monkeypox outbreak a Public Health Emergency of International Concern (PHEIC), the highest alert level of the WHO, on July 23.
Non-endemic countries refer to those nations that have not historically reported instances of a disease, in this case, monkeypox. Since monkeypox is not a newly discovered disease and cases of it were recorded in 11 African countries since 1970, it has been categorized as endemic, or a disease that has not fully gone within a geographical region, in those countries.
According to the May 21 report of the WHO, since May 13, cases of monkeypox have been recorded in 12 Member States that are not endemic for the monkeypox virus. Some of these countries include Australia, Canada, France, Spain, and the United States of America.
Although WHO identified most cases of monkeypox among males who have sexual relations with individuals of the same sex, the health organization underlined that the risk of contracting the virus is not limited to the said group.
The WHO described numerous mechanisms of disease transmission for monkeypox in their Q&A webpage, such as close contact with infected persons or animals, fomite transmission or transmission through contaminated objects, and pregnancy, where infected pregnant women can pass the virus to their unborn child.
Furthermore, they stated that some of the most common symptoms of monkeypox are fever, headache, muscular pains, back pain, swollen lymph nodes, rashes, and the formation of lesions, which normally last two to three weeks and usually go away on their own with medicine, if needed.
“Newborn infants, young children, and people with underlying immune deficiencies may be at risk of more serious symptoms, and in rare cases, death from monkeypox,” the WHO added.
Unequal access to health services
According to WHO’s current situation update on monkeypox, the reported mortality came from Nigeria, one of the African countries with a high infant mortality rate. Statista, an online resource that provides statistical data on various topics, reported that as of May 2022, the infant mortality rate in Nigeria for children under one year old is about 56 deaths per 1000 live births.
In addition, as reported by the WHO, the majority of patients in Nigeria face exorbitant and expensive medicine expenditures. This unfortunate circumstance is similar to what Filipinos are experiencing in the country, even before the COVID-19 pandemic.
In the press release posted by the DOH, results of the Ulat ng Bayan September 2019 Report conducted by Pulse Asia revealed that 99% of Filipinos do not buy all the medicines prescribed to them due to the high cost of medications.
“Further, 23% said that medicines are not accessible, 16% said there are no medicines in their place, 4% said they had no time to buy the medicines, and 2% said they did not need to take medicines,” the research continued.
Meanwhile, a news release posted by the WHO in April 2019 discussed how uneven access to health services affects the gap between life expectancy based on sex.
“The gap between men’s and women’s life expectancy is narrowest where women lack access to health services. In low-income countries, where services are scarcer, 1 in 41 women dies from a maternal cause, compared with 1 in 3300 in high-income countries,” the report mentioned.
Moreover, in the context of a pandemic, the correlation between unequal access to healthcare services and higher mortality rates became more evident in how the Philippine government dealt with COVID-19 in its early years.
Amnesty International, a worldwide non-governmental organization (NGO) focusing on human rights, stated in its April 2021 report that the government’s mishandling of the pandemic adds to a critical lack of access to healthcare.
As of writing, there have been 60,727 deaths due to COVID-19. More than 33,000 of the country’s over 3 million total cases are still active.
As mentioned by the WHO, since the treatment for people with monkeypox relies mostly in the advice of their health care provider — if needed, drink medication for pain and/or fever, stay hydrated, use sterilized water or antiseptic to clean rash, and apply lidocaine to oral and perianal lesions for pain alleviation — access to a proper healthcare is vital.
“Minimum public health standards will prevent monkeypox transmission: wear your best-fitted mask, ensure good airflow, keep hands clean, and keep physical distance. These also protect us against COVID-19,” advice of the DOH, written on their public health advisory issued on May 20.
Struggle for free healthcare
As the threat of COVID-19 remains and a rising monkeypox outbreak is on the way, having access to healthcare is becoming more critical.
In a press release posted by the Health Alliance for Democracy (HEAD) on the same day as the first State of the Nation Address (SONA) of President Ferdinand Marcos Jr., son of the late dictator Ferdinand Marcos, they reiterated their call for free health services in all government hospitals and health centers, as well as free medicines in all public health facilities beginning at the barangay level.
“In his inaugural speech, Pres. Ferdinand Marcos, Jr. said that ‘Ang pangarap ninyo ay pangarap ko rin’ (Your dreams are my dreams). [However, the aforementioned demands] are not just dreams for millions of Filipinos. These are people’s needs and rights that must be addressed immediately,” said HEAD in their post.
HEAD also stated that the healthcare system is failing and that six out of ten Filipinos die without receiving medical care.
“Health facilities are concentrated in urban centers and cities. There is a longstanding imbalance in patient-to-health personnel ratio in hospitals and health centers. Devolution has fragmented health care services and worsened the health situation in geographically isolated and depressed areas,” they concluded.
