Managing monkeypox through behavioral changes

Should we contain the monkeypox outbreak?

Yes, we should see that the number of cases decreases. Because the infection is very unpleasant for the individual. But it must also be said that the disease is generally healing well. The risk of dying from monkeypox here in Switzerland is extremely low. I am convinced that the monkeypox viruses do not have the potential to spread like the HI viruses. In my opinion, there is no threat of a pandemic like AIDS.

Why not?

This is due to three key differences between the two diseases. First of all, according to the current state of knowledge, monkeypox viruses are hardly transmitted if the infected person does not yet show any symptoms, i.e. before the typical smallpox blisters and pustules become visible. Infected people know – provided they are informed – that they are contagious.

Second, you are not contagious for long. After the healing is over, the person is immune. This is completely different with HI viruses. It usually takes years for visible symptoms to appear, and those infected can pass on the virus before that. In addition, an infection never heals. HIV-infected people are only non-contagious if they are well treated with medication.

Thirdly, according to the current state of knowledge, monkeypox viruses are hardly transmissible via blood. Close physical contact is required for the transmission of monkeypox viruses, it is currently almost always through sexual contact.

So how can we contain the current outbreak of monkeypox?

We can manage the disease through isolation. But I don’t mean that all infected people have to stay alone in a room or apartment for three weeks. By isolation I mean a change in behavior: the infected person prevents the areas affected by pustules and blisters from coming into contact with other people.

Can you explain that in a little more detail?

We know that monkeypox viruses are only transmitted through close physical contact. A person must come into contact with the virus-containing liquid in the smallpox blisters and pustules and absorb the viruses via the skin or mucous membranes. So if an infected person sees their own pustules and thus knows about the infection, they will – if they are well informed – greatly reduce the number of close sexual contacts. Then there are fewer transmissions.

However, at the beginning of the outbreak there were some people who were wrongly treated as syphilis patients. There is still learning potential at all levels.

So isolation means abstinence?

The word is not entirely appropriate here. A significant reduction in the number of sexual partners is important. The phase in which this is necessary is not particularly long. An infected person is only contagious for a few weeks, i.e. from the appearance of the smallpox until the smallpox has healed. An infected person does not have to change their whole life with it. I think it is not a problem and doable if someone goes to work normally, as long as the affected areas are covered with clothing.

Mainly affected are currently homosexual and bisexual men who maintain sexual contact with many partners. Are young people also at risk?

If you mean straight youngsters, no. It’s the sexual network that makes the difference. If I, as a gay man, have sex with another man, then the probability that he, like his partner, has had sex with several partners is simply significantly greater than in a heterosexual network. Sure, isolated infections can – and probably will – occur among adolescents, as well as other population groups outside of the group of men who have sex with men, the so-called MSM community. But the risk of another infection is then again smaller, and so from an epidemiological point of view this is a “dead end”.

If I understand you correctly, we now have to inform men in particular who have sex with men about symptoms and ways of infection.

Exactly. What is important now is unbiased, factual and, above all, motivating information. The AIDS pandemic has taught us all that stigma and coercion are counterproductive. If we start doing this, people who suspect they have monkeypox will stop going to medical consultations. We miss the chance to get the important information to the man. And we no longer have the opportunity to motivate those affected to help. Because they are themselves interested in preventing the spread of viruses. And as a precaution, they will also inform any sexual partners as far as possible.

So no public contact tracing?

No, certainly not like we did with Corona. As advisors, we have to inform. In all my years of raising awareness about AIDS and other sexually transmitted diseases, I have seen members of the MSM community behave very responsibly. Those affected have an interest in not passing the disease on. I am convinced that if you explain the situation well to those affected, then we will have the greatest success in prevention.

That now sounds like a very positive image of humanity, despite the global AIDS pandemic and other sexually transmitted pathogens that are still circulating.

Yes, I experienced that with AIDS. Virtually all patients behave very responsibly. I am convinced that monkeypox containment works with motivating, non-stigmatizing information. And by the way, I have nothing against a positive image of humanity.

Is it possible to reach people in the MSM community with the necessary information about it?

Yes, I think that in Switzerland – and certainly in other countries as well – that will happen very quickly. Because the MSM community in particular has very well-functioning communication channels and paths. These were established during the AIDS pandemic. I am therefore convinced that the monkeypox outbreak in countries like Switzerland will subside before the end of this year.

Do you expect that the viruses will then disappear completely?

Not necessarily. They will remain, and outbreaks could continue in the future. But I am convinced that those most affected are now learning to deal with it and are adapting their behaviour. In the future, at least in this country, there will be no major outbreaks – unless the virus surprisingly changes completely.

Vaccination against classical human smallpox, which also protects well against infection with monkeypox, is currently recommended in many countries as a means of containment. Do you support widespread vaccination?

Basically, vaccination will solve the problem. But I wouldn’t rush into anything now. Monkeypox is a mild disease compared to smallpox. Now, before we roll out a vaccine, I’d like to see more data on the safety of the vaccine that’s currently on the market. As I said, I am convinced that the current outbreak will decrease without vaccination due to temporary changes in behavior in the MSM community.