£51m urgently needed to stop monkeypox becoming endemic in the UK

July 12, 2022 in ADPH Updates, Health Protection, PH Funding, Sexual and Reproductive Health by Heather Partridge

  • Hundreds of thousands of vaccine doses needed to curb the outbreak 
  • Financial support must be given to those isolating with monkeypox
  • Unsustainable pressure on sexual health services as cases rise

Urgent action is needed to prevent monkeypox from becoming endemic in the UK and super charge the targeted vaccine programme for gay and bisexual men – with over 1,500 cases already reported and modelling of the current outbreak warns cases are doubling every 15 days [1]

That’s the view of sexual health experts in a joint statement calling for a speedy step change to avert disaster and sent today (12th July) to Steve Barclay, Secretary of State for Health and Social Care, Amanda Pritchard, CEO at NHS England, Jenny Harries OBE, CEO of the UK Health Security Agency. 

Sexual health services are at the frontline of the country’s monkeypox response with the additional responsibility for testing, diagnosis and vaccinations coming at a time when demand for these services is already out-stripping availability. The monkeypox response – including infection control – is unsustainable and currently being delivered without additional funding or staffing.  

Many sexual health services are already reporting reductions in other services because of the additional burden of monkeypox, with some seeing a 90% reduction in access to the HIV prevention pill PrEP and long-acting reversible contraception (LARC) [2].  

The organisations calling for action are British Association of Sexual Health & HIV (BASHH), Association of Directors of Public Health, Terrence Higgins Trust, National AIDS Trust, British HIV Association, LGBT Foundation, Prepster, i-base and UK Community Advisory Board. 

The latest data from the UK Health Security Agency shows gay and bisexual men make up the vast majority of monkeypox cases, but inaction risks transmission to wider groups including those more vulnerable to the infection. For example young children, older people and those who are pregnant.  

The organisations are calling for £51million from the Department of Health & Social Care to control the outbreak, optimise monkeypox care, protect the wider service delivery of sexual health services and to support people who are required to isolate because of monkeypox. As well as the appropriate resourcing for the targeted vaccine programme for gay and bisexual men to be delivered, with BASHH estimating a cost of £62.63 to deliver two vaccine doses.  

The current vaccination roll out is too slow with far too few being vaccinated. This is compounded by a lack of coordination between those who are responsible for its delivery and insufficient quantities of vaccine.  

The statement calls for detail on vaccine quantity, a clear procurement timeline and ensuring all who are eligible receive the recommended two doses 28 days apart. The experts estimate that 250,000 doses must be procured and given to 125,000 people.  

There is also urgent support needed for those who are diagnosed with monkeypox and required to isolate – often for a significant period and currently without financial or practical support. This can result in stigma, ill-health, loss of work and other hardship. For those in vulnerable circumstances, such as shared housing or who have unsupportive employers, this can be devastating.  

This action is necessary to prevent serious risk to public health as the pressure from monkeypox grows daily. As the statement says, this includes the risks caused by the destabilisation of wider sexual health services, including services for testing and treating sexually transmitted infections with delays increasing the risk of antibiotic resistance.  

The disruption in access to HIV prevention and testing also risks seriously jeopardising the Government’s target of ending new HIV cases in the UK by 2030 – with a sharp increase in testing and wider access to prevention pill PrEP vitally needed.  

Dr Claire Dewsnap, Chair of British Association of Sexual Health & HIV, said:  

Not only is this epidemic something we must eliminate, but currently unfunded activity means people who need appointments for PrEP and other treatment appointments for sexually transmitted infections cannot get them. That risks outbreaks of sexually transmitted infections we could avoid by having a clear national plan for monkeypox. This situation risks worsening fast, and harming people.” 

Jim McManus, President of the Association of Directors of Public Health, said:  

“We must eliminate this outbreak. If it becomes endemic in any part of our population because it will cost hundreds of times more in pain, misery, harm and avoidable cost than eliminating it. Our shared call provides a plan to do that. We want to work with all partners, from NHS England to GBMSM organisations to do this. Together, and only together, we can do this. “ 

Richard Angell, Campaigns Director at Terrence Higgins Trust, said:

“There is a clear choice in front of us: urgently do what is needed to tackle the spread of monkeypox or continue the lacklustre response to date which will mean the virus becomes endemic in the UK with more and more people impacted. More vaccines are vital to this. Monkeypox is overwhelming our world class sexual health services. Healthcare staff are doing a brilliant job on the frontline of the country’s monkeypox response – but they’re at breaking point, having to make painful choice between treating monkeypox and issuing PrEP or long acting contraception and desperately in need of additional funding to urgently turn the tide.” 

References  

[1] The UKHSA monkeypox nowcasting model implies positive growth between 3.8% to 6.7% per day, corresponding to a doubling time of 15 days (90% CI: 10 days, 18 days): https://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings/investigation-into-monkeypox-outbreak-in-england-technical-briefing-3 

[2] Data collected by the British Association of Sexual Health & HIV