In Amsterdam, many general practitioners are concerned about monkey pox, Rob Hermanussen knows. “There is a lot of unrest.” He leads a large general practice (7,200 patients) in Amsterdam where many people come from the risk group: men with varying sexual contacts with men. Last Monday, Soa Aids Nederland organized a webinar about monkey pox for healthcare providers. There were so many interested people, eight hundred, that the digital meeting had to be repeated.
On Thursday, RIVM announced that the number of confirmed cases of monkey pox has risen to almost 550 since the recent outbreak in the Netherlands. Almost all of them concern men who have sex with men, but in principle everyone can get the virus, which spreads through close contact. such as cuddling or sex.
According to Hermanussen, the actual number of infections is much higher. “Many people have limited symptoms and don’t go to the doctor. I also suspect that symptoms are often so mild that when someone does go to the doctor, they don’t think about monkey pox. In addition, Belgian research has now shown that it also prevents people from having symptoms. These cases are also not included in the figures.” In addition, the figures are “by definition behind the facts” because the incubation period of monkeypox is usually more than a week.
Hermanussen calls on Minister Ernst Kuipers (Public Health, D66) to acknowledge that the figures only show ‘the tip of the iceberg’. He wants to see more urgency to vaccinate faster. He speaks on behalf of the sexual health advisory group of the Dutch College of General Practitioners, the sex HAG, and on behalf of fourteen fellow GPs who work a lot with the risk group.
‘Preparation in full swing’
Many clients at the GGD Rotterdam-Rijnmond ask when the vaccine will become available, doctor Hannelore Götz emailed. And she also hears that from other sexual health centers (soapoli’s). “An understandable question. At the same time, I know that the preparations for this campaign are complex and in full swing.”
On July 7, Kuipers wrote that he wanted to start vaccinations “as soon as possible” – first in Amsterdam, where the majority of infections now take place. But a week and a half later, the Amsterdam Municipal Health Service does not yet know when the first preventive jab can be taken, a spokesperson said. “A plan of action is now being written.” Several hundred people have already received a vaccine because they had close contact with a confirmed monkeypox patient. The injection should ensure that any illness is milder.
Kuipers defines the target group for the preventive vaccine as: men who have sex with men and transgender people who are now receiving the HIV prevention pill PrEP through the GGD, are on the waiting list, or who are known to have an increased risk of STDs, for example because they have recently been warned about an STD or have had STD complaints. For example, 32,000 people are eligible for preventive vaccination, consisting of two doses. The Netherlands has 70,000 vaccines available, so just enough.
Hermanussen points out that according to the ‘expert council’, which wrote the advice on which Kuipers sails, members from the risk group do not only come to the GGD soapoli, but also to other care providers, such as the general practitioner. “I would like to call on the minister to adhere to that advice.” He acknowledges the scarcity of vaccines, and therefore wants the minister to press for expansion of production capacity in a European context. The delivery time of the vaccine, which is still being made by one Danish company, is one and a half years, according to the expert council. Hermanussen “wants to know why that is the case”. With corona, a vaccine was devised in a year and a half.
Soa Aids Nederland also believes that vaccination should start sooner and that the vaccines should be provided immediately to all GGDs. RIVM says it wants to start “as soon as possible”, but states that the vaccination campaign must be carried out “carefully”. A spokesperson points out that it is not yet known how effective the smallpox vaccine is: the manufacturer has not registered it in Europe as a preventive vaccine for monkeypox (which has happened in the US and Canada). Therefore, recipients must give additional permission. There must be a registration system for possible side effects and a parallel study to measure the effectiveness of the vaccines. The total costs are estimated to be more than 3 million euros.
Also, staff must be “trained and aligned” during vacation time, according to the RIVM, and given the scarcity of vaccines, “invitations must be sent in a careful manner”. A number of people from the target group are ‘not registered under their own name for privacy reasons’ with the soapoli, which may make it more difficult to reach them. STI Aids Nederland does indicate that the willingness to vaccinate among the target group is high.
“We have to make some blows now,” says GP Hermanussen. According to him, the RIVM is afraid of not doing it perfectly. “I don’t think you should be afraid of vaccinating someone too much.” He gladly sets aside a few weekends to poke himself. “Men who have sex with men really don’t live on another planet. They also have contacts in the rest of society. We now mainly see young, healthy people who get monkey pox, but what happens if it spreads to the elderly? Or children? We have no idea.”
A version of this article also appeared in the newspaper of July 18, 2022