RESIDENTIAL AGED CARE IN AUSTRALIA: is push is about to meet shove over the next four years?

 

Yes, an Australia-wide review of the residential aged care system was long overdue given the ongoing train wreck which started in the Howard Government era and continued through to the Morrison Government era and hasn’t yet come to a complete halt. 

Although the Albanese Government's 20 per cent increase ($3.9 billion) in federal government funding for residential aged care and home care in 2022-23 was a promising sign. As was the $23 billion over the 4 years from 2022-23 to improve aged care infrastructure and services that provide support to older Aboriginal & Torres Strait Islander people and to older individuals from diverse communities and regional areas.

Although the fact remains that between 2012 to 2022 bed numbers in residential aged care facilities were effectively being privatised and creating risk with:

• government managed beds down from 10,825 to 8,170;

• Not-for profit managed beds up from 107,410 to 120,053;

• privately managed beds up from 66,335 to 91,658; and

• the number of residential aged care providers falling to just 811 business entities by 2022.

Yes, the ageing population is also growing. By June 2022 the number of people 65 years of age and older composed 17 per cent of the total population at an est. 3.3 million individuals and, there were 180,750 older people in permanent residential aged care – 58 per cent of those being aged 85 years to 100+ years. These individuals were accommodated across 219,965 permanent residential aged care places as of 30 June.

Should we panic at these numbers? No, not quite yet.

Admissions to permanent residential aged care across Australia between July 2020 to June 2021 totalled 67,146 older people.

In the same financial year these 67,146 people entered residential care and a total of 2,823 exited due to death. By 2025 the majority of those admitted in 2020-21 will have been discharged from permanent residential aged care by death, given that for at least half of all permanent care residents appear to have a length of stay after admission of between 24 to 48 months.

In fact, of the 180,750 older people in permanent residential aged care in June 2022, it is possible that up to 95,797 will have been recorded as discharged by death before 2027.

However, by 2027 Australia’s population 65 years of age and older will be est. 5.2 million or est. 18% of a total national population which might have reached 29.2 million persons by then, according to projection scenarios by the  Australian Dept. of Health & Aged Care and Australian Bureau of Statistics. Out of that older population pool as many as 300,000 might by then require some form of residential aged care (permanent or respite) which potentially creates a bed shortfall risk.

That bed shortfall combined with the growing amount of federal funding required to keep government & not-for-profit operators afloat and satisfy the demands of a profit-driven private sector means that decisions have to be made within this present election cycle on residential aged care costs and infrastructure.

Whatever the Albanese Government decides will probably satisfy very few — because that is the nature of the collective political beasts roaming the Arena at present, as well as the mood of the national electorate watching this brutal Roman Circus.

Tens of thousands of older Australians will now be able to access cheaper healthcare following the relaxation of income tests for the Commonwealth Seniors Healthcare Card

 

SBS News, 4 November 2022:

The Commonwealth Seniors Healthcare Card is changing. Here's what you need to know

HIGHLIGHTS

• The income threshold for senior healthcare cards has been increased to allow more people to access cheaper healthcare

• Singles earning up to $90,000 will now be able to access the scheme, as will couples earning up to $144,000

• The move will benefit an extra 44,000 seniors and cost the federal budget $69.4 million over four years.

Tens of thousands of older Australians will now be able to access cheaper healthcare following the relaxation of income tests for the Commonwealth Seniors Healthcare Card.

The changes were an election promise by the Albanese government, and mean higher income earners will now be able to qualify for subsidised treatment and medicines.

"We want to create a better Australia where no one is left behind and no one is held back, and this is particularly true for older Australians," Social Services Minister Amanda Rishworth said.

Here's what we know.

Who can access the concession card and what are the benefits?

The cards are open to anyone over 66 and six months and not receiving a social security pension or benefit.

Recipients must be living in Australia when they receive the card, and have either Australian citizenship, permanent residency, or a Special Category visa.

Newly arrived residents may face waiting periods of up to four years.

Health card holders can get discounted prescriptions through the Pharmaceutical Benefits Scheme and bigger refunds for health expenses than what's usually offered through Medicare.

GPs are also encouraged to bulk-bill for cardholders……

The seniors health card bill passed the Senate last week, and comes into effect from Friday.

It follows reductions in the cost of medicines, with the government reducing the maximum co-payment under the Pharmaceutical Benefits Scheme (PBS) by $12.50 earlier this year…...

And the uncertainty continues for Lismore flood victims.....

 

Australian Associated Press AAP, 28 October 2022:

Flood victims in northern NSW have described the government’s $520 million buyback scheme as a “cookie cutter” package designed without adequate community consultation.

The $520 million buyback scheme is the centrepiece of an $800 million package co-funded by the NSW and federal governments, to give 2000 flood-impacted residents of the Northern Rivers region the opportunity to raise, repair or retrofit their houses.

For homes in the areas most at risk – Lismore and the surrounding Northern Rivers region – governments will offer to buy the home and land from the owner.

But victims of the Lismore floods criticised the scheme on Friday, saying it lacks detail and was developed without their input, nearly eight months after the town was devastated.

“Nobody’s actually spoken to us about what our community’s needs are prior to determining the package,” flood victim and domestic violence worker Vicky Findlay told AAP.

“I feel like it’s a bit of a cookie-cutter approach.”

Ms Findlay’s North Lismore home was inundated during flooding earlier this year, destroying bedrooms and leaving her without a kitchen.

Her son, 27, has a disability and is on a waitlist for social housing, meanwhile living in a caravan on their property.

“I imagine we will get a buyback, but the problem for us is that we can’t leave unless our son is given social housing,” she said.

Prime Minister Anthony Albanese says the package offers a way forward for communities devastated by repeated flooding this year, adding governments could not continue to allow homes to be built on floodplains.

“This is the biggest agreement of its kind, ever, in response to a very significant event,” he told reporters in Lismore on Friday.

“We need to do better on planning, but we also need to do better than thinking we can just do the same thing over and over again.”

NSW Premier Dominic Perrottet will lead discussion at a national cabinet meeting about improving planning to ensure floodplain developments didn’t continue.

Mr Perrottet said rebuilding with resilience in mind would avoid past mistakes, adding the days of developing on floodplains in the state were over.

“I’ve already spoken to the planning minister in relation to this,” he said.

Criminal lawyer and Lismore local Eddie Lloyd, who was rescued from a roof during floods earlier this year, said residents living on floodplains remained unsure about which support packages they would be eligible for.

“We hoped that this would be a community-led recovery and rebuild,” Ms Lloyd told AAP.

“The really disappointing factor for us is that the community haven’t been consulted.”

Labor leader Chris Minns welcomed the Commonwealth-state funded package but said it was vital the Northern Rivers were not forgotten.

“It’s a tricky policy situation. I think everybody acknowledges it’s not as simple as coming out with an announcement within days of a natural emergency … I’m glad that we’re now where we are at,” he said.

The program will be open to residents in the Ballina, Byron, Clarence Valley, Kyogle, Lismore, Richmond Valley and Tweed local government areas.

The voluntary buyback scheme will be offered from Monday to home owners in the most vulnerable parts of the Northern Rivers, where renewed flooding continues to pose a serious risk.

They will be offered money to raise, repair or retrofit their property, or sell it to the government, based on expert assessments of the damage, its safety risks and potential future flood levels.

Many assessments will have already taken place, Mr Perrottet said.

Those eligible will be given a payment based on a valuation of the home and land.

Up to $100,000 will be available to raise homes and up to $50,000 for retrofitting in cases where flood risk can be mitigated by better building.

The state government will also spend $100 million buying new land in flood-safe locations for new developments with the Northern Rivers Reconstruction Corporation.

Grafton Loop of the Knitting Nannas speaking plainly to the Minister for Climate Change & Energy and Labor MP for Prospect (NSW), Chris Bowen

 

Hon Chris Bowen

Minister for Climate Change and Energy

Parliament House

CANBERRA ACT

Email:

EnergyMinisters@industry.gov.au

Chris.Bowen.MP@aph.gov.au

Dear Minister Bowen

Federal Government Climate Policy

The Grafton Loop of the Knitting Nannas Against Gas and Greed is a community group which was formed in 2012 in response to plans by the NSW Government to foist a gas mining industry on our NSW Northern Rivers region. As you may be aware, the determined campaigning of grass roots community groups, including various regional loops of Knitting Nannas, forced the abandonment of these plans. Because of our ongoing concerns about climate change and the impact it will have on future generations, the Nannas have remained active since the removal of the immediate gas threat to our region.

The Nannas are delighted that our new Federal Government has responded to community concerns about the existential threat of climate change by committing to greater emission cuts than the former government.

While this is a good first step, we are concerned that what you are doing is far short of what is actually required. As we understand it, your proposed cuts are in line with a temperature rise of 2°C not the 1.5° which is in line with the Paris goal. Scientists keep advising that much more is needed – much faster. Indeed the bushfires and floods in Australia as well as the climate-induced disasters elsewhere are making this very plain.

In addition the Nannas are extremely concerned that your Government has adopted a “business as usual” approach to the fossil fuel industry – an approach that is completely inconsistent with your apparent commitment to do better on climate change.

We are concerned that you see no problem with the opening of new coal and gas mines.

We are concerned that your colleague, Minister King, recently announced 46,758 sq km of new petroleum acreage for exploration in Commonwealth waters to the north of the country.

We are appalled that Minister King also indicated your Government’s support of the pie-in-the-sky technology of carbon capture and storage (CCS) so beloved of the fossil fuel industry by approving two permits for off-shore greenhouse gas storage areas north of WA and the NT. And there are a further three to come. We are also very concerned that taxpayer funds continue to be wasted on subsidies to CCS which are another form of “green-washing” by polluters intent on pursuing their damaging businesses.

If the fossil fuel industry had been concerned about the election of a government committed to greater climate action, they must be collectively rubbing their hands in glee, because nothing has really changed from the policies of the previous government.

As you are undoubtedly aware, more Australians than ever before are concerned about climate change and they expect more consistent and effective action from their government.

We urge you, Minister Bowen, to improve your government’s action on climate change.

Yours sincerely

Leonie Blain

On behalf of the Grafton Nannas

Cc Hon Tanya Plibersek, Minister for Environment and Water

Unpacking details of the Cashless Debit Card Scheme rollback

 Reprinted without comment......

Ministers for the Department of Social Services, media release:

Empowering communities with the abolition of the cashless debit card program

24 September 2022

Joint with:

The Hon Amanda Rishworth MP

Minister for Social Services

Member for Kingston

The Hon Linda Burney MP

Minister for Indigenous Australians

Member for Barton

The Hon Bill Shorten MP

Minister for Government Services

Minister for the National Disability Insurance Scheme

Member for Maribyrnong

The Hon Justine Elliot MP

Assistant Minister for Social Services

Member for Richmond

The Albanese Labor Government is delivering a long-term plan to ensure certainty, choice and support to communities moving off the cashless debit card program.

Following extensive consultation in sites across the nation, the Government has today announced a suite of measures that empowers local communities and will assist in abolishing the cashless debit card program and ensure communities are better off.

This will deliver on our election commitment to end a failed program.

The Government will abolish the cashless debit card program and make income management voluntary in Ceduna, East Kimberley, Goldfields and Bundaberg-Hervey Bay.

Under the plan, the Cape York region will retain all of its powers of self-determination and referral for community members to go onto income management under the Family Responsibilities Commission.

CDC participants in the Northern Territory will be subject to the requirements under previous income management legislation.

The plan will see around 17,300 individuals in cashless debit card program sites transition off the CDC and onto the new arrangements, or off the program completely.

Participants in Ceduna, East Kimberley, Goldfields and Bundaberg-Hervey Bay will be able to transition from October 4, subject to the passage of legislation.

The plan for the abolition of the cashless debit card program includes:

• an updated income management technology solution with an enhanced card linked to Services Australia

• a continuation of current community support services and addition of new services

• legislative amendments to strengthen and streamline income management and oversight

• delivering $49.9 million for additional alcohol and other drug treatment services and support in cashless debit card trial sites

• providing $17 million for community-led and designed initiatives to support economic and employment opportunities in cashless debit card sites

• additional staffing support from Services Australia to support communities through the transition

In the Northern Territory and Cape York and Doomadgee region – as well as volunteers in other sites – the transition to the new enhanced card will be completed early next year.

The changes have been communicated with states and territories, who have all indicated willingness to work with the Commonwealth on the longer-term issues facing these communities.

Updated Technology

Updated technology for people moving to income management will provide access to more merchants and facilitate BPAY and online shopping. Protections such as pin technology and consumer-driven product blocking will also be explored.

Crucially, under the changes all income management will be delivered by Services Australia. Individuals will no longer be required to deal with a private company for customer support functions.

The measures will restore the role of Services Australia in income management and provide enhanced choice.

Legislative changes

Amendments will be introduced to the Parliament on Monday to further affirm the role of the Family Responsibilities Commission in the Cape York region, ensure those on income management in the Northern Territory have access to the enhanced technology and allow people to volunteer to be on the updated solution.

Changes will be made to bring income management under one piece of legislation. Participants transitioning from CDC will have 50 per cent of their income quarantined and 50 per cent accessible in cash, except in Cape York where the Family Responsibilities Commission determines the appropriate proportion.

Stronger Services

A total of 44 essential support services in communities – such as the community bus in Ceduna for children who cannot access other transport – that were set to have funding expire next year, will continue.

A range of new support services, including those requested by communities during consultation with the Government, will also be developed and funded.

The government will also deliver $49.9 million for additional alcohol and other drug treatment services and support in the four CDC trial sites in Ceduna, East Kimberley, Goldfields and Bundaberg-Hervey Bay. These services will be co-designed with the local community to ensure the support meets local needs, in another example of the government supporting local decision-making and voices.

Funding will be used to support alcohol and other drug treatment that complements existing services, addresses service delivery gaps, and is consistent with the needs and expectations of the communities - designed to support First Nations and other people living in these locations.

As a critical first step, the Government will work with communities on a localised approach to funding alcohol and other drug treatment services for each location.

Strengthening economic development

A total of $17 million will be made available to support the creation of economic and employment opportunities in cashless debit card sites following the abolition of the CDC program.

The grant funding will be directed towards community-led and designed initiatives, in line with our principles of self-determination and choice.

Additional staffing support

Additional front of house staff from Services Australia will be provided in cashless debit card program sites over the transition period.

Staff will support community engagement activities, including Indigenous Service Officers and Community Engagement Officers and there will be additional Remote Servicing visits arranged. More Financial Information Service (FIS) Officers will also be available to work with individuals on budgeting issues or more complex financial issues.

Social Workers will be available to work with individuals with more complex issues. Additional specialist staff may be deployed into CDC sites during the transition period if the need arises.

The Department of Social Services will also provide additional social supports as required in response to the need of the individual CDC communities.

Minister for Social Services Amanda Rishworth said the Albanese Labor Government was delivering on its election commitment to abolish the CDC program and had carefully considered measures that would help communities.

“This package will deliver real solutions for those communities who were subject to the cashless debit card trial and provide choice and long-term certainty into the future,” Minister Rishworth said.

“We’ve heard from communities about what they need and these measures deliver on that.”

Minister for Indigenous Australians Linda Burney said the Government has listened to local communities and would continue to consult community-by-community on the future of income management.

“Entrenched disadvantage must be tackled by adequate support that addresses the causes of that underlying disadvantage and build capacity.” Minister Burney said.

Minister for Government Services Bill Shorten said restoring the role of Services Australia would result in those on income management receiving the right support services.

“Services Australia is the Government’s key implementation agency and will work to deliver the policy as laid out under the Government’s plans,” Minister Shorten said.

Assistant Minister for Social Services Justine Elliot said hearing first-hand what communities wanted had informed this package.

“I’ve been out on the ground consulting and the package we have delivered is comprehensive and it is what communities want,” Assistant Minister Elliot said.

The Albanese Labor Government remains committed to making income management voluntary over the long term for those 24,000 people on IM nationally.

We will continue consultation over the next 18-months to ensure communities are supported to decide what the future of IM looks like for them.

This is important work but we have to ensure we are consulting thoroughly and listening to communities.

Information about the changes will be distributed in First Nations languages and dedicated Commonwealth support teams will be deployed to assist with the transition.

Albanese Government announces $75 million flood mitigation grant for NSW - drawn from the $3.9 billion national Emergency Response Fund

 

The National Tribune, 26 August 2022:

The Albanese Government has today announced a $75 million investment in flood mitigation and infrastructure resilience programs for New South Wales.

The support will be delivered across the 62 local government areas (LGAs) which were disaster-declared after the February-March flood event.

The program is wholly funded by the Commonwealth Government’s Emergency Response Fund, but will be delivered by New South Wales Government agencies, including Resilience NSW, the Department of Regional NSW and the Department of Planning and Environment.

The program includes:

• $40 million for flood infrastructure: grants for councils and government agencies for flood mitigation projects, including funding for home raising projects.

• $15 million for flood warning gauges: support for councils and government agencies to install, upgrade and operate flood warning gauges, systems and associated advice to make the community aware of the warning system.

• $14 million for a levee assessment and improvement program: flood impact assessments of flood mitigation infrastructure damaged by the February-March flood event. These assessments will be used as the basis for flood mitigation repairs and improvements.

• $5 million for valley level flood assessments: to provide improved information for flood risk management and emergency management decisions, and support improved State-wide understanding of flood risk.

• $1 million for a flood infrastructure impact assessment and report: to outline flood infrastructure impacts, available information on the relative rarity of the flood at key locations and identify known priority flood risk management measures.

In no small measure Northern Rivers communities have helped bring this about by their own passionate advocacy in the media and, before both government & parliamentary inquiries, ably assisted by state MLA for Lismore Janelle Saffin and federal MP for Richmond Justine Elliot.

WHO declares Monkeypox to be a Public Health Emergency of International Concern & Australia declares it to be a Communicable Disease Incident of National Significance with NSW Health beginning vaccine rollout

 

Monkeypox: First deaths outside Africa in Brazil and Spain

Image: BBC, 30 July 2022

A statement from Professor Paul Kelly, Australian Government Chief Medical Officer, declaring monkeypox (MPX) a Communicable Disease Incident of National Significance.

28 July 2022

I have declared the unfolding situation regarding monkeypox (MPX) in Australia to be a Communicable Disease Incident of National Significance.

This follows the World Health Organization (WHO) declaring the global situation regarding MPX to be a public health emergency of international concern.

The latest data from 1 January to 28 July 2022 as reported by the US Centers for Disease Control and Prevention (US CDC) indicates there have been 20,311 MPX cases in 71 countries (including Australia) that have not historically reported MPX.

In Australia, there have been 44 cases – the majority of which have been within returned international travellers.

It is important to note that although I have declared MPX to be a Communicable Disease Incident of National Significance, it is far less harmful than COVID-19 and there have been no deaths reported during the current outbreak outside of countries where the virus is endemic.[inoperative statement as of 30.07.22] 

MPX is also not transmitted in the same way as COVID-19 – and is far less transmissible.

The decision to declare MPX a Communicable Disease Incident of National Significance was made under the Emergency Response Plan for Communicable Disease Incidents of National Significance, in consultation with the Australian Health Protection Principal Committee.

Since May, Australian Government Department of Health and Aged Care public health experts have engaged with at-risk communities in partnership with key stakeholders and have been working very closely with their counterparts in state and territory health departments to ensure our response to MPX has been swift and coordinated.

The National Incident Centre has been activated to provide enhanced national coordination to assist states and territories to effectively manage the outbreaks within their jurisdictions.

MPX’s rash and flu-like symptoms are relatively mild, and in most cases, resolve themselves within two to four weeks without the need for specific treatments.

Most cases of MPX in Australia have been among people aged 21 to 40 years. The experience internationally and in Australia to date is most cases have been among gay, bisexual and other men who have sex with men.

Although MPX is not usually considered a sexually transmissible infection, physical contact with an infected person during sexual intercourse carries a significant risk of transmission and intimate physical contact such as hugging, kissing and sexual activities represent a risk of infection, with infectious skin sores being the likely mode of transmission.

The rash usually occurs on the face before spreading to other parts of the body, including the palms of the hands and the soles of the feet. However, in this outbreak it is being seen especially on the genital and perianal regions of affected people.

The rash can vary from person to person and take on the appearance of pimples, blisters or sores. The flu-like symptoms often include fever, chills, body aches, headaches, swollen lymph nodes and tiredness.

The National Medical Stockpile has available stock of MPX treatments, such as antivirals, for states and territories to access on request.

The Australian Technical Advisory Group on Immunisation (ATAGI) has updated clinical guidance on vaccination against monkeypox using the ACAM2000 vaccine to include the use of MVA-BN vaccine to prepare for supplies of the third-generation vaccine being made available in Australia.

Further information about monkeypox is available from the Department of Health and Aged Care’s website www.health.gov.au/health-topics/monkeypox-mpx 

NOTE 

As of 28 July 2022 there were 45 cases (confirmed and probable) of MPX in Australia. This includes 25 in New South Wales, 16 in Victoria, 2 in the Australian Capital Territory, 1 in Queensland and 1 in South Australia [Australian Dept. of Health, 29 July 2022].

Eleven days later, on 8 August, it was reported that the number of cases has risen to 58 cases, with 33 of those cases being found in NSW. All but two cases appear to have been contracted overseas.

NSW Health has begun distribution of the JYNNEOS smallpox vaccine to groups considered vulnerable to MPX.

The Lancet, 30 July 2022:

WHO's declaration on July 23 that the current monkeypox outbreak constitutes a Public Health Emergency of International Concern (PHEIC) was unprecedented. It is the seventh such declaration, but the first made against the advice of a majority of the emergency committee (nine were against, six were for). Dr Tedros’ decision is a brave one. It needs to serve as a global wake-up call. The question is whether it will prompt the escalated efforts required to control the outbreak.

Dr Tedros gave three broad reasons for his decision. “We have an outbreak that has spread around the world rapidly, through new modes of transmission about which we understand too little, and which meets the criteria in the International Health Regulations.” The details make for a compelling case. So far this year, up to July 22, 16016 cases have been reported from 75 countries. Where monkeypox is endemic, such as in DR Congo, large new outbreaks have been reported in diverse populations. Outside of west and central Africa, the outbreak is concentrated, for now, in men-who-have-sex-with-men (MSM). Why the disease's epidemiology has changed is still unclear, as are many other aspects of the outbreak. Recent case series from non-endemic countries have shown differences in clinical features compared with previous reports. Lethargy and fever seem to be less common, and several patients have no prodromal symptoms. Skin lesions are found predominantly in genital or perianal areas. Transmission is known to occur through skin-to-skin contact, but monkeypox DNA has been found in patients’ seminal fluid—whether it represents replication-competent virus remains unknown. The rapid worldwide spread of a disease, for reasons we are unsure of, was clearly an over-riding concern for Dr Tedros. An urgent energised research effort is now needed to understand these and other issues related to the outbreak.

Countries must strengthen public health preparedness and response. Case definitions should be updated and harmonised as new data emerge, with heightened surveillance, case detection, and contact tracing. Patients need to be supported in isolation and treatment, and targeted immunisation might be needed for people at high risk of exposure. Recent experience with COVID-19 might help countries institute these measures but many health systems are at breaking point already. There is a risk too that the public is fatigued by talk of pandemics and their control. Misinformation about monkeypox has already begun to circulate. The public need to be engaged and targeted risk-communication strategies developed. Monkeypox is not COVID-19. The R0 is around 1, and transmission mechanisms are entirely different. The clade of monkeypox that seems to be responsible for the outbreak largely causes mild self-limiting illness, although patients have been admitted to hospital, mainly for pain. Ensuring wide understanding of these points is key for managing public anxiety.

Engagement among many MSM has been high since the outbreak started, and this population is—as ever—keen to take care of its health (and do their part to protect others). Countries that criminalise homosexuality and marginalise LGBTI+ communities risk both patients’ wellbeing and chances of controlling transmission. Stigma and discrimination need to be fought. It would be wrong to categorise monkeypox as a disease of MSM.

The expedited pathways for research, development, regulatory approval, and manufacturing of medical countermeasures developed for COVID-19 should be repurposed for monkeypox. A lack of diagnostic tests is hampering case identification in some countries. Tecovirimat, originally produced to treat smallpox, has been licenced by European regulators for monkeypox, but not yet by the US FDA. Other promising treatments, such as cidofovir and brincidofovir, require clinical study. A monkeypox vaccine (sold as Imvanex in Europe and Jynneos in the USA) has been approved, but supplies of both treatments and vaccines are extremely limited. WHO will have to take a much more muscular approach to ensure global access and avoid the inequities of the COVID-19 response.

Whether or not you agree with WHO's decision, there has undoubtedly been a missed opportunity. Monkeypox is not new. It has been causing illness and death in large numbers for decades. Specialists have long called for affordable countermeasures, strengthened surveillance, and more study. But like Ebola and Zika, monkeypox only commands global attention when it hits high-income countries with predominantly White populations. As a result, the window of opportunity to prevent monkeypox becoming established in communities worldwide is closing. Now is a key moment. It warrants the strongest medical, scientific, and political global effort.

BACKGROUND

World Health Organisation:

Key facts

• Vaccines used during the smallpox eradication programme also provided protection against monkeypox. Newer vaccines have been developed of which one has been approved for prevention of monkeypox

• Monkeypox is caused by monkeypox virus, a member of the Orthopoxvirus genus in the family Poxviridae.

• Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks. Severe cases can occur. In recent times, the case fatality ratio has been around 3–6%.

• Monkeypox is transmitted to humans through close contact with an infected person or animal, or with material contaminated with the virus.

• Monkeypox virus is transmitted from one person to another by close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding.

• Monkeypox is a viral zoonotic disease that occurs primarily in tropical rainforest areas of central and west Africa and is occasionally exported to other regions.

• An antiviral agent developed for the treatment of smallpox has also been licensed for the treatment of monkeypox.

• The clinical presentation of monkeypox resembles that of smallpox, a related orthopoxvirus infection which was declared eradicated worldwide in 1980. Monkeypox is less contagious than smallpox and causes less severe illness.

• Monkeypox typically presents clinically with fever, rash and swollen lymph nodes and may lead to a range of medical complications….

Outbreaks

Human monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo in a 9-month-old boy in a region where smallpox had been eliminated in 1968. Since then, most cases have been reported from rural, rainforest regions of the Congo Basin, particularly in the Democratic Republic of the Congo and human cases have increasingly been reported from across central and west Africa.

Since 1970, human cases of monkeypox have been reported in 11 African countries: Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Cote d’Ivoire, Liberia, Nigeria, the Republic of the Congo, Sierra Leone and South Sudan. The true burden of monkeypox is not known. For example, in 1996–97, an outbreak was reported in the Democratic Republic of the Congo with a lower case fatality ratio and a higher attack rate than usual. A concurrent outbreak of chickenpox (caused by the varicella virus, which is not an orthopoxvirus) and monkeypox was found, which could explain real or apparent changes in transmission dynamics in this case. Since 2017, Nigeria has experienced a large outbreak, with over 500 suspected cases and over 200 confirmed cases and a case fatality ratio of approximately 3%. Cases continue to be reported until today.

Monkeypox is a disease of global public health importance as it not only affects countries in west and central Africa, but the rest of the world. In 2003, the first monkeypox outbreak outside of Africa was in the United States of America and was linked to contact with infected pet prairie dogs. These pets had been housed with Gambian pouched rats and dormice that had been imported into the country from Ghana. This outbreak led to over 70 cases of monkeypox in the U.S. Monkeypox has also been reported in travelers from Nigeria to Israel in September 2018, to the United Kingdom in September 2018, December 2019, May 2021 and May 2022, to Singapore in May 2019, and to the United States of America in July and November 2021. In May 2022, multiple cases of monkeypox were identified in several non-endemic countries. Studies are currently underway to further understand the epidemiology, sources of infection, and transmission patterns.