May 2022

The World Health Organization’s top monkeypox expert said she doesn’t expect the hundreds of cases reported to date to turn into another pandemic, but acknowledged there are still many unknowns about the disease, including how exactly it’s spreading and whether the suspension of mass smallpox immunization decades ago may somehow be speeding its transmission.

In a public session on Monday, WHO’s Dr. Rosamund Lewis said it was critical to emphasize that the vast majority of cases being seen in dozens of countries globally are in gay, bisexual or men who have sex with men, so that scientists can further study the issue and for populations at risk to take precautions.

“It’s very important to describe this because it appears to be an increase in a mode of transmission that may have been under-recognized in the past,” said Lewis, WHO’s technical lead on monkeypox.

Still, she warned that anyone is at potential risk of the disease, regardless of their sexual orientation. Other experts have pointed out that it may be accidental that the disease was first picked up in gay and bisexual men, saying it could quickly spill over into other groups if it is not curbed. To date, WHO said 23 countries that haven’t previously had monkeypox have reported more than 250 cases.

Lewis said it’s unknown whether monkeypox is being transmitted by sex or just the close contact between people engaging in sexual activity and described the threat to the general population as “low.”

“It is not yet known whether this virus is exploiting a new mode of transmission, but what is clear is that it continues to exploit its well-known mode of transmission, which is close, physical contact,” Lewis said. Monkeypox is known to spread when there is close physical contact with an infected person or their clothing or bedsheets.

She also warned that among the current cases, there is a higher proportion of people with fewer lesions that are more concentrated in the genital region and sometimes nearly impossible to see.

“You may have these lesions for two to four weeks (and) they may not be visible to others, but you may still be infectious,” she said.

Last week, a top adviser to WHO said the outbreak in Europe, U.S., Israel, Australia and beyond was likely linked to sex at two recent raves in Spain and Belgium. That marks a significant departure from the disease’s typical pattern of spread in central and western Africa, where people are mainly infected by animals like wild rodents and primates, and epidemics haven’t spilled across borders.

Most monkeypox patients experience only fever, body aches, chills and fatigue. People with more serious illness may develop a rash and lesions on the face and hands that can spread to other parts of the body. No deaths have been reported in the current outbreak. 

WHO’s Lewis also said that while previous cases of monkeypox in central and western Africa have been relatively contained, it was not clear if people could spread monkeypox without symptoms or if the disease might be airborne, like measles or COVID-19.

Monkeypox is related to smallpox, but has milder symptoms. After smallpox was declared eradicated in 1980, countries suspended their mass immunization programs, a move that some experts believe may be helping monkeypox spread, since there is now little widespread immunity to related diseases; smallpox vaccines are also protective against monkeypox.

Lewis said it would be “unfortunate” if monkeypox were able to “exploit the immunity gap” left by smallpox 40 years ago, saying that there was still a window of opportunity to close down the outbreak so that monkeypox would not become entrenched in new regions.
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In Ghana, sexual assault victims must show medical reports to prove they have been assaulted before a rape suspect can be prosecuted. These medical examinations come at a relatively high cost, and are not covered by the national health insurance, and so can deter a victim from pressing charges. Now, a lawmaker is seeking to abolish the health exam requirement so that more women are able to pursue justice. Senanu Tord reports from Battor, Ghana.
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Methamphetamine seizures across East and Southeast Asia hit yet another record high in 2021, proof of the “staggering” scale and reach the region’s drug gangs have gained after a decade of steady growth that looks set to continue, the United Nations says in a new report.

In Synthetic Drugs in East and Southeast Asia: Latest Development and Challenges, issued Monday in Bangkok, the U.N. Office on Drugs and Crime says seizures of meth tablets topped 1 billion for the first time last year. While crystal meth, or ice, seizures dipped slightly to 79 metric tons, it says, total meth seizures by weight were a record 171.5 metric tons in 2021, nearly eight times the total seizures a decade ago.

Combined with stable or falling street and wholesale prices across the region, the UNODC says the spiraling drug hauls are evidence of soaring production more than stepped-up law enforcement.

“It is fair to say the region is struggling badly to address meth, and frankly to deal with other synthetic drugs as well,” Jeremy Douglas, the UNODC’s representative for Southeast Asia and the Pacific, told VOA.

“There needs to be a radical policy shift and rebalancing if the region wants to get to a point of managing the meth problem or making some headway,” he added.

Border battle

With fewer and fewer busts of meth labs across the region, the UNODC says production continues to concentrate in the notorious Golden Triangle, a rugged and remote domain of warlords, drug gangs and gunrunners where the corners of eastern Myanmar, western Laos and northern Thailand meet.

Within that triangle, it says meth production is concentrating further still in eastern Myanmar, where militias backed by the country’s brutal military and rebel armies set against it vie for territory — and a cut of the drug trade.

Most of the meth made there continues to pour into northern Thailand, from where it cascades across the rest of the country, Southeast Asia and as far away as Australia and Japan.

However, beefed-up security by Thai police along the country’s northern border has been pushing a growing share of the traffic through Laos instead. From there, drug gangs can bypass the north of Thailand and push their product into the country across its less-guarded border in the northeast Isaan region, most of which tracks the Mekong River.

 

Of all the ice and meth tablets interdicted in Thailand’s top 10 provinces for seizures last year, northeast provinces accounted for 49% and 39%, respectively.

 

Lt. Gen. Pornchai Charoenwong, an assistant to the Thai police force’s narcotics suppression division, confirmed the trend.

 

“We can point to a couple of factors,” he told VOA. “First is the increased suppression by the government, police and the military in the northern region. With that increased suppression, we’ve seen a change in trafficking routes from the northern part of Thailand to the Isaan region along the Mekong River.”

 

He said COVID-driven border controls have played a part as well.

 

To help Thai authorities plug the gaps, the U.S. State Department’s International Narcotics and Law Enforcement Affairs Office has donated some $670,000 worth of equipment to local police in the northeast this year.

 

Mark Snyder, the U.S. Drug Enforcement Administration’s acting head of mission in Thailand, said that represents an increase in U.S. crime-fighting aid to that part of the country, reflecting its growing role in the region’s drug trade.

 

“Thai law enforcement has been doing a lot of work on the northern border,” he said, and “when you have increased law enforcement presence in one area, the criminal organizations will adapt to that.”

 

He declined to say what the equipment consists of. Pornchai said the U.S. donations typically include vehicles, communications gear and drones.

 

From Thailand, much of the meth flows south to, and through, Malaysia, which the UNODC report highlights as an increasingly important springboard to the rest of Southeast Asia and beyond for Golden Triangle drug gangs.

 

Laos, Thailand and Malaysia all saw record seizures of meth tablets in 2021.

 

Growth potential

 

The UNODC says the trade is also getting harder to stop, for a few reasons.

 

Most producers “brand” their packages with distinct codes that help the gangs keep track of them down the line. Variations on “999” and “Y1” are the most common, for reasons that are not entirely clear. Last year, though, the share of meth seized from a host of smaller producers using other codes shot up from 2.8% to 13%.

 

Douglas said the “unprecedented” surge in smaller producers, who buy meth powder from larger groups but press the tablets themselves, is likely adding to the overall rise in supply. He said more producers also means more trafficking networks, which means more players for the authorities to try and uncover, infiltrate and stop.

 

Blocking the flow of the chemicals the larger groups use to make their meth is getting tougher too, the U.N. agency says.

 

Seizures of the most common meth precursors, burdened by import and export controls that force drug gangs to get their hands on much of what they need on the black market, have crashed across Southeast Asia in recent years. The UNODC suspects that means the groups have switched to making those precursors themselves from other chemicals, or pre-precursors, that are not controlled.

 

The new report says authorities in the region seized a number of these other chemicals last year and into 2022 either at or on the way to suspected lab sites.

 

Douglas said pre-precursors “make an already complex situation more difficult.”

 

The U.N. and others are working with local authorities to highlight the problem and help them share intelligence on where and when those chemicals are moving, he added, while talks at the global level on controlling their shipment are also underway.

 

The report also notes the spread of meth from Myanmar westward into northern India, Middle Eastern drug gangs now using Malaysia as a steppingstone for amphetamine shipments, and illicit ketamine producers setting up shop in Cambodia.

 

Douglas said Southeast Asia’s drug gangs “have all the ingredients in place that they need to continue to grow,” and will do so unless local authorities themselves adapt.

 

“The scale and reach of the methamphetamine and synthetic drug trade in East and Southeast Asia is staggering,” he said, “and yet it can continue to expand if the region does not change approach and address the root causes that have allowed it to get to this point, including governance in the Golden Triangle and market demand.”
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Capri Isidoro broke down in tears in the office of a lactation consultant. 

The mother of two had been struggling to breastfeed her 1-month-old daughter ever since she was born, when the hospital gave the baby formula first without consulting her on her desire to breastfeed. 

Now, with massive safety recall and supply disruptions causing formula shortages across the United States, she also can’t find the specific formula that helps with her baby’s gas pains. 

“It is so sad. It shouldn’t be like this,” said Isidoro, who lives in the Baltimore suburb of Ellicott City. “We need formula for our kid, and where is this formula going to come from?” 

As parents across the United States struggle to find formula to feed their children, the pain is particularly acute among Black and Hispanic women. Black women have historically faced obstacles to breastfeeding, including a lack of lactation support in the hospital, more pressure to formula feed and cultural roadblocks. It’s one of many inequalities for Black mothers : They are far more likely to die from pregnancy complications, and less likely to have their concerns about pain taken seriously by doctors. 

Low-income families buy the majority of formula in the U.S., and face a particular struggle: Experts fear small neighborhood grocery stores that serve these vulnerable populations are not replenishing as much as larger retail stores, leaving some of these families without the resources or means to hunt for formula. 

The Centers for Disease Control and Prevention estimates that 20% of Black women and 23% of Hispanic women exclusively breastfeed through six months, compared to 29% of white women. The overall rate stands at 26%. Hospitals that encourage breastfeeding and overall lactation support are less prevalent in Black neighborhoods, according to the CDC. 

The Association of Women’s Health, Obstetric and Neonatal Nurses also says Hispanic and Black women classified as low-wage workers have less access to lactation support in their workplaces. 

The racial disparities reach far back in America’s history. The demands of slave labor prevented mothers from nursing their children, and slave owners separated mothers from their own babies to have them serve as wet nurses, breastfeeding other women’s children. 

In the 1950s, racially targeted commercials falsely advertised formula as a superior source of nutrition for infants. And studies continue to show that the babies of Black mothers are more likely to be introduced to formula in the hospital than the babies of white mothers, which happened to Isidoro after her emergency cesarean section. 

Physicians say introducing formula means the baby will require fewer feedings from the mother, decreasing the milk supply as the breast is not stimulated enough to produce. 

Andrea Freeman, author of the book “Skimmed: Breastfeeding, Race and Injustice,” said these mothers still aren’t getting the support they need when it comes to having the choice of whether to breastfeed or use formula. They also may have jobs that do not accommodate the time and space needed for breastfeeding or pumping milk, Freeman said. 

“Nobody’s taking responsibility for the fact that they’ve steered families of color toward formula for so many years and made people rely on it and taken away choice. And then when it falls apart, there’s not really any recognition or accountability,” Freeman said. 

Breastfeeding practices are often influenced by previous generations, with some studies suggesting better outcomes for mothers who were breastfed when they were babies. 

Kate Bauer, an associate professor of nutritional sciences at the University of Michigan School of Public Health, said she began hearing back in February about Black and Latino families in Detroit and Grand Rapids feeling stuck after finding smaller grocery stores running out of formula. 

Some were told to go to the local office of the Special Supplemental Nutrition Program for Women, Infants, and Children, better known as WIC, the federal program that supports low-income expectant and new mothers. Between 50% and 65% of the formula in the U.S. is bought through the program. 

“Going to the WIC office is like a full day’s errand for some moms,” Bauer said. 

She fears mothers are getting desperate enough to try foods that are not recommended for babies under 6 months. 

Yury Navas, a Salvadoran immigrant who works at a restaurant and lives in Laurel, Maryland, says she was not able to produce enough breast milk and struggled to find the right formula for her nearly 3-month-old baby Jose Ismael, after others caused vomiting, diarrhea and discomfort. 

One time, they drove half an hour to a store where workers told them they had the type she needed, but it was gone when they got there. Her husband goes out every night to search pharmacies around midnight. 

“It’s so hard to find this type,” she said, adding they sometimes have run out before they can secure more formula. “The baby will cry and cry, so we give him rice water.” 

On a recent day, she was down to her last container and called an advocacy group that had told her it would try to get her some at an appointment in five days. But the group could not guarantee anything. 

Some mothers have turned to social media and even befriended other locals to cast a wider net during shopping trips. 

In Miami, Denise Castro, who owns a construction company, started a virtual group to support new moms during the COVID-19 pandemic. Now it’s helping moms get the formula they need as they go back to work. One of them is a Hispanic teacher whose job leaves her with little flexibility to care for her 2-month-old infant, who has been sensitive to a lot of formula brands. 

“Most of the moms we have been helping are Black and Latinas,” Castro said. “These moms really don’t have the time to visit three to four places in their lunch hour.” 

Lisette Fernandez, a 34-year-old Cuban American first-time mother of twins, has relied on friends and family to find the liquid 2-ounce bottles she needs for her boy and girl. Earlier this week, her father went to four different pharmacies before he was able to get her some boxes with the tiny bottles. They run out quickly as the babies grow. 

Fernandez said she wasn’t able to initiate breastfeeding, trying with an electric pump but saying she produced very little. Her mother, who arrived in Miami from Cuba as a 7-year-old girl, had chosen not to breastfeed her children, saying she did not want to, and taken medication to suppress lactation. 

Some studies have attributed changes in breastfeeding behavior among Hispanics to assimilation, saying Latina immigrants perceive formula feeding as an American practice. 

“Over the last three to six weeks it has been insane,” Fernandez said. “I am used to everything that COVID has brought. But worrying about my children not having milk? I did not see that coming.” 

 
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