November 6, 2023
JAKARTA – Health authorities have found more mpox cases across the country after epidemiologists estimated that the actual caseload was much larger than the number of reported and detected cases.
Experts say the high number of cases that had gone undetected could be due to stigmatization and the government’s poor risk communication, potentially putting more people at risk if these aspects were not corrected soon.
Mpox is a viral zoonosis that originated in Africa. The World Health Organization initially considered the disease to be a Public Health Emergency of International Concern (PHEIC) following an outbreak in several countries in May last year. Later in November 2022, the United Nations health body renamed the disease formerly known as monkeypox to distance it from “racist and stigmatizing language”.
As of Thursday evening in Jakarta, at least 26 active mpox cases are currently receiving treatment in isolation, according to the city’s health agency. All patients are men aged between 25 and 50 years, and doctors suspect they contracted the pathogen through sexual contact.
The figure marks a jump from around six cases in mid-October.
Indonesia detected its first mpox case in August 2022, and the patient recovered that same month.
‘Tip of the iceberg’
Health authorities ramped up detection and prevention measures beyond the capital amid the increasing number of cases.
At least two new cases were detected on Thursday in the neighboring province of West Java, kompas.id reported.
One patient is still undergoing treatment in the isolation ward of the Hasan Sadikin Central General Hospital in Bandung, while the other patient from Karawang regency has recovered.
The Jakarta Health Agency has administered 492 mpox vaccine doses out of a total target of 495. Indonesia reportedly has 1,000 vials of the mpox vaccine at its disposal.
Maxi Rein Rondonuwu, the Health Ministry’s disease control and prevention director general, told a press briefing on Oct. 26 that the number of mpox cases in the country might be higher than recorded.
“Looking at our key [high risk] population, we could have 3,600 mpox cases [without] proper intervention and education,” Maxi said, citing an epidemiological forecast.
Epidemiologist Dicky Budiman at Griffith University in Australia concurred with the projection, saying that mpox had spread through local transmission since authorities detected the country’s first case in 2022.
The recently detected cases were “just the tip of the iceberg”, he added.
Experts believe that high number of cases were undetected due to misconception and stigma surrounding the disease.
When the WHO rang the alarm during last year’s mpox outbreak, misinformation spread quickly online, including among Indonesian netizens, with many describing the disease as a “gay disease”.
The mpox virus primarily spreads through close contact with an infected individual, according to the WHO, including sexual contact as well as face-to-face contact, defined as “talking or breathing” close to each other, “which can generate droplets or short-range aerosols”.
Some studies have also found that the virus could persist for some time on clothing, objects and surfaces touched by a person with mpox.
An individual is deemed to be infectious until after all lesions had crusted over, the scabs had fallen off and a new layer of skin had formed. The process usually takes between two to four weeks.
Better public communication
In a statement issued on Oct. 23, the government said that six mpox patients who identified as bisexual also had HIV. Later, it identified additional patients as men who have sex with men (MSM).
Experts concur that this type of communication approach is ineffective in informing people about the risk of transmitting and contracting the disease, likening it to the discriminative HIV/AIDS campaign of decades ago.
“Anyone who has close contact with mpox patients or contaminated materials are at risk of infection. That’s what the public needs to know,” said Tjandra Yoga Aditama, a public health expert at YARSI University.
Publicly releasing the sexual orientation of patients also rendered ineffective the government’s communication on the health risk of the disease, said Baby Jim Aditya, a sex psychologist and HIV/AIDS activist.
“Any infectious disease has to be treated objectively, be it mpox, COVID-19 or HIV/AIDS, because they never specifically infect a certain gender, age, sexual orientation or other [social] group,” Baby said.
Ironically, on the Frequently Asked Questions (FAQ) page published in 2022, the Health Ministry urged the importance of not stigmatizing patients with mpox “because anyone can get monkeypox, and [stigmatization] can undermine control measures”.
Baby also underlined that without proper risk communication, stigma against mpox and infected individuals would hinder at-risk people from accessing health services and psychological support.
“Rather than focusing on patients’ sexual orientation, the government should highlight the importance of [leading] a clean and healthy lifestyle to prevent spreading the virus,” she said.
The government should also work closely with NGOs to reach high-risk populations, Dicky suggested, as social stigma could deter gay and bisexual men from getting tested, even after they had developed symptoms of the disease.
“Many parties must be involved to maximize contact tracing among vulnerable groups,” he added.