The Canadian Federation of Nurses Unions has been monitoring the evolving situation involving monkeypox, and we are working with governments to ensure that health care workers are adequately protected while delivering care.
On July 2022, the World Health Organization labelled monkeypox a public health emergency of international concern. The virus is behaving in novel ways which are fueling its spread across the globe. Additionally, the WHO is looking to rename the virus to mitigate some discriminatory and stigmatizing implications associated with its name. In the interim, the CFNU will refer to the virus as hMPXV – a placeholder name currently used in the scientific community – to avoid further entrenching the stigma associated with the virus.
As health care workers, we need to be vigilant. As we have done time and time again – during SARS, H1N1, MERS, Ebola and COVID-19 – the CFNU is urging everyone to follow the precautionary principle. This principle holds that the highest level of precaution should be employed, pending scientific consensus on how a virus is spread. This advice was especially prescient during COVID-19, which ultimately turned out to be airborne. There is currently scientific uncertainty around hMPXV; it would appear that the virus has changed somehow, as evidenced by its rapid spread worldwide. Until we fully understand hMPXV’s transmission vectors, all health care workers should err on the side of caution; this means airborne, droplet and contact precautions.
The Public Health Agency of Canada has been transparent about this scientific uncertainty, acknowledging the potential for hMPXV to be airborne. PHAC, therefore, recommends that health care settings implement “droplet and contact protections, in addition to airborne precautions until more information about the potential for aerosol transmission is known.”
This advice is consistent with the precautionary principle.
On the provincial level, the CFNU and all provincial nurses’ unions have contacted their chief medical officers of health to reinforce the need for a precautionary approach.
Another important layer of protection will be vaccination. The smallpox vaccine, which affords some protection against hMPXV, is currently being rolled out in a targeted manner to at-risk populations. At present, the vaccine is in limited supply. It remains to be seen whether a mass vaccination campaign of health care workers will be necessary; as always, we encourage all health care workers to get vaccinated as soon as a vaccine becomes available to them.
Finally, we know from experience that outbreaks of infectious diseases have a long history of bringing harmful stereotypes to the forefront and stigmatizing equity-seeking groups. In the case of COVID-19, we saw a dramatic and deplorable rise in anti-Asian racism, which we are still combatting today.
A chief concern with hMPXV is balancing the need for risk communication without stigmatizing populations. Public health officials are currently focusing their communications and outreach efforts on men who have sex with men, among whom the virus appears to have gained a foothold. Viruses, however, do not discriminate. The current outreach efforts targeting this community are designed to empower individuals to evaluate their risks and take precautions. While this outreach effort is essential, we must be careful not to stigmatize a population still reeling from the enduring harms and discrimination it suffered during the AIDS epidemic.
As nurses, our positive interactions with patients, clients and residents have deep reverberations – they can make an impact that lasts a lifetime. Sadly, the opposite is also true; negative experiences with the health care system discourage equity-seeking folks from seeking care when needed, which further contributes to unequal health outcomes.
As we weather this next chapter, let’s ensure everyone can access safe, compassionate and affirming care.
For more information on hMPXV, please consult the following sources:
Public Health Agency of Canada – hMPXV
Canadian Medical Association – Five things you need to know about hMPXV
Centers for Disease Control and Prevention – hMPXV
World Health Organization – hMPXV
For more information on combatting racism, homophobia and transphobia in health care, please consult the following CFNU articles:
“It’s not because you’re Black that COVID likes you better.”
“You’ve got to talk to the people who are affected,” says Métis Senator
Trans-affirming care is life-saving care
