Blistering pace: monkeypox spreads

Hello and welcome to The Intelligence from The Economist. In London, I'm Jason Palmer.

And in New York, I'm Jon Fassman. Every weekday, we provide a fresh perspective on the events shaping your world. Nuclear power may be green, but spent nuclear fuel is anything but. Most is currently stored in temporary underwater pools. But our environment editor has visited the world's first permanent repository in Precambrian bedrock deep beneath Finland.

And over the past 4 decades, access to education around the world has increased dramatically. That's the good news. The bad is that in far too many countries, the quality of schooling that students are getting is in decline.

First up, though, One person in Brazil and two in Spain have died of monkeypox. These are the first fatal cases of the disease outside Africa. Health authorities in Brazil said the man who died was suffering from lymphoma, which had weakened his immune system. For most people, though, the risk of death remains low. But the disease is proving excruciatingly painful for many as it spreads around the world.

I had a friend of mine who went out one night and he came back a few days later with a huge, enormous rash on his side and on his nose. And we were all a bit shocked. And he couldn't even get out of bed and he'd been stuck in there for a week. And he said it was horrific. So I think that instilled a little bit of almost panic in me.

99% of infections are in men who have sex with men.

As a member of the gay community, I think it's important So stay safe and learn lessons from the past. And I think the real clinker for me was when a friend of mine contacted me when I was away with work and he said, "Whatever you do, go and get this vaccination." New York State and San Francisco have both declared monkeypox a public health emergency.

London is another locus of monkeypox transmission. Long queues have formed there outside some hospitals after vaccination units were set up.

I heard that they were offering vaccinations through basically word of mouth and on social media. When we found out about it on the WhatsApp group, we immediately went down and got our vaccinations, as did many, many other people. You'd be easily looking at about 2,000 or 3,000 people there at Guy's Hospital on that day.

For many in those queues, the outbreak is reminiscent of the early days of HIV.

I think the lessons from the past and history and all the things that happened in the '80s, you know, I think it's really important that we take charge of a situation while we've got the opportunity. I think I and I think the rest of the gay community would like to lead by example, and I think that's really important to show that There's an opportunity there to really tackle it, and I think we really should.

Limiting the impact and the spread of the virus relies on the right information getting to the right people. But that's becoming harder as the disease spreads.

Since the outbreak began, there have been around 20,000 cases of monkeypox globally. About 70% of them are in Europe, and most of the remaining cases are in America.

Slaveja Cankova is The Economist's healthcare correspondent.

On July 23rd, the World Health Organization declared the spread of monkeypox a public health emergency of international concern, which is the highest level of alert it can issue. The hope is that this declaration will intensify global efforts to curb the spread of the virus, and the designation also gives the World Health Organization more power to coordinate action to stop transmission.

And, Slaveya, we've now had 2 fatal cases in Spain and another in Brazil. We know that the person in Brazil already had a weak immune system, but how dangerous is the virus really, and how has it spread?

So it's not very dangerous in places with good healthcare, but in Africa, where monkeypox is endemic, usually people catch it from wild animals there, as many as 3 to 6% of cases can be fatal. In Europe, however, only about 130 of more than 13,000 cases have needed clinical care of hospitals, and that's usually for pain relief because some of the blisters from the disease can be in places where they can be extremely painful. There's also an antiviral drug which is used in Europe, in America. Now, how people catch it, they can pick it up from infected bedding, clothes, or utensils that have been used by an infected person. But scientists believe that skin-to-skin contact, including sexual contact, is the primary route of transmission in this outbreak.

And most of the infections, Sylvie, as I understand it, appear to be in men who have sex with men, even though this is not strictly speaking a sexually transmitted infection. Why in that population?

Well, while it's not a sexually transmitted infection per se, monkeypox is most easily transmitted through very close bodily contact, which can include sex. And men who have multiple sexual partners are more likely to get it because of that. And From surveys of patients, we know that in pretty much every Western country that has had cases, 98, 99% of cases are currently in this group. So the outbreak is very heavily concentrated among men who have sex with men, particularly those who have high-risk sexual encounters. So multiple partners, group sex, sex with anonymous partners. From those surveys, we know that sometimes the average number of partners in the past 3 months that are reported is more than 10. 10. So it's a very specific group in which it's spreading at this moment.

Given that spread, I wonder if there are comparisons to be made with the early days of the HIV pandemic, how that virus spread in the 1980s and how society reacted.

There are some parallels that have been drawn with the HIV epidemic. In its early days, of course, few people were concerned because it wasn't in the so-called general population. It was just gay men. And back in the '80s, adverts, public health adverts, telling people how to protect themselves were very general.

There is now a danger that has become a threat to us all. It is a deadly disease and there is no known cure. The virus can be passed during sexual intercourse with an infected person. Anyone can get it, man or woman.

Few people would even talk about men having sex with each other, So targeted warnings, which would have been most effective, were slow to come. But we are in a very different situation now. There is a much greater acceptance of gay and bisexual men, and that means that they seek healthcare more openly. Public awareness campaigns can be directed towards them. They have very actively organized communities which have been very helpful in spreading the message with monkeypox outbreak. So a very, very different place. But that being said, we were off to a late start with public messaging on monkeypox because at the beginning of this outbreak, it started in May, there were still problems of public health officials saying anyone can get monkeypox. And it was clear that yes, anybody can get it, but the really high risk was among men who have sex with men. The risk for the general population was, and it still is, quite low. The director general of the World Health Organization In fact, was very specific and said you should limit your sexual partners, be careful, just directing this message to this group. And of course, this time around we have a vaccine and gay and bisexual men have readily lined up for the jab, which will make a huge difference.

Now vaccination, of course, is a big difference between the HIV pandemic and this monkeypox outbreak. How has it been possible to offer vaccination so quickly?

Well, it would be a remarkably fast turnaround for a disease that first started spreading in May, wouldn't it? The truth is that monkeypox is very closely related to the smallpox virus, and we already have several vaccines for smallpox. So some countries have even stockpiled them in the event of bioterrorism with smallpox. So we don't know exactly how effective the vaccine will be in this particular outbreak. That data is being gathered, but the thinking is that it will be highly effective.

Do you think effective vaccination programs will prevent the virus from becoming broadly endemic, from spreading into other groups?

Yes, I do think so. It's of course hard to tell where this outbreak is going to go. The virus is probably not going to disappear. It has spread quite widely at this stage. So experts are of two opinions of what may happen. Some experts think that the way the virus is spreading, is it just needs those networks of people with multiple sexual contacts to continue to spread. So those experts think that if it does spread out of those groups, it may hit a dead end just because the contact required, the intensity of the contact between many people wouldn't be there. But other experts fear that the virus may cross over into other groups and spread there in a more sustained manner like HIV did. In America, HIV first spread among gay men. It's still primarily circulating among gay men, but a quarter of new cases now are among women, mostly Black women. And of course, some people worry that small children, where skin-to-skin contact in daycare settings and kindergartens is very high, may really spread the disease widely if it does end up in those groups. But These are just scenarios that may not come to pass, and we've already had more than 20,000 cases, and they're clearly confined to one specific group that's also lined up for the vaccine in large numbers.

I think gay men in general, we're quite healthy people, and we're always getting checked, and probably more regularly than straight people, to be honest. And so ultimately, I think we want to lead by example. It's not just something affecting the gay community, it's something that could affect everyone. On as a whole, and we need to get on top of it while we can.

And hopefully, because of the widespread awareness among this group about the virus and the availability of vaccines, these things will dampen down its spread.

All right, Slava, thanks so much for your time today.

Thank you for having me.

Oncola is a research facility owned by Posiva Limited. Oncola can be utilized in the construction of a spent fuel repository.

I went to visit a nuclear power facility on the island of Olkiluoto in southern Finland.

Katrine Braeck is The Economist's environment editor.

It will be one of the first places in the world to permanently store highly radioactive nuclear waste deep underground.

For reasons of safety.

The idea of deep geological storage for nuclear waste is that you need to isolate the waste from humans for centuries to millennia. And in order to do this, you put multiple barriers between the waste and humans. Currently, in the absence of any facility having yet been created, all nuclear waste from power stations all around the world is currently stored in temporary storage. Fundamentally, what you need to do is provide barriers that will degrade much more slowly than the nuclear waste within it is degrading itself. So the Onkalo facility, which is where the nuclear waste will be stored, is effectively an oversized elevator shaft with a large encapsulation facility at the surface and then a 450-meter-deep shaft descending to the storage facility at depth.

On a visit to Onggo, you are required to wear the following protective equipment: safety helmet, hearing protectors, protective goggles. A signal in the helmet so somebody knows where you are.

After the safety briefing, I pulled on my boots, grabbed a torch and a helmet, and accompanied by Pasi Tuohima, our guide, we set off for the first part of the site. The nuclear waste arrives at the facility from the nuclear power plant nearby in these thin steel rods. Those steel rods then get sealed into large copper cylinders in the hot chamber. So the entire encapsulation process will be done by remotely operated robots. And in fact, in the room, we could see one of these enormous robotic hands effectively suspended from the ceiling. From there, the capsules get pushed into a lift shaft that goes vertically down 450 meters into the bedrock. To visit the final storage site, we had to get into a car and drive down the access road that spirals 5 kilometers all the way around the elevator shaft. We've been driving down a tunnel for maybe 10, 15 minutes now, down in England. Line. It's quite cold and my ears feel weird because, because of course we're now already, I don't know, possibly several hundred meters down. We eventually arrived at the storage level and got out of the car.

The end of the elevator is also there.

It's the end of the shaft that comes 450 meters down from the surface above, and that's where the canisters of spent nuclear fuels come down. Walking around with us was Antti Joutsen, a geologist with the project. At canister 7, you saw these copper capsules, which are about 8 meters high, so they're enormous, will be taken away again by remotely operated vehicles.

We will follow that, uh, route that canister will take.

So you've got to imagine that this entire facility is absolutely enormous. So to go from one place, for instance the temporary storage room, to another, the final storage facility, you've got several minutes of driving between those two places. So we had to get back into the car to go to the disposal tunnels, and eventually We arrived at a place where the tunnels actually got smaller. This is the final deposition site.

And we have been locked here.

So this tunnel is really dark.

This is under construction, so not equipped yet, so there is no light.

They took us to a demonstration site where they've been testing methods for sealing off the capsules.

This is our demonstration area.

So in this demo tunnel there are 1, 2, 3, 4 demo hatches, each of which has a little square hatch on top that you can open up and peer down into. The final storage place for the nuclear fuel, which is a column 8 meters high. And the idea is that they will have these robotic vehicles carrying the capsules that will drive up above the hatch, and then the capsule will be lowered into it. The whole thing will be backfilled with a material called bentonite, which is effectively kitty litter. The idea being that you need something that absorbs water and it prevents the water from reaching the metal of the capsule. And then more bentonite is filled on top and the hole is sealed off.

Every country in Europe—

Ultimately, the entire site will be composed of roughly 100 interconnected storage tunnels. Each of those storage tunnels will have a capacity for 65 tons of spent fuel in 30 evenly spaced holes. The exact location of the repository was chosen because of the geology of the site, and in particular, the rock down here has barely shifted in millions of years.

This rock, it's 1,900 million years old.

The current consensus is that corrosion rates combined with the rates of processes which might bring any radioactive material towards the surface are so slow that by the time that anything does get to the surface, it will pose little risk to whatever life is around at the time.

Then there's been at least 10—

The company which is operating the site is responsible for it for 100 years. After 100 years, the entire thing gets backfilled and sealed off from the surface, and they hand over responsibility for it to the government. At that point, the idea is to effectively leave no trace. so vegetation will be restored. There will be no signage of what's underneath. They think that this will prevent anyone from stumbling across it or even seeking out the radioactive waste for more nefarious reasons. It was fascinating to see this one-of-a-kind site, but as we drove out, I couldn't help but wonder what it would take to build similar sites in countries around the world to tackle the 60,000 tons of high-level radioactive waste that is currently in temporary storage. Technologically, this isn't particularly difficult to do. It's basically a big tunnel with a lot of fun tech around it. But what's stopped something like this being built over and over again in other countries is nimbyism. Most people don't want nuclear waste to be buried in their backyard for hundreds, let alone millions of years. And yet the Finnish people, I'm told, tend to be very trusting of their governments. And here in particular, the population tends to be extremely pro-nuclear simply because they've grown up with a nuclear power station in their backyard. That's not a situation that is easily replicated in other countries.

It's clear that the pandemic has been disastrous for children. According to the World Bank, school shutdowns have set learning back by months or even years. Last month on the show, our education correspondent told us about studies that found learning loss was worse in middle-income countries than in poor ones. But that may reflect long-term failure more than comparative success. In lots of countries, the quality of education is so bad that being out of school hardly matters.

In recent years, the World Bank has highlighted a learning crisis in low-income and middle-income countries around the world.

Vishnu Padmanabhan is a data journalist at The Economist.

In 2022, 70% of 10-year-olds in these countries could not read or understand a simple written text. Even before the pandemic, this figure, which the World Bank calls the learning poverty rate, was 57%. This data suggests that schools are failing children, but this is not a recent crisis. A paper published earlier this year by researchers at the Center for Global Development suggests that the problem is actually part of a worrying long-term trend which is that even as more children have enrolled in schools, the quality of education they're getting has steadily declined or remained stagnant.

So let's start though with the good news. More children are enrolled in schools. How's that been playing out?

Yes, that is very much the good news here. The researchers used data from demographic and health surveys conducted in more than 80 poor countries over a span of 40 years to show that access to education really has increased dramatically. For example, in South Asia, only 29% of women born in 1960 have completed at least 5 years of schooling. But among women born in 2000, that figure is 84%. Similarly, in Sub-Saharan Africa, the share of women completing at least 5 years of schooling has doubled. Since these demographic and health surveys tend to focus on women, there was less data available for men, but the limited data we have there suggests a similar trend. And this greater access to schools, especially for women, is a remarkable achievement. The problem is that quality is not keeping up.

But how do they know that? How is that measured?

So measuring the quality of education across countries and over time is tricky. Poor countries rarely participate in international assessments and often lack the resources to conduct regular standardized tests. So the researchers use the ability to read one sentence among women who have completed 5 years of schooling as a proxy for the quality of their education. And the picture that's painted was very mixed, with most of the news being bad. In 56 countries, literacy rates decreased among women with 5 years of schooling born in the 1960s compared with those born in the 1990s. Countries in South Asia and Sub-Saharan Africa experienced the biggest declines. In India, for example, the percentage of women born in the 1990s who are able to read one sentence after 5 years of schooling is just 45%, but for older women born in the 1960s, it is more than 80%. In other countries in Southeast Asia and Latin America, education quality has not declined but remained stagnant over time. Only in 14 countries such as Peru and Vietnam has education quality significantly improved. In these countries, women born more recently, in the 2000s for example, were more likely to be literate than those in earlier cohorts. And here too, the trends for men are similar.

And what's the thinking on why that would be the case?

One explanation for this decline in education quality could be that as more students enter classrooms, the quality of teaching suffers. Around the world, there's been an influx of students from low-income households into schools, especially after several countries made primary education free. These students may be less prepared for classroom instruction and find learning to read more difficult. The researchers suggest that these factors could explain some of the decline in education quality, but not all of it.

So there are other factors at work here.

Yeah, the results suggest that there may be systemic problems with the way countries deliver education. In fact, the World Bank in 2017 blamed poor teaching, ineffective education policies, and weak management of schools for this learning crisis. And given the steady decline in quality of education over the years, a business-as-usual approach to schooling clearly won't work. They will need to address some of these systemic issues. And of course, COVID-19 did not help with any of this. It forced countries to grapple with delivering education remotely, which presents a different set of challenges. But now with schools reopening, the focus should go back to the more fundamental issue, which is improving school quality.

Vishnu, thanks very much for your time.

Thank you.

That's all for this episode of The Intelligence. Let us know what you think of the show. You can get in touch at podcasts@economist.com.

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