Dear Editor

Pakistan is experiencing the worst economic crisis in the country’s history. A recent political tumult further deepens the economic misery in the country, resulting in limited or no budget for various sector including health care. ^{Reference Horowitz1} It is pertinent to mention that the health authorities in Pakistan are already facing numerous obstacles in their efforts to contain coronavirus disease 2019 (COVID-19) and increase vaccination coverage amid financial constraints and conspiracy theories. ^{Reference Khan, Mallhi and Alotaibi2} During this hard time, the detection of monkeypox cases in the country may result in health-care crisis and may facilitate the transmission of this viral infection to other regions. It is crucial to keep in mind that there are several ways in which 1 disaster might lead to another. Due to its substantial negative effects on community resilience and health-care system response, the COVID-19 pandemic poses the risk of compounding processes. ^{Reference Liu and Huang3} A network and clustering analysis revealed that countries with more COVID-19 infections also had higher rates of monkeypox infections, with each additional million COVID-19 cases corresponding to 1.286 times more monkeypox cases. ^{Reference Gao, Zhou and Lilang4} These findings support the compound risks of monkeypox outbreak associated with the COVID-19 pandemic that may result in another catastrophe, particularly in developing countries with fragile health-care systems. In this context, designing and implementation of effective disaster risk reduction (DRR) and disaster risk management (DRM) polices and program would minimize the increased threats of compound disasters.

The first monkeypox case was reported in Pakistan on April, 2023, in a 25-y-old male traveler returning from Saudi Arabia. ⁵ It is important to note that as of May 22, 2023, the country had reported 5 cases, all of which involved passengers arriving from abroad, particularly Saudi Arabia. ⁶ The national guidelines on monkeypox have recommended numerous measures to prevent and control disease transmission at international airports. ⁷ However, the country lacks the resources necessary for the implementation and monitoring of control measures, which require vigilant surveillance and screening of passengers at entry points. In addition, most government efforts are concentrated on resolving political issues, and all official apparatuses are engaged primarily in managing political protests and unrest. In this context, there is a propensity for neglecting imported cases of monkeypox as well as local transmission of the disease, which could result in a major health catastrophe for which the country is unprepared. Moreover, another infectious disease outbreak in the context of a recent increase in COVID-19 cases and inadequate vaccination coverage could cause the collapse of Pakistan’s fragile health-care system and pose a significant threat to other South-East Asian regions.

The government of Pakistan needs immediate and stern measures to prevent transmission of monkeypox across the country. Because the majority of Pakistan’s well-equipped labs lack testing equipment such as diagnostic kits for monkeypox, ^{Reference Najeeb and Huda8} it is imperative that the health authorities acquire the necessary testing kits, primers, and reagents to combat a potential viral epidemic. The media, which is currently preoccupied with reporting on political unrest in the country, should concentrate their efforts on educating the public about preventive measures. The educational programs for health professionals will aid authorities in the rapid detection and isolation of cases. Moreover, strict surveillance measures and timely contact tracing are the most effective preventative measures for preventing or managing a potential outbreak of monkeypox in the country. Moreover, a ring vaccination strategy (vaccination against smallpox for those in close contact with infected people) can be an effective technique. The testing stations at entry points will aid in reducing the local transmission of cases imported from abroad. Pakistan requires funds, a special task force, an explicit framework, aggressive surveillance, and monitoring, which necessitate international support from neighboring and global health authorities.