The emergence and re-emergence of new and old infectious diseases has widely been linked to poverty and vulnerability, malnutrition and poor healthcare behavior that is more prevalent in low-income countries mainly in sub Saharan Africa. Previous studies and reports have showed a significant relationship between poverty and vulnerability to poverty related outbreak or infectious outbreak emergence and spread in developing and developed countries [3]. This emergence of Monkeypox in over 50 high income countries has been probably associated with multiple and unprotected sexual activities amongst young age/adults, contact with infected patient, infected tools and products or untreated HIV/compromised immunodeficiency infections respectively. The disease can be transmitted directly or indirectly through contact with infected skin lesions of contaminated patients, share towels and bedding, gays and unprotected bisexual intercourse. Typical symptoms varied from fever, aches, myalgia, intense headache, lymphadenopathy and skin eruption similar to Chickenpox, syphilis and herpes simplex [1, 3].

Although the factors influencing the current Monkeypox outbreak in non-endemic areas are unclear. However, the COVID-19 pandemic, unemployment, international trade and travel have an impact on the cross-country transmission of Monkeypox. Moreover, the lack of surveillance and detection capacity due to poverty in endemic areas affects the prevention and control response to Monkeypox. Yet, ongoing Monkeypox outbreak emergence and rapid spread in non-endemic countries is still poorly understood. However, global travel and trade, job loss and COVID-19 pandemic economic and social conditions effects to unhealthy sexual and reproductive activities have been linked to the ongoing outbreak and transmission in non-endemic developed countries. It has long be recognized that poverty is one of the major social and economic determinants of health, hunger, ill-health and poor environment, inadequate sanitation and poor potable drinking water related vulnerability amongst at risk groups. Since the poor populations face a higher spark risk and spread related health and economic shocks, understanding why and how the poor or rich are more vulnerable to neglected tropical disease outbreak and pandemic burden is crucial. Analyzing and understanding aspects of what protections are required and how they affect individuals and societies due to under investment in health system preparedness, lack of effective Monkeypox vaccine and therapies, weaker health systems, limited capacity and how impoverishment reflects the painful choices facing poor African countries at greatest risk, undetected longer and smolder spread will go far in aiding address the increasing outbreaks dynamics around management and control of outbreaks [3, 4].

It has been demonstrated that poverty in time of pandemic or epidemic infection rates showed no significant difference under non-intervention, the peak case is maximized across poor and rich people. Also, larger populations, higher fraction of poor and long durations of interventions are found to progressively worsen outcomes for the poor mainly stigmatization and social deprivations. Addressing Monkeypox outbreak poverty related vicious cycle and challenges requires a deep and rigorous operational research to understanding structural poverty and epidemic. Syndemic or comorbidity of COVID-19 and ubiquitous malnutrition linked to rapid expansions of human settlements and climate change, intensifying livestock production and amplifying outbreaks threats continue to bear the brunt and a toll on vulnerable and marginalized groups in Africa and others low income countries. Noting the absence of regular and sustained Monkeypox surveillance and monitoring mechanisms in both endemic and non-endemic countries, the syndemic of COVID-19 pandemic and Monkeypox epidemic could be of more significant health, socioeconomic and global health security consequences if effective and sustained programs and interventions failed to respond to poverty vicious cycle needs amongst the most vulnerable and marginalized groups.

Ongoing epidemiological investigation reported that most cases are linked to men–men sexual intercourse and have no travel history in endemic settings. Hence, non-travel reported case is atypical and could serve as outbreak alertness and strengthening of international health regulations 2005 and global health security measures [1]. The unexpected Monkeypox outbreak spread in new zones remain of global and regional concern to forthcoming two major mass gatherings events will be taking place in Gulf countries namely the Hajj and Umrah 2022 in Saudi Arabia and Qatar FIFA World Cup 2022 slated to over 2 million participants, tourists and visitors. Hence, proactive and precautionary measures including traveler information update and appropriate vaccinations implementation are vital responses and countermeasures to prevent and contain the threats and post-event effects.

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