In the second of our series of letters from African journalists, film-maker and columnist Ahmed Rashid looks at monkeypox testing

After two years of covid-19, the conversation about monkeypox testing gives off an unnerving sense of deja-vu. The similarities are: painful swabs, the struggle to find a test, bottlenecks, and a long wait for results.

In the early days of the covid-19 pandemic, experts bemoaned the lack of investment in rapid, at-home testing for various diseases in the U.S.. Eventually, that scale-up happened anyway.

Monkeypox is n’t the best benchmark for whether that future is going to materialize. It’s an unfamiliar disease spreading rapidly, and there’s high demand for tests.

Monkeypox tests involve swabbing the sores that appear over the course of an infection. There are n’t at-home tests for other lesions – like herpes, for example. There is still a lot of work to do to figure out if people are able to successfully swab their own lesions.

People can test for covid-19 without waiting for any specific symptoms to appear. University of Washington professor Paul yager says patients can only be tested once the telltale signs of the disease appear.

A California-based company developed a saliva-based molecular test for monkeypox. It asks people to spit in a tube and send in the sample for PCR testing. Some companies are working on tests that do n’t involve lesions at all.

The FDA still says monkeypox tests should be run on lesions. The test is not authorized or approved by the food and Drug Administration. It’s offered through a program that lets certified Labs develop and run their own in-house tests without going through the normal regulatory process.

If the monkeypox virus shows up in saliva before lesions develop, a saliva-based test could help flag the disease early on. Flow health has tested someone who closely interacted with monkeypox patients but did n’t yet have lesions.

Covid-19 at-home tests are primarily available under emergency use authorizations. Flow health is prepared to file for an emergency use authorization if a public health emergency is declared.

Cue health, which has a rapid molecular covid-19 test, said it’s in the’concept phase’ for a monkeypox test. The at-home test, by definition, does n’t use a lab to start diagnosing patients.

Monkeypox testing takes more work than building directly on the covid-19 experience. A Nigerian doctor who tried to raise alarms about the disease in 2017 was n’t taken seriously by officials and the international medical community. If there’d been more attention to the disease over the past few years, infectious disease experts might have a better understanding of how the virus affects the body.

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