EXPLAINED: How Spain wants to contain the monkeypox virus

Spain has the second highest number of monkeypox infections in Europe, but what are Spanish authorities doing to try to stop the outbreak?

EXPLAINED: How Spain wants to contain the monkeypox virus
France has 277 detected cases of Monkeypox virus as of June 21, 2022. Photo: CDC handout

Spain’s Health Ministry on Tuesday confirmed 51 monkeypox cases so far, placing the country ahead of Portugal (37) and just behind the United Kingdom (57) in terms of confirmed infections. 

It also means that Spain is currently the non-endemic country with the second highest number of monkeypox infections in the world. 

Monkeypox is not as contagious as Covid-19 and all cases in Spain so far haven’t been serious, but this virus, a milder version of the eradicated human smallpox, isn’t fully understood yet. It has a fatality ratio of 3 to 6 percent according to the World Health Organisation. 

At least 160 monkeypox cases have been confirmed in May 2022 in non-African countries where the virus isn’t endemic, almost all in Europe: mostly Spain, the UK and Portugal and with single-digit cases in Austria, Belgium, France, Germany, Denmark, the Netherlands, Sweden, Italy and Switzerland.

The unprecedented outbreak of this monkeypox virus has put the international community on alert. On Monday, the European Union urged Member States to take steps to ensure positive cases, close contacts and even pets be quarantined, as this is a zoonotic virus (a virus that spreads from animals to humans).

Spain’s monkeypox protocol 

On Saturday, Spain’s Health Ministry published an early detection and prevention health protocol for the monkeypox outbreak, with health officials due to meet again on Tuesday to evaluate further measures. 

People infected with the virus in Spain should self-isolate in “separate rooms” as well as avoid physical contact and sexual relations with others “until the lesions have disappeared”, as monkeypox produces rashes with blisters as in the case of smallpox. 

Spain’s action protocol also requires infected people to wear a face mask and that they have to go out to seek medical attention that they use public transport.

Recent cases of the virus in Europe are thought to have been spread through sexual activity but according to the CDC “human-to-human transmission is thought to occur primarily through large respiratory droplets”, which explains the mask requirement. Transmission via bodily fluids, lesions or through contaminated materials such as bedding is also possible.

Close contacts of positive cases in Spain do not have to quarantine but they should also “constantly” use a face mask in public, Spain’s Health Ministry writes, as well as take extra precautions and reduce social interaction.

People infected with the monkeypox virus should cover and care for their wounds and there should be adequate hand hygiene with soap or hydroalcoholic gel by members of the same household.

The Health Ministry considers close contacts to be people who have had contact with a confirmed case, “less than a metre away” from them in the same room and without a mask, or if they’ve shared clothing, bedding or other objects.

Spanish health authorities also state that infected people should “avoid contact with wild or domestic animals”, in the sense that “pets must be excluded from the patient’s environment”.

Smallpox vaccines 

There is no EU-approved monkeypox vaccine for Spanish health authorities to purchase currently, but according to Spanish national daily El País, Spain’s Health and Defence ministries are to buy 2 million vaccine doses for the traditional smallpox virus at a cost of €7.2 million. 

Vaccines for smallpox have an 85 percent effectiveness rate against monkeypox according to the WHO, as the two viruses are members of the same family.

This vaccine is not intended to be administered to the general population, but rather only to close contacts of confirmed cases if infections continue to rise.

Monkeypox, la viruela del mono in Spanish, is a rare viral infection that’s endemic to West and Central Africa, and unlike human smallpox, it hasn’t been eradicated. 

Its symptoms are similar but somewhat milder than smallpox’s: fever, headache, muscle aches, back pain, chills, exhaustion, although it also causes the lymph nodes to swell up.

Within one to three days, the patient develops a rash with blisters, often beginning on the face then spreading to other parts of the body. 

Monkeypox typically has an incubation period of six to 16 days, but it can be as long as 21 days. Once lesions have scabbed over and fallen off, the person with the virus is no longer infectious.

Although most monkeypox cases aren’t serious, up to one in ten people who contract the disease in Africa die from it, with most deaths occurring in younger age groups.

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Shortage of medicines in Spanish pharmacies grows by 150 percent

Spanish pharmacies are increasingly struggling to get the proper supply of certain medicines such as paediatric amoxicillin and some anti-diabetic drugs.

Shortage of medicines in Spanish pharmacies grows by 150 percent

In 2022 Spanish pharmacies experienced supply problems with 403 medicines, according to Spain’s General Council of Pharmaceutical Colleges (CGCOF).

Though this figure represents just 5 percent of the total 20,000 medicines sold in Spain, it is an increase of 150 percent compared to 2021 and represents what experts have deemed a “worrying” trend that is rising after two years of decline. The shortages last an average of four or five weeks.

This was the warning made by the CGCOF based on its data on the supply of medicines (CisMED), which is focused on ‘supply alert’ notices provided by almost 10,000 of the 22,000 pharmacies across Spain.

READ ALSO – Reader question: Are there limits on bringing medicines into Spain?

On average in 2022, more than 70 medicines were identified as suffering from shortages per week. The weekly average for 2021 was 28 incidents and in 2020 it was 41.

Of these shortages, experts say they are especially pronounced in medicines for the nervous system and cardiovascular groups, and “very significantly” pronounced with paediatric amoxicillin and some anti-diabetic drugs.

Medicines for the nervous system made up around 20 percent of the incidents, followed by cardiovascular therapeutics, with 19 percent, digestive 14 percent, and respiratory 13 percent.

READ ALSO: Pharmacies in Spain will be able to sell medical marijuana by the end of 2022

Call for calm

Stark as this statistic may seem out of context, however, it does not suggest that shelves in Spanish pharmacies are bare nor that Spaniards are being turned away by out-of-stock pharmacists.

Speaking at a press conference on Tuesday, President of the CGCOF, Jesús Aguilar, soothed fears by drawing distinctions between different types of shortages, one, he said, was “when there is none for anyone,” and the other a lack of supply “when there is none today but there will be tomorrow, or when there is none here but there is there”. 

Spain, he said, was suffering the second, adding that pharmacists can always replace or find alternative medicines. “Citizens have to be calm. It’s under control. We have the problem when it comes to looking for the medicine, not the citizens,” he added.


The causes of the shortages of certain medicines in Spain are various, but many stem from a combination of the centralised nature of production, meaning some medicines are produced only in certain parts of the world or even single factories, and a shortage of raw materials and packaging from Asian countries where production has been slow to recover from the pandemic shutdown, as well as the low price of medicines in Spain.

The issue is “a multifactorial problem that comes from problems with the increasingly globalised nature of drug manufacturing,” Aguilar said. “This supply problem has been affecting Spain for years, as well as the rest of Europe and the world.”


To try and ease the supply shortages, the CGCOF has launched a new campaign to expand ‘Farmahelp’, a collaborative network of pharmacies that already has almost 6000 participating branches.

The Farmahelp app allows patients to find medicines in nearby pharmacies when they are unavailable and connects the pharmacy branches so they can update one another about the availability of medicines.