The monkeypox virus belongs to the genus that includes smallpox, but it is not as contagious or severe as smallpox, which has been eradicated from the planet. Monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo. Since then, it has circulated in 11 African countries. There are two lineages: one from the Congo Basin, which has historically caused more severe disease, and another from West Africa. Nigeria suffered a major outbreak in 2017.
Now the disease is spreading in Europe and North America without an obvious transmission mechanism, such as travelers from Africa. This is an unwelcome surprise, and the reason isn’t entirely clear. Monkeypox generally transmits by close contact with lesions, body fluids and contaminated materials such as bedding, clothing or eating utensils. It is not a respiratory virus like the one that caused the coronavirus pandemic. A person with monkeypox remains infectious while they have symptoms, which can include fever, headache, muscle aches, backache, lack of energy, swollen lymph nodes and a skin rash or lesions. The illness typically lasts two to four weeks. There have been no deaths outside of Africa. Some early reports indicate spread has occurred among men who have sex with men.
The World Health Organization director general, Tedros Adhanom Ghebreyesus, said the sudden appearance of the virus outside of Africa indicates it may have been spreading for some time. Nearly 800 cases have been reported worldwide since May 13, with the largest numbers in Britain, Spain, Portugal and Canada. As of Thursday, 21 U.S. cases had been identified in 11 states.
Monkeypox does not threaten a global pandemic. But it does underscore the enduring vulnerability of all nations to transnational global health threats and the consequences of underinvestment in preparedness, rapid response and disease surveillance. When the WHO set up an independent panel to examine the pandemic response, the co-chairs, Ellen Johnson Sirleaf and Helen Clark, found “weak links at every point in the chain of preparedness and response. Preparation was inconsistent and underfunded. The alert system was too slow — and too meek. The World Health Organization was under-powered. The response has exacerbated inequalities. Global political leadership was absent.” In a follow-up report last month, they warned that the world was moving too slowly to fix these deficiencies. “New pandemic threats will emerge,” they said. “The risks of not being better prepared for them are great, and inaction is hard to fathom.”
Monkeypox may sound like a distant problem out of Africa. But it is another bell tolling for the future of global disease. We ignore the warnings at our risk.