Just as the world breathed a sigh of relief following a relative drop in the severity and prevalence of COVID-19 cases, the alert was raised again after monkeypox arrived in Europe and the Middle East. The World Health Organization (WHO) recently announced that there have been more than 220 confirmed cases and 89 suspected cases of monkeypox in 23 countries, including in non-endemic countries. This has raised fears that monkeypox could be the next pandemic after COVID-19. The WHO stated on 27 May 2022 that it was concerned about the community spread of monkeypox and affirmed that containing the spread of the virus in non-endemic countries was a priority.
A Perplexing Virus
Monkeypox is a rare disease that originates in animal populations, although it is thought to come from rodents, not monkeys. The virus is usually transmitted animal-to-human when a person living in an endemic region touches an animal carrying the virus, and the virus jumps from one species to another. Monkeypox first causes a rash, which later develops into pustules and lesions.
Monkeypox symptoms in humans are similar but less severe to those previously seen with smallpox. The WHO stated in its most recent fact sheet on monkeypox that it is a rare disease that occurs primarily in remote areas in West and Central Africa near tropical rainforests. An antiviral agent developed for smallpox can also be used to treat severe cases of monkeypox due to the similarities between the two viruses. However, many experts caution that the virus’s spread can only be contained through certain restrictions and safeguards to prevent its transmission. According to the WHO, "some of these cases are being found in communities of gay, bisexual and other men who have sex with men." Nevertheless, any person can be infected with monkeypox.
A Cause for Concern
Although the monkeypox virus is not new, what is new about the current situation is that the virus is spreading outside endemic areas in West Africa. Cases have been discovered in Canada, the US and Europe. Experts have indicated that the virus is behaving differently, but they are not sure why. There are two possible explanations for this: either the virus has mutated, or the original version of the virus has become more prevalent. This has compounded concerns that the virus poses an emerging threat due to the following reasons:
1. Failure to contain similar viruses: In recent decades, chickenpox, Ebola, and Zika virus spread quickly in various countries around the world. These viruses proved difficult to contain even though experts at the time did not think they would be a problem. Monkeypox has started to spread more quickly, which has sparked further concern.
2. New pathways for viral spread: Monkeypox had previously been thought to be transmitted to humans from infected animals, such as monkeys, rats, and squirrels, through touching contaminated surfaces or objects, such as bedding or clothing. Less commonly, transmission could occur through direct contact with infected persons, either through skin lesions, respiratory droplets, or through contact with the eyes, nose, or mouth. However, this recent wave of relatively wider spread of monkeypox has involved many unconnected cases, which has heightened concerns. Experts think that the virus has been spreading undetected for some time and mutated in a way that allows it to infect more people. For this reason, cases are expected to continue to rise.
3. Cases likely to rise in summer: Although monkeypox is a DNA virus, which means that it cannot mutate as quickly as viruses like COVID-19 or influenza, very preliminary genetic analyses suggest that the current cases of monkeypox are closely related to versionsof the virus that were seen in 2018 and 2019. There is no evidence as of yet that this wave is the result of a new monkeypox variant. However, many experts warn that cases are likely to rise, especially during the peak summer season when more gatherings take place.
4. High-risk populations: Monkeypox is a virus that evades the host’s immune system. It can be more dangerous for young children, pregnant women, and persons with immunodeficiencies, i.e., for a not-insignificant portion of the population. This has exacerbated concerns about these higher-risk individuals becoming infected or that they could become carriers of the virus and contribute to its spread.
5. WHO warnings: Although the WHO announced that it would provide further guidance and recommendations in the coming days regarding how to limit the spread of monkeypox, it has also provoked further anxiety by stating that it expects to see cases rise, especially in countries where the virus does not usually occur.
Based on the information available at this time, monkeypox could have significant repercussions for various countries around the world. These ramifications can be summarized as follows:
1. Rising panic: While experts remain calm, the world is currently gripped by fear and panic that rising cases of the new virus could lead to COVID-19-like shutdowns, economic woes, and production stoppages. People have run out of energy to endure another pandemic.
YouGov conducted a poll from 20 to 23 May 2022 on the US public’s degree of concern about monkeypox and on opinions regarding the likelihood of a sudden increase in cases in the US. Only 38 percent of persons polled said that they were very concerned about the spread of monkeypox, while 27 percent expected a surge in cases. Approximately 51 percent of Democrats and 33 percent of Republicans said that they were concerned about monkeypox, while only 12 percent of Democrats and 32 percent of Republicans said that they were not at all concerned. Adults under45 were more likely than older populations to be concerned about the virus and to expect an increase in cases.
2. Stigmatizing language: Although monkeypox cases have appeared among various populations, some reports have linked men who have sex with men with this new wave of the virus. This is similar to the kind of stigmatizing language that was used during the early stages of the COVID-19 pandemic. As a result of this stigma, some men could become hesitant to report their cases of monkeypox due to concerns they could be accused of sleeping with men, even if they do not. Additionally, because the virus originated in Africa, there could be a rise in hate speech against Black people, especially in Western countries.
3. Vaccine tussle between countries: Various centers for disease control and prevention, including the CDC, have indicated that there are two smallpox vaccines that can be used to help protect people from becoming infected with monkeypox. These vaccines are currently being prepared for distribution. The WHO has stated that prior chickenpox vaccination is also successful in preventing monkeypox: it is 85 percent effective against the disease and is still sometimes used for this purpose.
Countries are now racing to offer more doses of the chickenpox vaccine out of fear that they could run short later if the current crisis escalates to the pandemic level. This is what has happened in the UK, which obtained a large quantity of vaccines that it is now starting to administer to persons with chronic illnesses or who are immunocompromised. Due to earlier concerns about the likely spread of monkeypox, the US government has also been stockpiling large quantities of vaccines, while the Spanish government bought a large batch of chickenpox vaccines to head off the spread of monkeypox. This could create a short-term crisis as countries scramble to obtain vaccines, which could cause a shortage in vaccine availability relative to demand.
In conclusion, although there have not been a huge number of monkeypox cases, community spread in Europe and beyond has raised concerns. This has also sparked disagreement about the nature of the threat that the virus poses. The prevailing viewpoint thus far has been that there is no reason to worry, especially since the virus is difficult to transmit, unlike influenza, COVID-19, or other viruses. There is no evidence of airborne transmission over long distances, only from direct and close contact between infected persons for an extended period of time. This reduces the likelihood that monkeypox will become a global pandemic like COVID-19. Furthermore, COVID-19 was an entirely unknown quantity when it first appeared, while monkeypox is similar to existing smallpox and chickenpox viruses. Monkeypox is also not usually a fatal disease; infected persons can be cured within a few weeks. By this logic, some feel that it is not necessary to implement lockdown measures, because the virus will likely go away on its own, and it is therefore enough to isolate the infected person.
However, others argue that we should be worried about monkeypox and treat it as a threat. This perspective is most prevalent in the West, where concerns have been raised that the virus’s behavior is changing. Some Western doctors treating persons infected with monkeypox have also indicated that they have seen a new and unexpected mode of transmission. Although they concur that this virus will not become a second COVID-19, they believe that action must be taken to prevent monkeypox from gaining a foothold or getting out of hand.