After Ebola and COVID-19: Why Mpox Is Alarming the World

On August 14, 2024, the World Health Organization (WHO) convened an emergency meeting, after which Monkeypox was declared a public health emergency of international concern for the second time in two years.

The WHO's announcement followed the outbreak of the disease in several African countries, including Burundi, Kenya, Rwanda, and Uganda, after a new strain emerged in the Democratic Republic of the Congo. Meanwhile, 13 other countries reported cases of infection.

This represents the highest level of alert that the organization can issue, and it comes at a time when vaccines are not available to help curb the spread of the epidemic in Africa.

The Democratic Republic of the Congo recorded a severe outbreak, with more than 14,000 infections and 524 deaths since the start of 2024.

This marked a 160% increase in infections and a 19% increase in deaths compared to the same period in 2023.

The WHO's state of alert intensified as cases spread beyond the continent, specifically to Pakistan and Sweden.

This warning has raised global concern since a "public health emergency" is a classification previously used during the Ebola and COVID-19 outbreaks and the rise in Monkeypox cases in Europe in 2022.

Monkeypox

Monkeypox, also known as Mpox, is a type of poxvirus with two distinct biological strains.

The first is the Congo Basin clade which causes more severe symptoms and has a higher mortality rate. It is also more easily transmissible.

The second is the West African clade, which is currently the more prevalent type. It causes milder symptoms and has limited person-to-person transmission through contact. However, both strains can be fatal.

“Mpox causes signs and symptoms which usually begin within a week but can start 1–21 days after exposure. Symptoms typically last 2–4 weeks but may last longer in someone with a weakened immune system,” WHO reported.

Common symptoms of the virus include skin rashes and mucous lesions that can last from two to four weeks, accompanied by fever, chills, headaches, muscle aches, back pain, general fatigue, swollen lymph nodes, sweating, coughing, sore throat, nasal congestion, and persistent nausea.

The virus spreads mainly through close contact with infected individuals, such as through touching, kissing, or sexual contact.

It can also spread through contact with infected animals during hunting, skinning, or cooking, as well as through contaminated materials like sheets, clothing, or needles.

Pregnant women infected with the virus can also transmit it to their unborn children.

Although identifying Monkeypox can be challenging due to its similarity to other infections and conditions, such as chickenpox, the diagnosis can be confirmed through a DNA test of the affected area or skin rash.

How Did It Start?

While Monkeypox is commonly associated with Africa, it was historically first discovered in Europe, specifically in Denmark in 1958, among a group of monkeys that were being held for research purposes.

The first human case of the virus was reported in 1970 in a nine-month-old boy in the Democratic Republic of the Congo.

The United States also experienced an outbreak in 2003, particularly in the Midwest states of Illinois, Indiana, and Wisconsin, with one case reported in New Jersey.

At that time, a team of researchers traced the source of the infection and found that it began in a pet store selling Gambian rodents imported with the virus, which then spread to citizens.

On August 16, 2024, a leading researcher in the field predicted that the world might be on the brink of a new global outbreak of Monkeypox. This concern was heightened by the discovery of the first case of the virus outside Africa, in Sweden.

Dr Brian Ferguson, Associate Professor of Immunology at the University of Cambridge agreed it was "clearly a concerning development" but unsurprising given the severity and spread of the outbreak in Africa.

Dr Ferguson said there would likely be further cases in Europe and other parts of the world “as there are currently no mechanisms in place to stop imported cases of Mpox happening.”

Nevertheless, there are vaccines used to treat Monkeypox, derived from antiviral agents like Tecovirimat, originally developed to treat chickenpox.

On August 17, 2024, The Guardian revealed that although vaccines are available, there are challenges in distributing them worldwide, as Africa alone needs 10 million doses.

However, the World Health Organization announced that only 200,000 doses are available, highlighting how the shortage of treatments and diagnostics hinders the response.

The 2022 Crisis

The current concerns surrounding Monkeypox potentially becoming a global pandemic, similar to COVID-19, are not without precedent.

In 2022, a strain of Monkeypox known as Clade 2, originating in West Africa, caused a global outbreak. The disease spread to nearly 100 countries, including several in Europe and Asia.

Countries affected included Canada, the United States, Mexico, the United Kingdom, Italy, Portugal, Spain, Sweden, France, Germany, Belgium, and Australia.

At the time, the World Health Organization declared a public health emergency and implemented contact tracing programs alongside widespread vaccination efforts, following approximately 90,000 reported cases.

However, a notable aspect of this crisis was the link some experts made between Monkeypox and homosexual activity, as the disease had spread significantly among the LGBTQ+ community.

In the United Kingdom and Europe, a proportion of cases was observed among homosexual and bisexual males, as reported by the Daily Mail on May 22, 2022.

In response, the UK government took measures to curb the spread by specifically vaccinating homosexual males against Monkeypox.

On August 6, 2022, the BBC published a report highlighting the connection between the virus's spread and homosexuality.

The report mentioned that “there have been nearly 27,000 confirmed cases of the disease - mostly in men having sex with other men - across 88 countries.”

Although a study published in the New England Journal of Medicine did not categorize the virus solely as a sexually transmitted disease, it estimated that 95% of Monkeypox cases were transmitted sexually, specifically among gay men.

This was corroborated by Susan Hopkins, Chief Medical Advisor at the UK Health Security Agency, who stated in an interview published by the Daily Mail on May 21, 2022, that “a notable proportion of recent cases in the UK and Europe have been found in gay and bisexual men so we are particularly encouraging them to be alert to the symptoms and seek help if concerned.”