Cases of monkeypox, a viral illness usually seen principally in western and central Africa, are popping up around the world.
There are now 257 confirmed cases and 120 suspected cases that have been reported in 23 countries where monkeypox is not endemic, the World Health Organization said on Sunday.
Canada has 26 confirmed cases (all but one in Quebec), Britain has 106, Portugal, 49, and Spain (where the current outbreak is thought to have originated), 20.
With cases rising steadily, and in new and unexpected places almost daily, it does feel a bit like the early days of 2020 when we saw a new coronavirus emerging from China and naively believed it would hardly cause us a spot of bother.
The way monkeypox has emerged has troubling similarities, too, to the early days of AIDS, when a strange new illness appeared in clusters of gay men. Most of the cases of monkeypox to date are also in men who have sex with men. (More on that in a moment.)
While there are some eerie echoes of past catastrophes, this is a very different (read: much lesser) threat than COVID-19.
First of all, monkeypox is a known entity. It was discovered in lab animals in 1958, and the first human case was seen in 1970. (The name is a misnomer because the virus is usually spread to humans by rodents, namely rat bites.)
We have both effective vaccines and treatments.
There is a vaccine specifically for monkeypox – brand name Imvamune in Canada (Jynneos in the U.S.) – as well as large inventories of smallpox vaccine, which is also effective.
Smallpox was declared eradicated by the WHO in 1980, one of the greatest public-health achievements in history. Very few people born in Canada after 1972 have been vaccinated.
There are effective anti-viral drugs used for treatment, called cidofovir and tecovirimat. Monkeypox also tends to be self-limiting, meaning most people get better on their own, though symptoms can linger for months. Deaths are rare.
While it is not a threat to the average person, monkeypox nonetheless merits our attention, because it’s the first big new threat to emerge after COVID-19, the worst pandemic in a century.
As the great science journalist Ed Yong wrote in The Atlantic: “Monkeypox, then, is a test of the lessons that the world has (or hasn’t) learned from COVID. Can we better thread the needle between panic and laxity, or will we once again eschew uncertainty in a frantic quest for answers that later prove to be wrong?”
So far, the response seems fairly level-headed.
It doesn’t look like the virus has mutated, just spread further afield than usual.
Still, we need to remain humble about what we know and don’t know. Hard-hit countries, including Canada, are adopting a “ring vaccination” approach, providing vaccines to close contacts of those infected with monkeypox.
Talk of a mass vaccination campaign has, mercifully, been muted. This, despite the fact that many countries, especially the U.S., are acutely fearful of terrorists using smallpox (the nastier cousin of monkeypox) as a bioterror weapon. That’s why they have massive stocks of vaccines.
We have, unfortunately, seen scapegoating with monkeypox, as we did with COVID. In the early days of the pandemic, we heard racist talk of a “China virus”; similarly, we’ve seen monkeypox labelled a “gay disease.”
We need to be clear, however, that monkeypox is not a sexually transmitted disease. Rather, it is spread by close contact – clothed or not – with an infected person. That the early cases were in men who have sex with men is largely coincidental; that an infectious disease spreads in a tight-knit community is not at all surprising.
If we assume that only men who have sex with men are at risk, we will create a stigma that lets the virus spread uncontrolled, just as what occurred early in the AIDS pandemic.
Monkeypox has also reminded us of our dangerous propensity for not paying attention to infectious disease threats until they are on our doorstep.
Since smallpox was eradicated, monkeypox cases have jumped 20-fold. The Democratic Republic of Congo alone had 4,600 cases in 2020, according to a recent study.
Yet, it wasn’t until a tiny fraction of that number of cases emerged in Western countries that we paid attention.
Infectious disease threats will grow steadily in the years to come, for a variety of reasons, chief among them climate change.
We owe it to ourselves to do a better job of prevention and preparation and, above all, learning from our mistakes.
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André Picard