What a difference a week can make to the state of Pandemic Panic in this country.

Today Monica Gandhi, professor of medicine and associate division chief of HIV, Infectious Diseases, and Global Medicine at UCSF / San Francisco General Hospital, wrote in the Atlantic that vaccinating gay and bisexual men against monkeypox is an urgent matter.

The U.S. is underreacting to the monkeypox outbreak. Given that a vaccine is available for the infection—and can be targeted toward the people most at risk—public-health authorities and health-care providers need to move more quickly and forcefully to change the outbreak’s trajectory.

Separately, a group of COVID-19 virtue-signalers known as the “World Health Network” decreed that monkeypox is a “pandemic” and a “Public Health Emergency of Global Concern”.

(Note: Despite the similar verbiage, the World Health Network is no relation to the World Health Organization, and has no official standing as a public health agency so far as I am aware.)

Just last week the Atlantic was telling one and all that monkeypox vaccines were “too gnarly” for most people.

Yes, they actually used “gnarly” in a headline. Edwin Newman is even now turning over in his grave.

Even the medical media was intimating that vaccination was not a priority for monkeypox, and might even be unnecessarily risky.

ACAM2000 could also do more harm than good because it carries an active virus, which poses dangers for people who are immunocompromised, pregnant or have HIV, The Atlantic reported. Because of this risk and the relatively small number of infections, Americans likely won't be waiting in line at mass immunization sites like they did for COVID-19. 

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What Changed?

Why the shift in narrative tone?

Partly, it may be a reaction to the belated realization by researchers and experts that the globally-spreading strains of monkeypox have considerably more mutations than normal mutation rates can explain.

In the latest study, researchers discovered around 50 genetic variations in the viruses they studied compared to ones from 2018 and 2019. This, they said, "is far more than one would expect considering previous estimates" of the mutation rate of orthopoxviruses of which monkeypox is a type—between six and 12 times more.

I am going to indulge in a small victory lap here, as I made the same point two weeks ago.

That monkeypox in Europe is significantly different than in Africa is confirmed by genomic sequencing. As University of Edinburgh researchers Áine O’Toole and Andrew Rambaut detail in preliminary analysis published online, the viral strain in Europe has far more mutations than expected, given the historical pace of mutation and evolution in the virus.

The first MPXV genome sequences from monkeypox cases in 2022 (Isidro et al. 2022; Selhorst et al. 2022) showed, phylogenetically, that these viruses had descended from a clade sampled in 2017-2019 from cases diagnosed in Singapore, Israel, Nigeria and the UK. Comparing 2022 genomes from Portugal, Belgium, USA, Australia, and Germany (see Table 1) with the closest earlier genomes (denoted UK_P2 and UK_P3), identified 47 shared single nucleotide differences (Figure 1).

47 mutations in a 3-4 year interval is an astronomical number of mutations, given the current projected rate of mutation at 1-2 nucleotide substitutions per year. Somehow, the European strain managed to accumulate 6-7 times the expected number of mutations since the strain was last seen in 2019.

Are We Inching Closer To A Bioweapons Hypothesis?

One intriguing—and disturbing—intimation of the latest research is the conclusions that the mutations in monkeypox are mainly associated with a mechanism within the human immune system that normally introduces mutations into a virus to make it less virulent and transmissible, but in this case seem to make monkeypox more transmissible.

Another notable finding from the study is that most of the mutations are of a particular type that could have been introduced by a human defence mechanism called APOBEC3, which works by introducing mutations to viruses in order to stop them from working properly, said Pam Vallely, professor of medical virology at the University of Manchester.

"However, in this case the mutations are apparently not making the virus non-viable and may be helping it to adapt to human-human transmission," Vallely, who was not involved in the study, told Newsweek. "This is just a theory that fits the current evidence, and lots more work is going to be needed to see if this is what is really happening. I don't think we can say the mutations have made it more contagious, but maybe they have made it better adapted to humans."

This appears to be a confirmation of research findings presented initially by Andrew Rambaut and Aine O’ Toole of the University of Edinburgh—the same research that suggested to me there were far too many nucleotide substitutions for a normal evolutionary path.

Does a sustained short-circuiting of what is otherwise a presumably reliable immunological defense mechanism indicate the artificial hand of man somehow guiding—and potentially weaponizing—the virus? I do not know the answer to that question, and certainly there is no other data that would support any sort of lab creation hypothesis.

Still, as I have mentioned before, it is documented fact that monkeypox has been evaluated for possible weaponization, and more than once. We cannot simply turn away from that as a possible explanation, although at this point it cannot be emphasized enough that a lab creation hypothesis is still very much a speculation. Future data may change that, but until that data emerges there is no solid evidence that these strains of monkeypox are lab created.

Simply Ignored?

Another possibility raised by this latest research is that monkeypox has simply been all but ignored even within Africa, and so has spread human-to-human for a far longer period than realized—the so-called “cryptic transmission” or “hidden transmission” hypothesis (which frankly I dislike even more than a lab creation hypothesis).

Jeremy Kamil, associate professor of microbiology and immunology at Louisiana State University Health Shreveport, told Newsweek the study as "very impressive" but said it is too early to say for sure whether monkeypox is undergoing rapid evolution until we can rule out the possibility that the virus has been circulating and adapting in people "for longer than people assume—perhaps starting out in undersampled regions of the world like parts of Africa where monkeypox is endemic."

However, the bureaucratic diffidence that would be indicated by such cryptic transmission does exist within the WHO in Africa.

Ironically, even with this researchers appear to be resistant to the idea of monkeypox spreading to Europe and becoming endemic there.

Two Very Bad Answers

As the research stands, the “experts” are left with two explanations for the mutations, neither of which speaks well of the WHO and other public health relief efforts in Africa:

1. The virus is undergoing “accelerated evolution”, which means there has been a significant shift in some aspect of the virus or its environment, possibly even within Africa unbeknownst to the WHO.

2. The virus has simply been spreading human-to-human, perhaps in Africa, perhaps in Europe, and the cases have simply been either ignored or dismissed.

Both explanations point to the state of the WHO as insular, disconnected, and largely unconcerned with the health situation in African countries—which would make that a recurring theme (again?) for the WHO.

Instead Of Data, Wishful Thinking

True to Pandemic Panic norms, the newfound vaccination advocacy draws significantly on wishful thinking rather than solid evidence and data.

In her Atlantic article , Ms Gandhi presents the Jynneos vaccine as highly effective with data from Africa to back that up.

Monkeypox is related to smallpox, the only human virus that has been eradicated worldwide. A highly effective smallpox vaccine, called Jynneos, has been licensed in the United States for use against monkeypox as well. Data from Africa suggest that it is at least 85 percent effective in preventing the latter condition.

However, that article also cites the CDC’s monkeypox and smallpox vaccination guidance page as the authority for those assertions, and what the CDC actually claims is significantly different.

The 85% efficacy number is actually for the ACAM2000 vaccine.

Because Monkeypox virus is closely related to the virus that causes smallpox, the smallpox vaccine can protect people from getting monkeypox. Past data from Africa suggests that the smallpox vaccine is at least 85% effective in preventing monkeypox. The effectiveness of JYNNEOSTM against monkeypox was concluded from a clinical study on the immunogenicity of JYNNEOS and efficacy data from animal studies.

ACAM2000 received FDA approval in August of 2007, and replaced Dryvax, the former smallpox vaccine administered in this country, in February of 2008.

Jynneos, however, was not approved by the FDA until September of 2019.

How well Jynneos works against monkeypox in the real world is mostly a matter of conjecture at this point. The FDA explicitly conceded this point when it announced approval of the vaccine.

The effectiveness of Jynneos for the prevention of monkeypox disease is inferred from the antibody responses in the smallpox clinical study participants and from studies in non-human primates that showed protection of animals vaccinated with Jynneos who were exposed to the monkeypox virus.

The CDC further amplified this point—as well as the lack of a robust data set on safety and adverse events—in their Morbidity and Mortality Weekly Report dated June 3 of this year.

In 2019, FDA licensed JYNNEOS, a replication-deficient MVA vaccine, for prevention of smallpox or monkeypox disease in adults aged ≥18 years determined to be at high risk for infection with these viruses. JYNNEOS is administered by subcutaneous injection as a 2-dose series delivered 28 days apart. There is no major cutaneous reaction, also known as a “take” (a vaccine site lesion often used as a marker of successful vaccination with replication-competent vaccines such as ACAM2000), following vaccination with JYNNEOS and consequently no risk for inadvertent inoculation or autoinoculation. The effectiveness of JYNNEOS was inferred from the immunogenicity of JYNNEOS in clinical studies and from efficacy data from animal challenge studies. Occurrences of serious adverse events are expected to be minimal because JYNNEOS is a replication-deficient virus vaccine. However, because the mechanism for myopericarditis following receipt of ACAM2000 is thought to be an immune-mediated phenomenon, it is not known whether the antigen or antigens that precipitate autoantibodies are present in JYNNEOS as well. ACIP began considering discussing the data for JYNNEOS in February 2020. This report describes the ACIP recommendations for the use of JYNNEOS for preexposure prophylaxis in persons at occupational risk for exposure to orthopoxviruses.

While the argument that gay and bisexual men could derive significant protection from monkeypox vaccination, given the disease’ curious prevalance within that particular patient demographic, is worthy of consideration, for Ms. Gandhi to so egregiously mis-state the status of the Jynneos vaccine is most charitably explained as being borne of a desire to protect a patient population at demonstrable risk, yet still falls far short of her ethical obligations as a clinical medical researcher and physician to present the data honestly. She should have known better.

Wishful thinking may make for great advocacy, but it is horrible science and even worse journalism—the Atlantic might want to engage in more rigorous fact checking of such pieces in the future (talk about wishful thinking!).

The Unknowns Are Still Unknown

Monkeypox is not, at this point, a major health crisis. It is not a Public Health Emergency of International Concern, nor is it a pandemic. Outside of Africa, people are not (yet) dying from monkeypox.

Yet monkeypox should be of concern, simply because even now the unknowns are still largely unknown.

• Whether monkeypox has found a suitable animal reservoir host in Europe—which would help explain sustained transmissions and “hidden” outbreaks there—is not being substantively addressed in the corporate media.

• How monkeypox managed to evolve at least 6 times its normal pace is a question that absolutely must be answered. That question has significant ramifications for future variants’ capacity to become increasingly virulent.

• Why the disease is favoring gay and bisexual men is a question researchers seem loathe to even admit exists. They would rather bend over backwards to avoid any “stigma” arising from such investigatons than confront the admittedly awkward question of whether monkeypox is evolving into a sexually transmitted disease.

Yet instead of presenting information in a responsible fashion to educate people on the true risks from the virus, and what mitigations and safety measures might be available to them, once again the corporate media is pushing their Pandemic Panic Narrative.

Once again facts are being sacrificed to that narrative.

Once again, Pandemic Panic is spreading faster than the actual disease.

Once again, people deserve better journalism and better presentation of significant information than what the corporate media is willing to provide.

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