What Happened To Monkeypox?
The Great Plague That Wasn't
Last week, the WHO and Africa CDC portentiously declared monkeypox to be the next global health emergency. The disease was not subsiding in Africa, and so therefore it was about to spread across the globe. The WHO even said so.
“This is something that should concern us all ... The potential for further spread beyond Africa and beyond is very worrying,” said WHO director-general Tedros Adhanom Ghebreyesus.
A new pandemic was in the offing, and we were supposed to be very worried. Weren’t you very worried?
Ummm….where are the international cases? It’s been 9 days since the WHO said monkeypox was a global health emergency, which means we’re passing the incubation period for the virus. Where are the reports of monkeypox outside of Africa?
Pakistan has had one case of monkeypox. So has Thailand and the Phillippines. Sweden had one case last week. No cases have been reported in North or South America, Oceania, or the Middle East.
All the cases are so far concentrated in Africa (numbers are cases from January through August).
According to data from the Africa Centres for Disease Control and Prevention (Africa CDC) and the governments of Kenya, Mozambique, Uganda and the Ivory Coast, the Clade 1 variant of mpox has been detected in the following countries this year:
Burundi (eight cases, zero deaths)
Cameroon (35, two)
Central African Republic (213, zero)
Ivory Coast (28, one)
Republic of Congo (146, one)
DRC (13,791, 450)
Ghana (four, zero)
Liberia (five, zero)
Nigeria (24, zero)
Rwanda (two, zero)
South Africa (22, three)
Uganda (two, zero)
Kenya (one, zero)
Mozambique (one, zero)
The DRC is experiencing the biggest outbreak of the disease ever recorded with thousands of people infected as of August 21. The government declared an epidemic in December 2022.
We have a global health emergency over monkeypox without global monkeypox cases.
The media wants to keep the disease narrative going if it can, so reminds us that the monekypox spread in Africa is “rapid”.
The rapid spread of mpox – what used to be called monkeypox – in parts of Africa has been declared a global emergency.
A new form of the virus is at the heart of concerns, but there still remain huge unanswered questions.
With the case totals still being given in the cumulative numbers from January through August, exactly how “rapid” the spread is remains problematic.
Ten days into the “global” health emergency and monkeypox is spreading in primarily Africa. The most dire asapect of this latest outbreak is that a number of the cases are of the newer Clade 1b, as I mentioned last week.
In that strange fashion for missing key details that only corporate media can muster, what is once again getting glossed over is that Clade 1b, like the Clade 2 strain from 2022, appears to be spreading via sexual contact.
It was first reported this year, but genetic analysis has traced its origins back to September 2023 in the gold-mining city of Kamituga, in the Congolese province of South Kivu.
“There is a sex industry in the mining city and it has rapidly spread out to border countries because of the massive movement of people,” Leandre Murhula Masirika, a health department research coordinator, tells me from South Kivu.
He said paying for sex was the main way the virus was spreading, but it is then passed from parent-to-child or between children and had been linked to miscarriages.
While in theory, this makes the new Clade 1b strain more transmissible, just as the Clade 2 strain from 2022 proved to be, the lack of cases beyond Africa suggests the virus is not continuing to be spread via sexual contact inside the countries to which infected individuals are traveling. The case in Thailand, which has been confirmed to be Clade 1b, has not been reported as being transmitted via sexual contact.
This is not surprising, however, as even the Clade 2 strain from the 2022 global STD outbreak was “sexually transmitted” only because sex puts infected persons in extremely close contact with uninfected persons. The actual transmission vector—infected bodily fluids (and not merely sexual fluids)—is not radically different in Clade 1b.
Despite these epidemiological realities on the ground, the media insists on presenting salacious headlines presenting monkeypox as an ubiquitous global threat.
This headline covers a story that is in both content and context one of a relatively localized African health crisis.
The absence of shots and the challenges in understanding the spread of the disease in the central African country underscore how hold-ups on the ground, a lack of international coordination and funding problems have hampered a swift response.
The chain of delayed reactions to the crisis began during the last mpox emergency that ended in 2023, with the Africa Centres for Disease Control and Prevention saying the continent did not get the appropriate support.
Even as the threat from mpox returned and the organisation responsible for global vaccine distribution expressed its concern, Congo held off formally requesting vaccine donations. Drug regulators in the country approved emergency use for the shots only in June.
Meanwhile, multiple countries, organisations and potential donors are trying to help but are only just starting to coordinate a joint response.
The reporting even concedes that this is not a “new” outbreak, but the continuation of an ongoing one.
Mpox has been in Congo for a long time, and “it didn’t receive much attention”, he said in an interview.
Of course, the conclusion is always that if Africa is not vaccinated against monkeypox today, it will be in Amsterdam tomorrow.
Without a rapid response, the disease will spread to other countries, he said.
After the initial donations, vaccines will need to be ordered through manufacturers like Bavarian Nordic. When the emergency was declared, those discussions were limited, according to the Danish company’s chief executive Paul Chaplin.
“Covid and also the mpox outbreak of 2022-23 should have taught everyone that you can’t just ignore an outbreak in one part of the world,” he said.
However, as I argued at the time, the factor which transmitted monkeypox globally in 2022 was not an aspect of the pathogen itself, but the behavior of the people infected with it.
Whether monkeypox should be apprehended as a sexually transmitted disease is a question rather beyond the scope of what can be clearly derived from the extant data. At the same time, that a majority of cases do involve gay and bisexual men indicates that sexual activity is at the very least facilitating the spread of the disease. Pretending this is not the case so as not to offend the sensibilities of that same demographic will do nothing to help educate those within that demographic on how best to protect themselves from infection.
As research would later substantiate, moderating that behavior is what tamped down the 2022 global STD outbreak of monkeypox.
As a matter of humanitarian decency, monkeypox in Africa should be treated. A disease which has the capability of killing as much as 11% of those whom it infects is not a minor illness.
It does not advance that cause of treatment in Africa to promote yet another Pandemic Panic Narrative, particularly one that only has fewer than five cases beyond Africa to support that narrative.
Likewise, it does not further the cause of containment and treatment outside of Africa to present monkeypox as emerging from Africa anew to threaten the world. Monkeypox is an ongoing infection in Europe and North America, and those cases are not tied to the current Clade 1b strain.
Nor is it at all productive to focuse exclusively on vaccines—which only serve to promote the financial interests of the vaccine manufactures—and ignore the sanitation and hygiene components to containment of all orthopox viruses. Clean water, better and more medical PPE, improved sanitation, would all help slow or stop the spread of monkeypox, and would provide a baseline response should any future orthopox viruses present as an emergent health threat in even one country.
The past week has shown the lunacy of the WHO’s global public health emergency declaration over monkeypox. Clade 1b is not credibly spreading beyond Africa, nor do the new cases in Africa speak to a transmission vector likely to give monkeypox global spread.
There is no global public health emergency over monkeypox. Corporate media’s inability to craft stories detailing significant community spread of monkeypox demonstrates the extent to which this latest monkeypox scare is more dystopian fiction than reliable journalism.
The only way to smash the 'state of emergency' formula is to ignore it. If everyone ignores and displays simple courage they - the emergency bullies - can't push moral panics.
Wow, your analysis provides a very well-informed, balanced take on the monkeypox situation. It’s clear that this isn’t a straightforward, black-and-white issue.
You’re absolutely right in highlighting the need for nuance when discussing the spread of the virus. The fact that most cases remain concentrated in Africa, despite the global emergency declaration, underscores the long-standing issues of healthcare disparities and media sensationalism surrounding outbreaks like this.
I totally agree with your point that the focus should be on improving healthcare infrastructure and access in Africa, rather than just pushing vaccines.