In order to spread, viruses exploit the connections between humans. The more connections there are, the more likely a virus is to find a new host to infect. Monkeypox is not terribly efficient at transmitting from human to human. The virus has been causing illness and deaths in some African countries, where animals carry the virus, for decades, but has gone largely ignored in the West. When the virus made it to places like Singapore, Israel and Britain in the past, it rarely led to any further cases. Most people do not have enough close skin-to-skin contacts for the virus to transmit. But those men who do have a lot of male sexual partners are more vulnerable. We have seen this with some other pathogens, like MRSA and drug-resistant shigella. Now we are seeing it with monkeypox.
The world needs to take the threat of monkeypox seriously. Around 7 percent of cases so far have resulted in hospitalization, usually for pain treatment, and several countries have reported deaths from the disease. Even in many patients who are never hospitalized, the virus causes immense suffering. On top of this, poxviruses have adapted to numerous species over time, and as the monkeypox virus continues to circulate it may evolve in unpredictable ways. Researchers have already reported signs of the virus’s genome changing. In the worst-case scenario, monkeypox could become more transmissible and more deadly. And even without any changes, the virus may yet make its way into other densely connected networks where it can spread.
To control the outbreak, those most vulnerable to infection need to have information that allows them to make decisions to stay healthy until there are enough vaccine doses available. That includes talking about reducing the number of sexual partners, creating “pods” of sex partners (where people keep sexual activity within a group) and other strategies to reduce the risk. It means communicating that scientists do not yet know how well one dose of the vaccine — or indeed two — will protect people, a crucial knowledge gap that needs to be addressed quickly. And it also means combating misinformation about the virus that is circulating widely on social media.
Public health responders need to make sure that the production of vaccines and drugs is ramped up, and that they are distributed quickly to those who need them most — especially in the countries that have long been affected by this disease. And we need to talk clearly and honestly about all this.
Keeping the focus on gay men and our sexual networks carries a risk, especially in those countries and communities where gay men are discriminated against and persecuted. Part of the public health response needs to be watching out for attempts to use this health crisis as a pretext for stigmatization and discrimination.
Today, in countries not previously affected, this virus is spreading predominantly in my community, and we need to focus efforts there. Talking about thousands of children being infected or millions of cases is not where the disease is right now. But, however unlikely, it is one possible future. The way to prevent it is by fighting this disease, not one another.