Perilous pathogen

The largest Monkeypox outbreak ever outside of Africa has revealed nearly 800 cases of infection, mainly in European countries. The global population and governments around the world appear to have just emerged from the COVID-19 pandemic and are now deeply concerned about the unfolding threat.

While the pathogen is not new, its unprecedented spread beyond the African continent has led to numerous uncertainties. Different countries, including India, react differently to sail through these uncertainties themselves. In this article, we’ll trace the origins of the viral outbreak, explore theories about its transmission, and see how India and other countries are preparing to prevent the Monkeypox virus from spreading. We’ll also look back at how we, as humans, should generally evolve to protect ourselves from viral outbreaks that are becoming more and more common these days.

Origin and history

The human race is not new to viral encounters. A study from the scientific journal Nature traces the lineage of certain viral infections to thousands of years ago. The smallpox virus – variola – is said to have circulated among humans some 1,700 years ago; Hepatitis B virus has been infecting humans since the Bronze Age and tuberculosis for more than 6,000 years.

It can be difficult to pinpoint the exact origin of a particular virus. To be clear, Monkeypox virus – belonging to the Orthopoxvirus genus of the Poxviridae family – was first discovered in 1958 in monkeys in a laboratory in Denmark. The first case of human infection came 12 years later in the Democratic Republic of the Congo.

Since then, the central and western parts of Africa have witnessed occasional outbreaks. While the disease has mostly been confined in Africa throughout its history, the disease spread to the United States in 2003 when the country recorded 70 cases of Monkeypox. The US had an explanation for the outbreak at the time. Prairie dogs, housed with Gambian rats and dormice imported from Ghana, had become the main carrier of the disease.

In the recent past, however, the outbreak of the disease in non-African countries has raised alarm bells worldwide. The detection of cases in, among others, Israel and the United Kingdom in 2018, 2019 and 2022 was attributed to international travel. This year, hundreds of people in dozens of countries have been infected in an unprecedented way, leaving scientists and health experts flabbergasted.

While the exact reasons behind this unprecedented transmission are unfounded, the root remains indisputable – rodents from the rainforests of Central and West Africa. Being a viral zoonosis – spreading from animals to humans – Monkeypox has a lot to do with the area under the forest cover. To prevent the spread of Monkeypox and other viral zoonoses from getting worse, attention should be focused on preserving the natural habitat of animals. If that doesn’t work, we can replicate the effects we’ve seen over the past two years.


Monkeypox virus is conventionally known to be transmitted through close physical contact with an infected person or animal, or with material contaminated with the virus. Until recently, human-to-human transmission was considered a rare phenomenon, but it is now known to spread among humans through close contact with lesions, body fluids, respiratory droplets, and other contaminated materials.

Its spread via respiratory droplets is of particular concern – as the mode of transmission is quite similar to that of Covid. In addition, unlike SARS-Cov-2, Monkeypox virus is known to remain on the infected surface for a longer period of time, increasing the chances of transmission.

However, the explanation for the current outbreak requires more than conventional wisdom. Scientists and health experts are desperate to decode the transmission. The atmosphere of uncertainty has led to several theories being given free rein without much evidence. One of those prominent theories suggests that more international travel in the wake of the easing pandemic could have led to such an extensive outbreak. This theory deserves attention.

Genome sequencing of recently collected Monkeypox samples in Belgium, France, Germany, Portugal and the United States, among others, has shown that almost all samples resemble the West African strain of the Monkeypox virus. Essentially, there are two strains of the Monkeypox virus: the West African strain and the Congo Basin strain (sometimes referred to as the Central African strain). The species currently in existence – the West African strain – has a case fertility ratio (CFR) of three percent, while the Central African strain has a CFR of 10 percent. In comparison, the CFR of the smallpox virus before it was eradicated was 30 percent. A low CFR of three percent means the current outbreak is less deadly.

The other theory holds that Monkeypox may have been undetected among populations outside of Africa for quite some time. This theory is gaining traction, but it is limited by the fact that symptoms of the Monkeypox virus in humans can be seen on their skin. If these were widespread, health experts would have taken notice. Another unsolved mystery of Monkeypox transmission is its spread among men who have sex with other men (MSM).

Prevention measures

Two years of the COVID-19 pandemic have brought us to the realization that viral outbreaks cannot be taken lightly. Monkeypox comes on his back and has attracted a fair amount of caution from countries around the world. In line with World Health Organization guidelines, India’s Ministry of Health and Family Care has claimed that even the detection of a single case in the country should be considered an outbreak. The ministry has issued detailed guidelines for detecting and monitoring the situation.

Since the outbreak is mainly concentrated in Europe and the United States, and India has not registered a single case to date, the Indian government has not issued any guidance regarding stockpiling of smallpox vaccines. This is at odds with the proactive actions of countries like the United States, which have stockpiled millions of doses of vaccines and smallpox drugs as a precaution against recurrence. Smallpox vaccines in particular are also effective in controlling Monkeypox. According to a report by The New York Times, in Switzerland, the World Health Organization maintains about 2.4 million doses of the vaccine used to eradicate smallpox, and has an additional 31 million doses stocked in five donor countries for release to countries in need.

Stockpiling Monkeypox vaccines and drugs has its own limitations. Primarily, most of these are only tested on animals. Second, for example, the United States has stockpiled 100 million doses of the older smallpox vaccine ACAM2000 and 28 million doses of Jynneos vaccine. While the former has been taught to have adverse health side effects and is banned for certain immunocompromised segments, a large number of doses of the latter have expired.

India’s efforts so far have been limited to case detection and monitoring. According to the guidelines, the contacts of a confirmed case should be monitored for a period of 21 days from the day they last met the patient. Monkeypox is largely a self-eliminating disease and lasts 21 days. The guidelines also suggest simple protective behaviors that citizens should adopt. People are expected to monitor their own health status to detect the symptoms of Monkeypox.

The way forward

The COVID-19 pandemic has introduced us to a new normal and the Monkeypox outbreak should further consolidate this concept. Drastic climate changes, human invasion of animal habitats, evolving nature of viruses – whatever the reasons, the world today is vulnerable to more frequent and intense viral outbreaks. Undoing the mistakes can be a long game. For now, one must believe that living with viruses is the only option humans have.

There will have to be a permanent adjustment of lifestyle and precautionary behavior. It is reported that safety protocols related to the COVID-19 pandemic are very similar to those related to Monkeypox. New behaviors, including masking, sanitizing, and being vigilant for strange symptoms, should be normalized. A totally different atmosphere needs to be created where the emergence of new viral threats will not leave people completely stunned. We have to broadly keep ourselves ready for all situations.

Opinions expressed are personal

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