Monkeypox!

And why everything we think we know about it doesn't matter

It’s too early to write anything intelligent about this monkeypox outbreak, but I’ll tell you this: It’s a bigger deal than a casual google search of “monkeypox” would indicate. If you look up monkeypox on the CDC website or Wikipedia, you’ll learn that it’s very rare, it’s hard to catch, and cases in the West are typically isolated and linked to travel.

All that conventional wisdom is off the table. Forget what you thought you knew about monkeypox. Forget what you learned two minutes ago.

As the World Health Organization tweeted a few hours ago, “Monkeypox has so far been reported from 11 countries that normally don't have the disease. WHO is working with these countries and others to expand surveillance, and provide guidance. There are about 80 confirmed cases, and 50 pending investigations. More likely to be reported.”

This pattern has not been seen before. Ever. There are cases all over Europe (and a couple in Massachusets and New York) which are not linked to travel or to each other. This implies community spread between people. In other words, this does not appear to be the typical hard-to-catch typical monkeypox, which is easily stamped out if a case happens to arrive with someone who traveled abroad. This is a disease with a lengthy incubation period, too, so combine that with community spread, and it’s no wonder the WHO says “More [cases are] likely to be reported.”

This is why the WHO is meeting today to consider what to do next, including whether to declare the monkeypox outbreak a Public Health Emergency of International Concern (PHEIC).

This article from Inside Medicine has some good basic information about the recent outbreak, including information about cases. It suggests, as has been written in several other places, that most (perhaps all?) the monkeypox cases in the West have been among men who have sex with men, although even if that is true, it’s unlikely to stay true. Respiratory droplets are a mode of transmission — you don’t need to have sex with someone to transmit monkeypox.

Here on virological.org is a first draft (very crude and preliminary) sequence of the genome of the virus in the present outbreak. If you look at the discussion of this, it looks like it is being presented as “good news.” For example this tweet:

Nothing to see here! This virus, which is popping up all over Europe, is just the same as one in the UK which in turn came from someone’s travel to Nigeria. Simple! It’s just a “superspreader event” — but that doesn’t make sense. This is not how monkeypox spreads. This starts to sound a lot like “someone sold an infected bat at the Wuhan market.”

What is this? What is happening and why? I don’t know. I don’t pretend to know.

Lots of Leftover Noise from COVID-19

The early info about SARS-2 and its origins was deliberately withheld and remains disputed even today. If I see a link to an article in Nature about this new monkeypox outbreak, will I be likely to believe it? If I see an early letter from virologists in the Lancet, describing what they claim is going on, am I likely to take it on faith? No.

That’s why I look at the genome with a skeptical eye too. “Oh it’s just the same as a 2018 sample!” does not explain why it seems to be spreading completely differently.

That’s unfortunate. It takes a lot longer to dig out the information yourself, bit by bit. I’d much prefer the luxury of assuming the experts are telling the truth this time.

In this climate of distrust — which by the way is completely reasonable — we still have large groups of noisy distrustful people who believe covid was a plandemic, or that the vaccines did terrible things (sometimes by design). There are people who believe that the government withheld superior treatments from us. There are people who believe covid, or the vaccines, destroyed everyone’s immune system — and mix in the people who think covid was just a hoax, or overblown, or “a cold that everyone is going to get.”

Whether those voices are sincere, or just tools of various (dis)information campaigns, they’re still out there. So, heaven help the person who wants to write about the monkeypox outbreak. Their tweet brings all the lunatics to the yard:

Why Do We Have a Monkeypox Vaccine, Though?

Here is an interesting fact.

The US FDA approved a monkeypox vaccine in September 2019. The FDA’s press release said “Jynneos will be …part of the Strategic National Stockpile (SNS), the nation’s largest supply of potentially life-saving pharmaceuticals and medical supplies for use in a public health emergency that is severe enough to cause local supplies to be depleted. The availability of this vaccine in the SNS will help ensure that the vaccine is accessible in the U.S. if needed.”

So a vaccine was commercially created and approved— an undertaking which costs an enormous amount of money — for a disease that is extremely rare in the West. In 2021, for example, there were two cases of monkeypox in the US, both related to travel to Nigeria.

So that’s odd. Then, after an enormous amount of money and time were invested to develop this vaccine, the government decided to spend a lot more to keep this fancy new vaccine in the Strategic National Stockpile.

Why?

Why would we need a vaccine in the US, in our stockpile, for a disease that most people never heard of until a few days ago?

One possible answer is that monkeypox — like a large number of other pathogens — is on the US’s radar as a potential bioweapon. Of course, you’d need a version of it that spreads more readily.

Am I saying that I have any evidence that this European monkeypox outbreak with community spread is related to bioweapons research or a bioweapons attack? No. I am not.

I have no idea where this monkeypox outbreak came from, and so far, neither do you.

But it’s worth paying attention.