Unexpected monkeypox outbreak cause for concern, but not conspiracy theories, experts say

As of writing, there have been more than 100 cases of monkeypox virus detected in about 20 countries. The cases are mostly in Europe, including Spain, Portugal, the UK, and Germany, and have also been reported in Canada, the United States, Argentina, Israel and Australia.

While monkeypox is not new to science and it has relatively low transmissibility, there is justification for growing concern about the infections.

The virus is endemic in parts of Africa, but the outbreak in countries outside that continent are raising questions about how the virus is being spread and the risks to the global population. Nearly two-and-a-half years into the COVID-19 pandemic, public and scientific concern for community safety is understandably high.

There are different strains of the monkeypox virus. The one that is currently popping up around the world appears to be the less severe West Africa clade which has a fatality rate of less than 1%. However, the clade from the Congo basin carries a 10% fatality rate. But, an article published in Nature last week states, “Exactly how much the strain causing the current outbreaks differs from the one in western Africa – and whether the viruses popping up in various countries are linked to one another – remains unknown”.

“Monkeypox is usually a self-limiting illness and most of those infected will recover within a few weeks without treatment,” notes World Health Organization regional director for Europe Hans Kluge. “However, the disease can be more severe, especially in young children, pregnant women and individuals who are immunocompromised.”

Usually, monkeypox is zoonotic – i.e. transmitted from animals to humans. Human-to-human transmission is less common and usually requires contact with skin lesions or respiratory tract droplets of infected individuals.

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But, in preliminary posts, scientists wonder whether the virus might have evolved to be more contagious and better suited to human-to-human transmission.

Globally, almost everyone younger than 42 years old has not received a smallpox vaccine since smallpox became the first virus eradicated by humans in 1980. Smallpox is closely related to monkeypox, and its vaccine is 85% effective at preventing monkeypox infection. Since 2017, annual monkeypox cases have been steadily rising in Africa. Some experts believe stopping widespread smallpox vaccination might have lowered population immunity against monkeypox.

“[T]he cessation of smallpox vaccination after the global eradication of variola virus in 1980 means that levels of cross-reactive immunity to monkeypox have now waned or disappeared, so that people can now be infected with monkeypox virus,” says Imperial College London virologist Michael Skinner.

A ScienceDirect paper published in 2020, suggests smallpox eradication could have the unintended effect that “emergent or re-emergent human monkeypox might fill the epidemiological niche vacated by smallpox”.

A new vaccine against monkeypox and smallpox was approved in 2019 but it is yet to be widely available.

Alongside reports of the spate of infections has come the now all-too-predictable string of conspiracy theories about the origins of, truth behind and purported purpose of the monkeypox outbreak. And, much like viruses themselves, the unfounded theories are spreading.

Let’s examine the scientific veracity of some of them, shall we? Spoiler alert: I wouldn’t go rushing to Facebook’s comment sections, and Twitter feeds for medical or public health advice and news.

Conspiracy theory 1: The monkeypox outbreak is linked to SARS-CoV-2 vaccination

Alongside the rollout of COVID-19 vaccines came many baseless claims about the risks of vaccination. There are some, usually mild, side effects associated with COVID vaccines. Monkeypox is not one of them.

The conspiracy theory begins by pointing to the use of adenovirus COVID vaccines, particularly in the AstraZeneca vaccine developed at the University of Oxford. These vaccines contain a live adenovirus vector – modified and weakened to be safe – that can cause the common cold in chimpanzees. First off, chimps are apes, not monkeys – but that’s a different rant. Secondly, monkeys aren’t even the natural source of the monkeypox virus.

In an article published by Imperial College London, Skinner, writes: “Monkeypox is actually a disease of small African animals, like rodents. The reason it’s called ‘monkeypox’ is that it was first found in monkeys who – like humans – can sometimes acquire infections from small animals.”

Azeem Majeed, professor of primary care and public health at Imperial College London, says:  “[Claims] that the vaccines affected people’s immunity, and made them more vulnerable to other infections, that’s not true either.”

The chimpanzee adenovirus “has been genetically changed so that it is impossible for it to grow in humans,” the University of Oxford stated. COVID-19 vaccines are safe and do not cause or make humans more susceptible to other infections.

Conspiracy theory 2: The return of the “plandemic” and biowarfare

As was the case after the emergence of the novel coronavirus, Microsoft co-founder Bill Gates, the WHO, various world governments, and even other scientists and scientific institutions themselves have been targeted by conspiracy theorists as the progenitors of the monkeypox virus.

There is no validity to any of these claims, which usually misconstrue and take out of context past quotes and studies looking at potential outbreaks.

There is not yet enough data to categorically identify the root of the outbreak.

“Why these cases have emerged now in Europe is not known yet. It is clear, however, that the virus has been circulating more actively in central and West Africa for decades as immunity to poxviruses conferred by the smallpox vaccine is waning in the general population,” says Fasséli Coulibaly, associate professor at Australia’s Monash University Biomedicine Discovery Institute and Department of Molecular Biology.

“There has been concern worldwide about the reasons for the resurgence in monkeypox cases, the most prevailing being waning immunity, although deforestation may be a factor or can even act in potentiation,” adds Vinod Balasubramaniam, a molecular virologist at Monash University Malaysia.

Conspiracy theory 3: This is just a media-“induced” frenzy and scare campaign

A measured, scientifically guided response of public health experts and virologists to an unusual outbreak of a rare disease should be welcomed.

While monkeypox usually isn’t very contagious, the current outbreak has sparked some genuine and well-founded concern. Wanting to protect the broader population is not tantamount to a media frenzy.

“[T]he amount of person-to-person transmission we’re hearing about so far seems more than expected, but it’s early days in the outbreak, so hopefully they might dwindle away. Or has the virus mutated to be more effective at person-to-person transmission?” says Sanjaya Senanayake, associate professor of medicine at the Australian National University.

Balasubramaniam says: “In light of the current environment for pandemic threats, the public health importance of monkeypox disease should not be underestimated. International support for increased surveillance and detection of monkeypox cases are essential tools for understanding the continuously changing epidemiology of this resurging disease.”

Balasubramaniam is unsure whether the current outbreak is evidence of a new, more virulent strain of monkeypox: “We still don’t have much data on this. The fact that so many cases are being reported in several countries certainly suggests that this strain is more transmissible than others. We still need to look at the current genomic data on the currently circulating strain to know more. One thing for sure is that the threat posed by this virus should not be taken lightly, and increased surveillance and vigilance is definitely needed.”

Professor David Tscharke of the Australian National University adds: “The current epidemiology of monkeypox cases is unusual, because most cases are unlinked and will mean that vigilance is required across the world, but unlike SARS-CoV-2 this virus is better understood and methods to prevent spread can be actioned swiftly.”

Conspiracy theory 4: Sexually transmitted?

This one is less of a conspiracy theory and more of a likely false assertion.

When four of seven UK monkeypox cases that could not be explained by international travel were found in people who identify as gay, bisexual or other men who have sex with men, there were suggestions that this indicated monkeypox was sexually transmissible.

“While there is a lot we don’t know about monkeypox, we do know the virus can be transmitted via close contact, for example, including prolonged skin-to-skin contact,” writes Michael Head, senior research fellow in global health at the University of Southampton, in the Conversation.

“There is no evidence that it is a sexually transmitted infection in the manner of HIV or chlamydia. It’s more that, in the UK outbreak, the close contact during sexual or intimate activity may have been a key factor during transmission,” Head adds.

It’s a classic case of correlation versus causation.

Conspiracy theory 5: The monkeypox outbreak is a hoax


It’s not. Fact-checking site politifact.com analysed a claim made in a Facebook post declaring that the misuse of a shingles photo in a story about monkeypox proved the whole outbreak is a hoax. The website’s conclusion? It doesn’t prove that the spread of monkeypox is untrue.

A s(h)ingle mistake does not discount the now well over 100 monkeypox cases outside Africa.

“People with suspected monkeypox would have a PCR test to confirm the diagnosis, and that test is very specific for the virus … so we will know from the clinical features of the patient and the positive PCR test, [it’s] monkeypox rather than some other virus,” says Majeed.

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