When monkeypox briefly made its way to the US in 2003, it infected prairie dogs. “We know that ground squirrels are very susceptible to the virus and there is a wide range of species,” Rimoin says. “If monkeypox could establish itself in a natural reservoir outside Africa, it would be a very complicated situation to navigate.”
To determine exactly how widespread the current outbreak is, the UK has chosen to make monkeypox a notifiable disease, meaning that all health professionals and labs detecting suspicious cases are required to notify the UK Health Security Agency (UKHSA).
“I think the UKHSA did the right thing, because they’ve broadened the surveillance net much,” said David Heymann, an infectious disease epidemiologist at the London School of Hygiene and Tropical Medicine who has spent years studying monkeypox in sub-Saharan Africa.
“They’ll begin to identify if it’s in other populations as well. It’s still early days and we don’t know which groups are really at risk, or other than MSM. And we expect there are likely to be other groups.”
More challenges lie ahead. Because the virus has already been linked to the MSM community — though it’s believed to spread through all sexual networks — scientists say health officials need to communicate clearly with the public to avoid stigmatizing monkeypox. If vaccines are rolled out in a targeted manner to select subpopulations, and the disease builds stigma, it could hamper contact tracing efforts, something epidemiologists fear may already be happening.
“There is concern about people wanting to identify themselves for fear of stigma,” Brownstein says. “There is concern that this virus, like others, may be unfairly associated with certain subpopulations.”
There are also questions about the capacity of healthcare systems, already exhausted and stretched by the demands of Covid-19, and whether they have the capacity to ramp up their response to monkeypox.
“The public health infrastructure is barely built to handle the response to one virus, let alone two,” Brownstein says. “But there are a lot of people who work really hard around identifying cases, tracing contacts and testing. It’s certainly capacity-building and there could be depletion, but I don’t think there’s apathy in public health to respond to this.”
While scientists believe there is room for optimism — and we’ll see in the coming weeks and months if the number of new cases begins to decline — it’s vital that the ongoing outbreak is taken seriously before the virus becomes entrenched too deeply in society. .
“I think the stakes are actually quite high when we think of having a smallpox virus that can circulate relatively efficiently in humans,” Rimoin says. “If it settles in, we could find ourselves in a situation where we will have to constantly spend resources, which have already been stretched, to fight a smallpox virus that is spreading worldwide.”
