By Stig S. Frøland
The world had just started recovering from the worst consequences of the Covid-19 pandemic when a new virus entered the global arena. From early May this year, there has been an increasing amount of cases of infection with the monkeypox virus – particularly in Europe and the US. In mid-August, more than 35 000 cases had been reported in 92 countries, with 12 deaths, and the epidemic shows no signs of decreasing. Many have wondered about the background of this epidemic with a virus that hitherto has mostly caused infections in certain African countries. Why would this epidemic emerge just now? A series of conspiracy theories has already arisen – from rather absurd to somewhat more plausible. There is still much we do not know about monkeypox, but the current state of knowledge nevertheless permits a sober evaluation of the current conspiracy theories.
The common denominator of most of the conspiratorial allegations is that the monkeypox virus has been deliberately unleashed with evil intentions on the world’s population. A trump card here is that the American non-profit organization NTI ((Nuclear Threat Initiative) at a conference in Munich in March 2021 organized a panel of 19 experts that were asked to evaluate the world’s pandemic preparedness concerning a hypothetical terrorist attack with a monkeypox virus that had been modified in the lab to make it more lethal. According to this scenario, the pandemic would break out in May 2022, admittedly a striking coincidence with the present epidemic. But otherwise, the background of the NTI’s theoretical pandemic exercise is perfectly plausible. In fact, epidemic experts have for several years regarded the monkeypox virus as a possible new epidemic threat.
Monkeypox is a typical example of emerging infectious diseases – new infectious diseases that have emerged through the last 50 years. Like the majority of these diseases monkeypox is a zoonosis – an infection with a microbe normally infecting animals and only occasionally afflicting humans. In most cases of emerging infectious diseases we are not dealing with a new microbe but with changes in environment and ecology that have brought the microbe into contact with humans. These changes are very often man-made. Deforestation, war and conflicts have probably increased the contact between humans and the animal species that carry the monkeypox virus – primarily rodents. Increased consumption of so-called bush meat from rodents and monkeys has also been important. A significant factor has been the cessation of vaccination against the closely related but much more lethal smallpox virus (Variola) from about 1980, when this virus was considered to be eradicated. Vaccine-induced immunity against the smallpox virus indeed provides significant immunity against the monkeypox virus as well. As increasingly fewer people in the affected African countries had residual immunity after smallpox vaccination, both the incidence of monkeypox and the average age of the patients has gradually increased, and this infection has now become a significant health problem in Central and West Africa. The potential risk for dissemination of the monkeypox virus out of Africa has been recognized by a few epidemiologists but has largely been ignored by the research community. Thus, the choice of the monkeypox virus for the NTI’s scenario was rather logical. That this should reflect a diabolical plan for unleashing a pandemic also does not fit the fact that the NTI already in November 2021 publicized their fictive scenario mentioning the start of the outbreak in May 2022.
Another matter highlighted by conspiracy theorists is that the US has a significant store of smallpox vaccines even though smallpox was declared to be eradicated in 1980. Does this indicate preparation for a monkeypox pandemic? The rather prosaic background for this store of smallpox vaccines is, however, that the monkeypox virus is included in the list of microbes that can be utilized for bioterror. The vaccine storage is part of the preparedness against such attacks.
Some conspiracy theorists postulate that the naturally occurring monkeypox virus has recently been modified in the lab in order to change and enhance the way of transmission. These theorists focus on the conspicuous fact that most of those affected in the non-African epidemic are homo- or bisexual men. In the first peer-reviewed study of the epidemic which has just been published comprising 528 patients, 98 % belonged to this group. Sexual transmission was suspected in 95 % of the cases. That the virus was detected in semen in most of the patients where this has been investigated further points to the possibility of sexual transmission, even if close bodily contact is also important. However, the experiences from the African epidemic that has raged for several decades show that the virus naturally has changed its character quite recently. In the first years of monkeypox, human-to-human transmission was relatively rare – it occurred in Central Africa but hardly ever in West Africa. In Nigeria, epidemiologists think that a change happened in 2017 when an extensive monkeypox epidemic broke out. Whereas most of the previous cases occurred in rural districts, the virus now concentrated on urban areas. The virus now also appeared to spread among humans – also by sexual contact. This may provide the key for understanding the current outbreak outside of Africa. The virus in this epidemic is the variant of the monkeypox virus which occurs in West Africa, not the slightly different variant endemic in Central-Africa. Several research groups have recently shown that this virus variant has gone through several genetical changes through the last five years. It is therefore little reason to suspect that the virus has been manipulated in a lab, for instance as a bioweapon.
The epidemiological pattern of the recent monkeypox outbreak bears a striking resemblance to the first phase of the HIV pandemic. The not very infectious HIV virus originating in Africa was introduced to Western countries in certain environments of homo- and bisexual men where special sexual behaviour patterns led to rapid spread. The HIV virus eventually also spread to certain other groups. This is now also happening with monkeypox. Cases in children and women have already been reported.
Several conspiracy theorists claim that the current monkeypox epidemic is due to Covid-19 vaccines. Some point rather irrationally to the fact that certain vaccines contain adenovirus – a type of common cold virus that is completely different from the monkeypox virus. Others postulate – groundlessly – that Covid-19 vaccines cause immune deficiency which then predisposes to infection by the monkeypox virus.
History shows that conspiracy theories regularly follow in the aftermath of epidemics. They can only be countered with full and transparent information of all relevant medical knowledge. The conspiratorial theories so far proposed concerning monkeypox can be rejected by the facts we already possess relating to this epidemic.
Stig S. Frøland is the professor of medicine and author of the book “Duel Without End: Mankind’s Battle with Microbes” (Reaktion Books, 2022).