The return of mpox and what it means for us

In the summer of 2022, just as the world was beginning to breathe a collective sigh of relief after the relentless grip of the COVID-19 pandemic, a new threat appeared on the horizon: monkeypox. The virus, recently rebranded as “mpox” to sidestep harmful racial connotations, sparked a wave of anxiety – particularly within the queer community, which found itself disproportionately affected. 

But, as we’ve done before, our community rose to the occasion. We took the warnings seriously, got vaccinated, adhered to public health guidelines, and largely managed to keep the outbreak under control. This wasn’t our first experience dealing with a public health crisis; we knew the stakes, we knew the drill, and we showed the world that collective action works.

Fast forward two years, and here we are again. Mpox is back. The World Health Organization (WHO) has declared the latest outbreak in Africa a “public health emergency of international concern.” So, what’s happening? And most importantly, what can we do?

The virus in brief

Mpox is caused by the monkeypox virus, which belongs to the same family as the smallpox virus. The disease isn’t new; it has been lurking in the background for decades, particularly in Africa, causing occasional outbreaks. The virus gets its name as it was first identified in monkeys in the 1950s, but it’s not limited to primates. Various species, including rodents and squirrels, can carry it.

There are two main types or ‘clades’ of mpox virus: clade I and clade II. The 2022 global outbreak was predominantly driven by clade II, while the current outbreak, mostly affecting countries across Africa, particularly the Democratic Republic of Congo (DRC), is linked to the clade Ib strain. There are now reports of cases emerging internationally, prompting concern.

Transmission and symptoms

The monkeypox virus can spread in several ways:

– close physical contact with an infected person, including sexual contact

– contact with surfaces or items contaminated with the virus (like bedding or towels)

– respiratory droplets from coughing or sneezing

– contact with infected animals or their meat

Once infected, symptoms typically appear within 5 to 21 days. They often begin with a flu-like illness: fever, lethargy, aches, pains, and swollen glands. A blistering rash follows, usually within five days, spreading across the body before scabbing over. In some cases, anal pain and bleeding from internal blisters may occur.

While most people recover within two to four weeks without treatment, the disease can become severe, even fatal. Complications like skin infection, pneumonia and even sepsis are a real risk, and it has already caused a number of deaths. The risk is especially high for certain individuals, like children, pregnant people, and those with compromised immune systems – particularly those with uncontrolled HIV.

Taking action

The current advice for containing the spread of mpox echoes the strategies we became all too familiar with during the COVID pandemic: stay at home if you have symptoms, avoid close contact and sharing items with others, practice good hygiene, wear masks, and disinfect surfaces regularly. In the UK, those who suspect they might be infected should seek medical advice promptly, particularly if in the last 3 weeks they’ve had contact with someone who might be infected, have had new sexual partners, or have travelled to high-risk areas.

While the situation may feel eerily reminiscent of COVID, it’s important to remember that this is different. We’re in a better position this time around and so we’re not looking at another lockdown situation. We already have testing, antiviral treatments for severe cases, and vaccines originally developed for smallpox, which should offer protection against mpox as well. Moreover, we successfully managed a similar outbreak just two years ago.

It remains to be seen whether we will roll-out a widespread vaccination program, but certain high-risk individuals might be offered the vaccine if they haven’t had it already. Those who have been vaccinated should already have a degree of lifelong protection (although precautions should still be taken).

The road ahead

So why the concern now? The current outbreak seems to be spreading more easily and to a broader demographic than before. While the last outbreak predominantly affected men who have sex with men, likely due to the nature of transmission through close, intimate contact, the current variant appears to be spreading through general close contact. Though cases are mainly in Africa at present, it’s only a matter of time before we see more cases internationally.

Complicating matters is the difficulty in getting vaccines to affected areas. Despite their availability, logistical challenges and other barriers mean that distribution is far from ideal.

The WHO’s recent declaration isn’t meant to incite panic but rather to spur global action. The goal is to prevent a relatively localised outbreak from becoming an international crisis by mobilising resources. The world needs to act swiftly, especially in getting help to Africa, where the virus is currently spreading most rapidly. However, we’re already seeing the rise of misinformation and conspiracy theories on social media, which could undermine efforts to control the virus, much like we saw during COVID. As a community, we’ve already shown how to handle a public health crisis. We’ve led by example, demonstrating that quick, informed action can prevent widespread catastrophe. Now, it’s up to the rest of the world to follow our lead. Whether that will happen remains to be seen, but in the meantime, please let’s continue to protect ourselves and each other