They’ve been repeating it ever since the start of the Covid pandemic: “We are entering an ‘age of pandemics’ — this is just the beginning”. And they’ve been true to their word: no sooner had the threat of Covid started to wane, and most people had started to put the nightmare of the past two years behind them, than we were told that another dangerous virus had begun to rapidly spread across continents: monkeypox, a rare disease normally limited to West and Central Africa, where it is endemic.
Since May 2022 there have been a spate of outbreaks reported in the US, UK, Australia, mainland Europe and Canada. On July 23, with more than 16,000 reported cases (and five deaths, all in Africa) in 75 countries and territories, the World Health Organization declared the outbreak a public health emergency of international concern, its highest alert for a disease, raising the status of the outbreak to a global health emergency — even though the WHO’s advisory panel opposed the declaration nine-to-six. The last time the WHO declared a public health emergency of international concern was in February 2020 for Covid, so people naturally drew parallels.
Such comparisons are completely unfounded. And yet, as the outbreak continues to make headlines around the globe, panic is once again setting in. A recent poll revealed that one in five Americans fears they’ll get monkeypox. This is especially true for young people, many of whom now claim they are more scared of monkeypox than Covid. “I had finally gotten to the point with Covid where I was starting to relax,” Lisa, a 30-year-old mother from Chicago, told Slate. “But when I heard about monkeypox, it was like a huge pit in my stomach. I open Twitter and see people telling me you need a full PPE suit to go outside. I can’t take living in fear for another two years, and I want to let my child live a normal life.”
Meanwhile, three US states, including California, have declared states of emergency over the monkeypox outbreak, just as they did for Covid-19, potentially allowing them to enact mask mandates, lockdown orders, and other restrictions. And two weeks ago, a south London school sent reception classes home until the end of term after a child came into contact with a monkeypox case, sparking fears of an outbreak. The school said it was acting on advice of the UK Health Security Agency (UKHSA) and were “obliged to follow these precautionary guidelines”. Authorities also advised parents to avoid hugging their child.
It is simply baffling that anyone would willing to go down this road again — shutting down schools; denying children physical contact — with everything that we now know about the devastating effects of such measures on children’s mental and physical well-being throughout the Covid pandemic. But that doesn’t seem to register. Today, we are seeing the first stirrings of yet another bout of mass hysteria, with politicians, the media and public health officials (including the WHO) all repeating the same mistakes they made with Covid-19: spreading misinformation about the nature of the disease, and sowing unnecessary panic and fear among those who risk little or nothing from it, while denying those who actually are at risk the kind of targeted messaging and protection they deserve.
With Covid, it was known right from the start that the disease was highly selective — the overwhelming majority of people, especially children, never faced any significant risk of getting seriously ill or dying from it. And yet public health officials systematically framed Covid as a lethal, indiscriminate threat to all human beings. The consequences were devastating: on the one hand, it stoked terror and panic in the population; on the other, it abandoned those who truly needed protection from the virus — first and foremost care home residents, who make up a staggering 40% of all Covid deaths in Western countries.
The same imprecise messaging is being delivered with regard to monkeypox. The media, for example, has given ample coverage to the fact that monkeypox has been detected in some children across the United States, making the disease a growing concern for parents, who are now worried about how safe it is to go back to school. Others are uneasy that a large-scale paediatric outbreak could ignite a full-blown pandemic or could result in staffing shortages.
Such concerns were exacerbated by the WHO’s director-general Tedros Adhanom Ghebreyesus, who stated: “I am concerned about sustained transmission because it would suggest that the virus is establishing itself and it could move into high-risk groups including children, the immunocompromised and pregnant women. We are starting to see this with several children already infected.” More recently, Rosamund Lewis, the WHO’s technical lead on monkeypox — in yet another claim that received much social media attention — went on to say that children in particular “are at higher risk of severe disease”, and that “every child that contracts a monkeypox virus infection will develop severe disease”.
The danger of monkeypox for pregnant women has also been receiving a lot of media attention. The WHO has warned that monkeypox during pregnancy could result in the foetus being infected with the virus or, worst of all, a stillbirth. Jennifer McQuiston, who is heading up the CDC’s monkeypox response, said that there are “a lot of concerns” about monkeypox and pregnancy, and that pregnant women should take extra precautions to protect themselves. Overall, the message is the same as with Covid: anyone can catch it, including children, so everyone should be concerned, especially parents and pregnant women.
It is highly misleading — and all the worse for coming from the world’s leading public health organisations. While it is technically true that anyone can catch monkeypox — most people can catch most diseases — the reality is that, according to the WHO data, 97.5% of cases are among gay or bisexual men, almost all of whom (91.5%) have contracted the disease through a sexual encounter. The median age is 37.
As the WHO writes: “the ongoing outbreak of monkeypox continues to primarily affect men who have sex with men (MSM) who have reported recent sex with one or multiple partners. At present there is no signal suggesting sustained transmission beyond these networks.” So far, there has been a relatively small number of cases outside of this group: health officials have reported around 100 monkeypox cases among women worldwide — about 1% of the global total — while cases among children are even rarer.
These facts are confirmed by the UK Health Security Agency, in the most comprehensive study to date on the 2022 monkeypox outbreak, published in the New England Journal of Medicine (NJEM), and by a British Medical Journal (BMJ) study based on 197 cases in British men. Moreover, despite widespread speculation to the contrary, monkeypox predominantly occurring among gay men isn’t driven by sampling bias. According to the UKHSA, we can see the positivity rate among men is considerably high compared with women and children. It’s not entirely clear why monkeypox is much more prevalent among gay men, and why we aren’t seeing a greater number of sexually transmitted cases among heterosexuals, though it is likely that the number and overlap of sex partners plays a big role.
Despite this, health authorities and media outlets have been wary of labelling monkeypox a sexually transmitted disease (STD), in part because researchers weren’t sure whether the disease is transmitted through semen or vaginal fluids. A new Lancet study, however, concludes that monkeypox could indeed be an STD, as the data already suggests.
Fortunately, the data also shows that those most at risk of contracting monkeypox — adult men — tend to present non-life-threatening (though certainly painful and distressing) symptoms. Moreover, the vaccines developed for smallpox are said to be highly effective against monkeypox. And while it is true that previous monkeypox outbreaks have proven to be especially dangerous for children and pregnant women, the strain involved in the current outbreak seems to be less of a threat to these groups: the first two paediatric cases in the US reported by the CDC are said to have been relatively mild — with more or less the same symptoms as for adults — while the infant recently born to the first monkeypox-positive mother in the US also seems to be doing well so far.
The data also indicates that while it is technically true that monkeypox can be spread through close (skin-to-skin) contact with an infected person, and even through exposure to items and surfaces that have touched an infectious person’s rash, such as clothing or bedding, non-sexual transmission is very low — though it is likely to increase through prolonged close contact. There is no evidence of airborne transmission.
So overall, there seems to be little justification for the mounting monkeypox hysteria. A responsible public health approach would make sure high-risk people — gay men — were made aware of the risks and offered sensible recommendations (such as practising safe sex) and access to vaccines, while reassuring everyone else that there’s no reason to panic, at least based on current data. Instead, a confused and imprecise messaging is once again sowing unnecessary panic among the general population, while potentially failing to protect those at risk.
One of the reasons for this is the assumption that emphasising monkeypox’s disproportionate effect on gay men might lead to ostracisation and stigma against gays, as during the HIV/Aids pandemic. As bestselling author Xiran Jay Zhao wrote in a tweet which has been liked almost 60,000 times: “I am SO TIRED of the monkeypox misinformation — it is NOT limited to gay men. It is NOT an STD. ANYONE CAN GET IT AND THE VIRUS CAN LIVE ON A SURFACE FOR DAYS!!”
One can be sympathetic with the reasoning behind such claims, but still believe it is unacceptable for public health bodies to bow down to such logic. The public deserves to know the truth about the health risks posed by diseases. Placing politics and ideology above the truth — and, even more shamefully, in the name of “The Science” — has already caused massive damage throughout the Covid pandemic, and to those most at risk from the virus. We are now doing the same with monkeypox.
As Owen Jones has claimed, it’s not stating that it’s gay men who are overwhelmingly at risk from monkeypox that puts gay men at risk, but rather denying this fact: “the problem with the HIV/Aids response wasn’t that it was targeted, it’s that it was stigmatised. We need targeted, non-stigmatised messaging: but it’s not homophobia to speak the truth about this. The real homophobia is not acting properly because it’s overwhelmingly gay and bi men at risk!” Indeed, when gay activists characterised the US authorities’ decision to give gay men prioritised access to the monkeypox vaccine as homophobic, Jones accused them of “hav[ing] completely lost the plot”. If anything, he added, what gay people should really be angry about is that “governments are failing to take swift action to protect this minority” — as evidenced by reports of vaccine shortages in the UK, US and elsewhere.
As for the homophobic discourse on social media related to monkeypox, this is arguably also a consequence of the authorities’ attempts to downplay who is most at risk. The Covid pandemic has sown massive distrust in public health authorities, and millions of people who refused to take the vaccine are still angry at misleadingly being accused of being reckless spreaders. Seeing those same authorities today go out of their way to avoid highlighting that a specific minority group is — for real in this case — much more likely to catch and transmit the virus is unlikely to make them positively disposed towards the latter, especially if this denialism contributes to the virus’s spread.
If we want to get out of this mess, and avoid a repeat of the past two years, there’s only one way forward: putting the truth back at the centre of public health. Monkeypox hysteria, just like the Covid hysteria that came before it, won’t save lives. It will only put them in danger.