When monkey poop briefly found its way to the United States in 2003, it infected prairie dogs. “We know that ground squirrels are very susceptible to the virus and that there are a wide variety of species,” says Rimoin. “If monkey cups were able to establish themselves in an animal sanctuary outside of Africa, navigating it would be a very complicated situation.”
To clarify the prevalence of the current outbreak, the UK has chosen to make monkey pox a notifiable disease, meaning that all healthcare professionals and laboratories detecting suspected cases are required to alert the UK Health Security Agency (UKHSA).
“I think the UKHSA has done the right thing by putting the surveillance network much wider,” said David Heymann, an infectious disease epidemiologist at the London School of Hygiene and Tropical Medicine who has spent many years studying monkey pox in sub- Sahara Africa.
“They will start identifying if it is in other population groups as well. It is early and we do not know which groups are really at risk, or beyond MSM. And we expect that there are probably other groups.”
There are further challenges ahead. Because the virus has already been linked to the MSM community – even though it is thought to be able to spread through all sexual networks – scientists say health authorities need to communicate clearly with the public to avoid monkey pox being stigmatized. If vaccines begin to be rolled out in a targeted way to select subpopulations, and the disease builds up stigma, it may inhibit contact tracking efforts, something epidemiologists fear may already be happening.
“There is a concern for people who want to identify themselves, for fear of stigma,” Brownstein says. “There is a concern that this virus, like others, may be unfairly associated with certain subpopulations.”
There are also questions about the capacity of health systems, which have already been depleted and stretched to their limits by the requirements of Covid-19, and whether they have the capacity to increase their response to monkey pox.
“The public health infrastructure is barely built to handle the response to one virus, let alone two,” Brownstein said. “But there are a lot of people who work very hard around case identification, contact tracing and testing. It’s clearly stretching capacity and there can be exhaustion, but I don’t think there is apathy on the part of public health to respond to this.”
While scientists feel there is room for optimism – and we will see in the coming weeks and months whether the number of new cases begins to decline – it is crucial that the ongoing outbreak is taken seriously before the virus becomes too entrenched 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 establishes itself, we may end up in a situation where we will have to constantly devote resources that have already been stretched to fight a poxvirus that is spreading globally.”