The news that the largest outbreak of monkeypox in Europe is currently ongoing, with over 100 cases confirmed in over a dozen non-African countries, has dominated global headlines in the last week. At first glance, this outbreak may seem concerning.

Emily Martyn, MPH, Healthcare Analyst at GlobalData, a leading data and analytics company, explores to what extent we should be scared of the outbreak.

Firstly, let us look at the background. Monkeypox is a virus closely related to smallpox. It is a rare disease endemic to countries in central and west Africa that is typified by pox-like skin rashes that occur on the face, palms of hands, and soles of feet. While less frequent, the rash can occur in the mouth (affecting the oral mucus membranes), genitalia, and corneas. Despite its name, it mainly exists in rodents. The majority of cases have occurred via animal-to-human spread, while 28% of transmission occurs from human-to-human spread—mainly through the exchange of bodily fluids and prolonged close contact with the infected person.

Now, let’s examine the current outbreak. On 24 May 2022, the World Health Organization (WHO) stated that there are 131 confirmed cases and 106 suspected cases of monkeypox outside of nonendemic countries, with the majority in the UK and Portugal. In many cases, these patients have no history of recent travel to Africa and no known exposure to another infected person. Cases are largely (but not exclusively) identified among men who have sex with men, leading to speculation that the disease is being spread through skin-to-skin contact, such as exposure to rashes during sexual activity. The WHO has also stated that the extent of transmission is unclear at this stage. Identification of further cases with unidentified chains of transmission is likely, including in other population groups. With a number of countries in several WHO regions reporting cases of monkeypox, it is predictable that other countries will identify cases in the following weeks.

So, having laid out the facts, should we be as scared? The answer is ultimately no for several reasons:

1. This disease is not new, unlike COVID-19. There is a vaccine already available, Bavarian Nordic’s Imvanex, and existing smallpox vaccines can be used. The US and Canada have stockpiles of millions of smallpox vaccines. Many other countries are securing large volumes of the Imvanex vaccine in case of a larger outbreak. Bavarian Nordic could increase production by partnering with large pharmaceutical companies. For vulnerable people that cannot have the vaccine, there is an antibody treatment called vaccina immunoglobulin (VIG) that provides immunity.
2. The disease itself is not serious in the majority of cases. It is self-limiting and usually resolves itself within two weeks, requiring minimal supportive care of antibiotics and fluids. If the disease becomes more severe, antiviral Tecovirimat is available for treatment. In some instances, smallpox antivirals could be used. The mortality rate is between 0-11%, but this is based on historical data from areas with poor access to health services. The rate is likely to be lower in this current outbreak, with cases occurring in developed countries.
3. To date, monkeypox isn’t asymptomatic: every person infected presents with obvious symptoms. This makes identifying patients and contact tracing easier than COVID-19.
4. Human-to-human transmission is much lower than COVID-19. The reproductive number (R0)—the expected number of cases generated by one infected person—has to be greater than ‘1’ if the infection is to spread in the population. The latest COVID-19 variant, Omicron, has an R0 of approximately 8.2. In comparison, monkeypox is thought to be just 0.32.
5. Monkeypox has a slow mutation rate, so it is unlikely that a new variant will emerge. Genetic testing shows that the current virus closely relates to a strain circulating in 2018 and 2019 in Nigeria. We are unlikely to see new variants break out that are more transmissible or deadly, as we have seen with COVID-19.

A monkeypox outbreak was inevitable, as these have been increasing during the 21st century because we are now at a point where a significant proportion of the population are not immunized against smallpox, which offered protection against monkeypox. However, we already have vaccines, treatments and resources to tackle this outbreak. Therefore, it is unlikely to result in months-long lockdowns and separation from our friends and family.

The world is coming out of a global pandemic that has affected all of us for two years. This has understandably led to a culture of fear and panic over any new infectious disease outbreak. However, we must remember that pandemics are rare. There were multiple outbreaks before COVID-19, and there will be plenty after. Yet, every outbreak we have helps the global science and healthcare industries better understand and prepare for the next one. And each time, society will be better prepared and informed.

By comparing this outbreak directly to COVID-19, we can see the risk of a new pandemic is minimal. Monkeypox just so happened to have the right conditions to result in an outbreak in non-native countries, and there will be more cases in the following weeks before we see a decline. Yet, we can see healthcare sectors and global agencies responding instantly: working together, with knowledge and skills developed from two years under a brutal pandemic, to curb and manage the disease. We don’t need to be scared, just prepared.