Monkey Pox Soars in Europe, Few Cases in Africa

The 2022 monkeypox outbreak in Europe although caused by the West African 10,000 year old clade of the monkeypox virus there are much fewer cases in Africa!

Currently there are 11,935 confirmed cases of Monkeypox around the globe. Most of the patients who contracted Monkeypox originally had been around prairie dogs, with human-to-human transmission not suspected as a source of infection. The culprits behind the outbreak were Gambian giant pouched rats that a European company had imported from Ghana and housed next to a shipment of prairie dogs. So the penchant Europeans have for collecting exotic things from Africa is the cause.In just over 2 months, a global monkeypox outbreak in non-endemic countries has led to at least 10,857 infections. Spain, the United Kingdom, Germany, and the United States have reported the most cases.

Since it was first identified in a colony of monkeys in Copenhagen in 1958, monkeypox has been largely overlooked by the Western world. An infectious poxvirus that causes fever, chills and rashes, the disease is regionally present in ten African countries. Until recently, however, it was rarely found in Europe and the Americas—a trend that has, historically, led Western public health officials to disregard its spread elsewhere. Western medicine doesn’t usually care about diseases in Africa unless a profit or political agenda can be attached.

“It’s a phenomenon of ‘not in my backyard,’” says Martin Hirsch, editor-in-chief of the Journal of Infectious Diseases and an immunologist at Harvard University. “There’s not much interest in Western health groups about something that’s only circulating in Africa.”

This May, as news broke of a multi-country monkeypox outbreak, sensationalized headlines and public hysteria (much of it tinged with racism and homophobia because it spread quickly through the European gay community) suggested that the disease was poised to kickstart another pandemic. But while there’s cause for concern—at least 2,103 cases have been recorded in 42 countries, most of them in Europe, and the disease appears to be spreading more rapidly than before—monkeypox is not a novel threat. Western countries that previously paid little attention to the disease can learn much from African scientists who have studied it for decades.

Believed to have been circulating for thousands of years, monkeypox is mired in misconception. Even its name is something of a misnomer: Monkeys (and humans) are just incidental hosts of the disease, which is thought to be found primarily in rodents. While monkeypox is more common in central and western Africa, it’s misleading to describe the virus as “being African,” wrote more than 20 scientists in a recent paper detailing the need for a non-discriminatory, non-stigmatizing name for the disease. (Monkeypox will soon be renamed to reflect this aim.) In fact, the virus’ continued presence in Africa is largely the result of limited access to global healthcare resources.

“Remember, the first monkeypox was actually found in a laboratory in Denmark, not Africa,” says Oyewale Tomori, a virologist at Redeemer’s University and the former president of the Nigerian Academy of Science.

A cousin of the far deadlier smallpox virus, monkeypox primarily spreads through direct contact with an infected person’s bodily fluids, sores or scabs. Airborne exposure through respiratory droplets is possible but less common and admittedly understudied.

The current outbreak appears to be spreading mainly among men who have sex with other men a trend that has drawn parallels with the HIV/AIDS epidemic, which disproportionately affected the LGBTQ community at its height in the late 1980s and early ’90s. Scientists are not entirely sure why the disease is spreading this way, but early findings suggest it “may have made its way into highly interconnected sexual networks within the Gay community, where it can spread in ways that it cannot in the general population,” per Science magazine.

Monkeypox’s past is inextricable from that of smallpox, which is believed to have first appeared around 10,000 B.C.E. One of humanity’s deadliest diseases, smallpox killed more than 300 million people worldwide in the 20th century alone. From puncturing people with iron needles dipped in smallpox pustules such as ancient communities did in Africa, non-Western nations have long sought to prevent the virus’ spread. (This measure, known as inoculation or, involved immunizing a patient by infecting them with a mild form of a virus from a person that had recovered .) But inoculation only arrived in Europe in the early 18th century, when Lady Mary Wortley Montagu, wife of the British ambassador to the Ottoman Empire, brought the practice back to England after learning about it from North African women.

Around that same time, in 1721, a smallpox epidemic in the colony of Massachusetts led Reverend Cotton Mather and physician Zabdiel Boylston to similarly experiment with the procedure. Today, celebrations of the pair’s tenacious efforts tend to erase the contributions of Onesimus, the enslaved child who taught Mather about inoculation—a practice Onesimus learned in his native West Africa. Otherwise, much about him remains unknown, including his original name and place of birth. As Princeton historian Elise A. Mitchell explains, “The silences surrounding Onesimus are produced at ... four moments: His history is obscured or omitted in Mather’s records, the archives, our historical narratives and our sense of his historical significance.” Basically the history is whitewashed, In a 2016 Boston magazine survey, Onesimus was declared one of the "Best Bostonians of All Time".

Inoculation’s roots in non-Western cultures made the practice highly contested, condemned as an African conspiracy. In Boston, a local doctor—the only man in the city with a medical degree—decried it as a plot by enslaved Africans to infect their enslavers. The backlash was so intense that someone threw a bomb through the window of Mather’s house, attaching a warning that read, “Cotton Mather, you dog, damn you! I’ll inoculate you with this; with a pox to you.”

What is popularly known about the history of smallpox generally begins and ends with Edward Jenner, an English surgeon who performed the world’s first vaccination in 1796. Powel H. Kazanjian, an infectious diseases physician and historian at the University of Michigan, says that Jenner is at the forefront of this history because he fits neatly into the story of Western (White) medicine’s authority.

A 2003 outbreak of monkeypox in the U.S. proved to be a different story. Three-year-old Schyan Kautzer was the first person infected in the country. Red welts flared all over her body after she was bitten by one of her two pet prairie dogs. As Kautzer’s mother told the Washington Post, “The bite on her finger just kept getting bigger and bigger. All she did was sleep or cry. She couldn’t eat anything. Her glands swelled up so much on her neck you could see them popping out.” One of the family’s prairie dogs died, but they kept the second, named Chuckles, after he made a full recovery.

In total, the Centers for Disease Control (CDC) recorded 71 monkeypox cases during the outbreak. Most of the patients had been around prairie dogs, with human-to-human transmission not suspected as a source of infection. The culprits behind the outbreak were likely Gambian giant pouched rats that had been imported from Ghana and housed next to a shipment of prairie dogs. After the CDC banned the importation of African rodents into the U.S., the outbreak was quickly controlled—and forgotten.

While Western countries have largely avoided other monkeypox outbreaks, African countries haven’t been so fortunate. Between November 2005 and November 2007, a study found that monkeypox cases in the DRC spiked 20-fold compared with the 1980s. In Nigeria, a severe 2017 outbreak occurred almost 40 years after the country’s last reported case. Again, the response outside Africa was minimal. “Why should the West care?” Tomori asks.

Monkeypox is the latest example of a disease being neglected by countries not yet affected. Similar responses—or lack thereof—took place with Ebola, Zika and countless other infectious diseases. “That’s the troubling, disconcerting thing,” says Kazanjian. “We only care about people in our own land.”

He adds, “Once the victim changes, concern about the disease heightens.”

Media coverage of the outbreak has reflected Western bias, too. Many news reports featured images of Black monkeypox patients from prior years, making them the face of an outbreak implying that they are the cause not rodents and unsafe sexual practices. Black faces are featured with the headlines because it’s spread to Europe and the U.S. “This is your pox, not ours,” Tomori says. “Why are you putting the figure of a person who is not even from Europe?” The racialized images have, in turn, elicited fear among Western audiences which of course increases sales and perpetuates a narrative of an “African” disease and an epidemic-ridden continent. “This wild thing from Africa,” Tomori scoffs. “Newspapers sell better when you have some exotic story to put out there.” When the reality is the disease was spread because Europeans wanted a burrowing rodent for a pet!