Monkeypox in India: Can It Lead to Another COVID-Like Pandemic?

What are the chances that the monkeypox virus can cause a global pandemic? Here's what experts are saying.

Monkeypox virus spread: Another pandemic?

(Photo: iStock/Altered by FIT)

(This story was first published in June. FIT is republishing it in light of India recording its third confirmed case of monkeypox on 22 July.)

With the world still reeling from the COVID pandemic, news of another viral infection, monkeypox, spreading fast was enough to set off alarm bells.

On Monday, 18 July, Kerala Health minister Veena George confirmed India's second case of monkeypox — a 31 year old in Kerala who had recently flown in from Dubai.

This, less than a week after the first case — a 35-year-old man in Kerala —was reported on 14 July.

In a matter of a couple of months – since it was first reported on 12 May – Monkeypox has spread to at least 60 countries where it is not endemic, according to the World Health Organization.

The global caseload of the disease is now at 9200 and counting.

And the one question that eclipses all others is, are we headed for another pandemic?

Not everyone is waiting to find out, though. Countries are already rushing to prepare for the worst by stockpiling smallpox vaccines.

Is it an overactive flight or fight response thanks to COVID?

Would we be repeating old mistakes by ignoring early warning signs?

What are the chances that monkeypox can lead to another global pandemic?

Here's what experts have to say.

What is Monkeypox?

Monkeypox fever is caused by the monkeypox virus. The name comes from blisters or 'pox' which often accompanies the infection.

Speaking to FIT, Immunologist, Dr Satyajit Rath, explains that "while it is called 'monkeypox', it is found in rodents as well as other animals."

"It is rare in humans, but we do know that it spreads by close contact, especially with fluid from the blisters."

Dr Satyajit Rath, Immunologist, National Institute of Immunology

Although monkeypox typically causes only mild illness, and patients usually recover in a few weeks, it can be fatal in some cases – especially in children below 6 months and the elderly.

According to the WHO, monkeypox mostly occurs in tropical rainforest areas of Central and West Africa. In these regions, the disease has been endemic for years.

The reason monkeypox is in the news now is because, in the last few weeks, the disease has spread to other parts of the world, with many patients having no travel history to these regions.

Monkeypox is not a new virus.

(Photo: iStock)

If Monkeypox has been around for years, why is it spreading now?

Although the answer to this is largely a mystery, experts have different hypotheses.

"I do not think it is 'suddenly' spreading now," says Dr Rath, adding, "There have been occasional small outbreaks off and on in the past, too."

"We are hyper-aware because of the COVID-19 pandemic, so what would have been an 'inside page' story has become somewhat more prominent. I do not think that this is misplaced, but simply that the situation so far does not seem particularly novel."

Dr Satyajit Rath, Immunologist, National Institute of Immunology

Renowned epidemiologist, Dr J P Muliyil, on the other hand, is of the opinion that changes in patterns of human behaviour has more to do with the current outbreak.

"Apparently this outbreak is–still a pretty scanty outbreak– in people who have had some exposure to endemic areas which is followed by intimate contact with those who have not been to these areas," he tells FIT.

"So given that background, there is nothing that the disease has acquired newly, it's only that human activity has become more diverse and more people are travelling much more easily and getting exposed to it."

Dr J P Muliyil, epidemiologist

"I suspect hypersensitivity to infectious diseases of viral origin, especially zoonotic viral infections, is triggering panic buttons globally," says Dr Vineeta Bal, an immunologist and scientist at IISER-Pune.

"Experts in the field are familiar with such zoonotic spread, as well as small outbreaks. Rapid movement of people has its own contribution to disease spread."

Dr Vineeta Bal, immunologist and scientist at IISER-Pune.

Monkeypox vs COVID: How Do they Compare?

In the initial days of COVID, the transmission rate and potential impact of the virus were downplayed – it was thought to have low transmissibility, and only spreads through very close contact. Some also argued that COVID only spread through large droplets.

We know how things escalated from there.

So, are we seeing a similar situation playing out now with monkeypox?

Dr JP Muliyil says the two are not comparable at all. "COVID was an absolutely new disease."

He adds that given we knew absolutely nothing about COVID, there were many speculations in the beginning that ended up being disproved as things unfolded.

"Here, we know about the disease quite a lot already," says Dr Muliyil.

So, how does monkeypox compare to COVID?

According to Dr Vineeta Bal, a key difference is that, "it is an old virus, of DNA type, which generally mutate infrequently as compared to RNA viruses, to which SARS-CoV2 belongs."

This is because DNA mutations generally have fewer errors, says Dr Muliyil.

Adding to this, he says, "This (monkeypox) has a very low secondary attack rate. So you would need prolonged close contact before you are infected."

Monkeypox Won’t (Mostly) Lead to a Pandemic

There are several reasons why Monkeypox is not likely to cause another pandemic.

(Photo: iStock)

"From the point of view of public health, it is unlikely to become very widespread," says Dr Muliyil.

The WHO, too, last week, said something along the same lines.

Although everything we know about the virus suggests that it is very unlikely to cause a global pandemic, "close monitoring, restriction of infected individuals etc. are needed for containment," says Dr Bal.

The real problem, according to Dr Rath, that the COVID-19 pandemic threw at us is that "our public health outreach systems, in India and in fact in most of the world, are really not up to the task of efficient, deep, careful real-time surveillance of such diseases."

"And we do not seem to be planning realistically and adequately over the long term for correcting these deficiencies,"he adds.

"I suspect that we will see ongoing series of occasional, sudden, relatively small-sized outbreaks, although biology has a way pfo proving biologists embarrassingly wrong!"

Dr Satyajit Rath, Immunologist, National Institute of Immunology

Small Pox Vaccines? ‘Let's Hope It Doesn’t Come To That'.

When smallpox vaccines were developed, it was found to be effective against monkeypox as well. Since then, after smallpox was eradicated in 1980, these vaccines were discontinued.

One of these vaccines, Jynneos, however, was approved by the FDA in 2019 specifically for use against monkeypox.

Now, some affected countries, including the UK, have started offering smallpox vaccines for those at high risk of exposure.

Now, just because we have the vaccine, though, doesn't necessarily mean we need to use it. At least not yet, say experts.

"I hope they don't fiddle around with that," say Dr Muliyil when asked if rolling out smallpox vaccines as a preemptive measure to prevent monkeypox is a good idea.

"I have had the smallpox vaccine. Just because I'm 72 now. Younger people haven't had the chance to. It was given to everyone because smallpox is a deadly disease, but thank god it is gone!"

Elaborating, Dr Muliyil says the side effects of the vaccine are 'no joke', ranging from high fever to delirium.

"I don't think there is a public health emergency to warrant any kind of mass inoculation (of monkeypox)."

Dr J P Muliyil, Epidiemologist

Moreover, although the WHO in a statement said new updated vaccine has now been approved for the prevention of both smallpox and monkeypox, they have also discouraged countries from jumping the gun and giving in to alarmism by stockpiling and administering the vaccines to masses at this stage.

How do you protect yourself from getting infected with monkeypox then?

'Maintain hygiene, and practice safe sex' says the WHO.