Monkeypox is the latest global public health threat to make headlines. Most people who get the monkeypox virus have flu-like symptoms and skin rash which lasts two to four weeks, but a small percentage of those infected develop sepsis or other serious illnesses and life-threatening complications.
It is not uncommon for there to be small outbreaks of monkeypox in central and western Africa, but in recent weeks dozens of countries in other parts of the world have reported thousands of cases of monkeypox.
As an infectious disease epidemiologist, I have received many inquiries from colleagues and friends about whether a monkeypox pandemic will be the next big disruption to our lives. A disease is considered pandemic when two distinct conditions are met: cases are occurring worldwide and the number of diagnosed cases is large enough to qualify as epidemic. An epidemic is characterized by new cases of a disease occurring at a higher than average rate in at least several communities.
While the monkeypox situation is certainly newsworthy, as of mid-July 2022 it clearly did not meet both requirements for pandemic status. More importantly, current evidence suggests that monkeypox is highly unlikely to become a global health disaster even if the virus spreads and becomes pandemic.
Is monkeypox global?
Both the 2009 H1N1 flu virus and the Coronavirus SARS-CoV-2 which emerged in 2019 has quickly spread to all parts of the world. Global health experts were in full agreement that these were pandemic events. On the other hand, the Ebola virus The outbreak in West Africa from 2014 to 2016 was mostly confined to this single region of the world and never spread globally.
The current distribution monkeypox cases falls somewhere between these two scenarios. In mid-July 2022, approximately 9,200 cases in total monkeypox had been reported by 63 countries. For reasons not yet fully understood, almost all of these cases occurred in Europe and Americasand only a few cases have been reported by Africa, Asia and the Middle East countries.
Is this distribution global enough to meet the definition of a pandemic? Maybe.
Is monkeypox an epidemic?
The next condition for reaching the pandemic threshold is whether the places where monkeypox is present are experiencing epidemics.
Europe and the Americas generally have zero cases of monkeypox per year, so the current number of cases in these areas is much higher than normal.
But it’s also important to look at the extent of community transmission. If hundreds of people fall ill after attending a single event – like a concert or festival – that would generally be classified as an epidemic. The situation would only become an epidemic if infections started to occur among many people who were not close contacts of the event attendees. Once widespread and sustained community transmission begins, it is much more difficult to control a virus.
Most of those diagnosed with monkeypox in May and June 2022 were males between the ages of 20 and 50 who identify as members of the LGBT+ community. As of July 2022, cases were not yet occurring at significant levels across multiple age and socio-demographic groups.
Is the current pattern of spread sufficient to classify monkeypox as an epidemic rather than an epidemic? Maybe, but only in some of the countries that have reported cases of monkeypox this year.
Since the answers to whether monkeypox is global and an epidemic are both “maybe” rather than “yes”, this suggests that monkeypox is not a pandemic – at least not yet. But it could soon be.
How Worried Should You Be About Monkeypox?
Pathogens like monkeypox usually spread through touch and other types of close contact with an infected person. Epidemiologists are much less concerned about pathogens that are transmitted “from person to person” than about respiratory viruses like influenza and coronavirus that can spread easily through the air.
In just a few months, COVID-19 has gone from a local concern in Wuhan, China, to the worst pandemic in a century. That’s to say it won’t happen with monkeypox.
Why? First, the monkeypox virus is much less contagious than circulating strains of coronavirus. Second, monkeypox is less deadly than COVID-19. The fatality rate during the current international epidemic is less than one death per 1,000 adult cases, which is less than the percentage of unvaccinated people who die after receiving COVID-19[feminine]. And, thirdly, existing vaccines may help slow the spread of monkeypox in high-risk populations if problems with limited supplies can be resolved.
The World Health Organization follows a set of rules called International Health Regulations that guide global public health responses to emerging threats. Under these regulations, the WHO has the authority to declare a “public health emergency of international concern” – commonly abbreviated to the acronym USPPI – when an infectious disease is spreading internationally and could “potentially require a coordinated international response”. The aim is to detect and respond to potential global health crises and prevent them from developing into pandemics.
A group of experts convened by the World Health Organization on June 23 determined that monkeypox was a “multi-country epidemic” but did not meet the criteria for a public health emergency of international concern. The panel will meet again on July 21 to review the distribution and frequency of new case reports. If the rate of new cases continues to increase and there is evidence of transmission in more diverse populations, monkeypox may be declared a public health emergency.
But even if monkeypox is declared a public health emergency of international concern, it will not become a devastating pandemic like COVID-19.