The Silent Spread of Mpox: A Wake-Up Call for Global Health Vigilance
The recent global outbreak of mpox is a stark reminder of the interconnectedness of our world and the potential for diseases to spread undetected across borders. As detailed in a comprehensive report by Jon Cohen and Abdullahi Tsanni, the virus circulated in Nigeria for years before sparking a worldwide epidemic, exposing significant gaps in global health surveillance and response systems.
The story of mpox’s resurgence is one of missed opportunities and delayed recognition. As early as 2017, Dr. Dimie Ogoina observed unusual cases in Nigeria that hinted at sexual transmission of the virus. However, his concerns were initially met with scepticism. “[They] asked me to be quiet,” Ogoina recalls one meeting where he tried to raise the alarm. This dismissal of early warning signs is a troubling pattern in global health. Too often, observations from frontline healthcare workers in the Global South are overlooked or downplayed by the international community. The result is a dangerous lag in response time, allowing diseases to gain a foothold before concerted action.
The mpox outbreak also highlights the persistent inequalities in global health resources and attention. While cases in Europe and North America prompted swift action and vaccine deployment in 2022, Nigeria’s ongoing struggle with the virus has received comparatively little support. As Oyewale Tomori, a prominent Nigerian virologist, pointedly states: “We’re waiting for outsiders to come and do for us.” This disparity in response is not just a moral failing; it’s a strategic blunder in the fight against emerging diseases. As the current outbreak of a deadlier mpox variant in the Democratic Republic of Congo demonstrates, viruses don’t respect borders. Neglecting outbreaks in any part of the world puts us all at risk.
Moreover, the mpox saga underscores the critical importance of comprehensive sexual health services and destigmatisation efforts. The virus’s spread through sexual networks, particularly among men who have sex with men, was likely facilitated by societal taboos and discriminatory laws that discourage open discussion and seeking of care. A tragic case in Nigeria illustrates the devastating consequences at the intersection of infectious disease and social stigma. A 40-year-old man, diagnosed with both mpox and HIV, took his own life after learning of his condition. This heartbreaking incident highlights the urgent need for mental health support and destigmatisation efforts alongside medical interventions.
The delayed recognition of mpox’s sexual transmission route also points to a broader issue in global health: the tendency to adhere to established narratives about disease spread. For decades, mpox was considered a zoonotic disease with limited human-to-human transmission. This assumption likely contributed to the slow response to Ogoina’s observations. It took years and a global outbreak for the scientific community to fully acknowledge the virus’s ability to spread efficiently through sexual contact. This experience should prompt us to question our assumptions about other known pathogens and remain open to new evidence about transmission routes.
Genomic surveillance has emerged as a crucial tool in understanding the mpox outbreak. Studies by evolutionary biologists like Áine O’Toole and Andrew Rambaut have revealed that the virus likely began spreading among humans as early as 2014, years before it was detected. This long period of undetected transmission allowed the virus to adapt to human hosts and spread to urban centres, ultimately facilitating its global dissemination. The power of genomic analysis in tracing the origins and evolution of outbreaks underscores the need for increased investment in these technologies, particularly in regions where new pathogens are likely to emerge.
The role of urbanisation in disease spread is another critical lesson from the mpox outbreak. As Michael Worobey of the University of Arizona points out, the virus needed the environment of a large city to take hold and spread efficiently. This mirrors the pattern seen with COVID-19 and highlights the growing importance of urban health in an increasingly urbanised world. As cities in the Global South continue to grow rapidly, investing in their health infrastructure and surveillance capabilities should be a global priority.
The international response to mpox also reveals the challenges of balancing public health messaging with the risk of stigmatisation. While it was important to communicate the primary mode of transmission to at-risk communities, this messaging inadvertently led to the perception of mpox as a “gay disease” in many parts of the world. This echoes the early days of the HIV/AIDS epidemic and demonstrates that we still struggle to communicate about diseases that disproportionately affect marginalised communities without fueling discrimination.
Looking forward, the mpox outbreak offers several crucial lessons for global health. First, we must create more robust systems for identifying and responding to unusual disease patterns, particularly in regions with limited healthcare resources. This includes taking seriously and rapidly investigating reports from local healthcare workers, regardless of where they originate. Second, investments in genomic surveillance and evolutionary biology studies are crucial for understanding how viruses mutate and spread. These tools can provide early warnings of emerging threats and guide response efforts.
Third, public health efforts must address the social and cultural factors that can hinder disease control, including stigma around sexual health. This requires a holistic approach that combines medical interventions with community engagement and education. Fourth, global health equity should be a priority, ensuring that all countries have the resources to detect, report, and contain outbreaks. The stark disparities in vaccine access during COVID-19 and mpox outbreaks demonstrate the urgent need for a more equitable distribution of health resources.
As WHO Director-General Tedros Adhanom Ghebreyesus warned when declaring a new Public Health Emergency of International Concern for the Congo Basin outbreak, “This is something that should concern us all.” Indeed, in our interconnected world, a threat to health anywhere is a threat to health everywhere. The story of mpox’s silent spread is a cautionary tale that should spur us to action. We must strengthen global health surveillance, foster international cooperation, and address the social and economic inequities that allow diseases to flourish undetected. Only through a coordinated, equitable, and proactive approach can we prevent future outbreaks from catching us off guard and protect the health of all global citizens.
References:
1. Cohen, J., & Tsanni, A. (2024). “The untold story of how Nigeria’s mpox outbreak sparked a worldwide epidemic”. Science.
2. World Health Organization. (2024). Declaration of a Public Health Emergency of International Concern for mpox.
5. Rambaut, A., et al. (2022). “Preliminary genomic characterisation of an emergent MPXV genotype in the UK defining the 2022 multi-country outbreak”. Virological.org.
