Let’s call monkeypox what it is: A pandemic

Eric Feigl-Ding is an epidemiologist and co-founder of the World Health Network. Kavita Patel is a physician and former director of policy for the White House Office of Intergovernmental Affairs and Public Engagement. Yaneer Bar-Yam is president of NECSI and co-founder of the World Health Network.

It is time for the global public health community to recognize a growing reality: Monkeypox is now a pandemic. And unless we declare an emergency and act quickly to combat it, we risk repeating the same mistakes we made with our covid-19 battle.

No longer contained to a single continent or found only among travelers, the monkeypox virus is undergoing community transmission in dozens of countries worldwide and spreading unchecked at an alarming rate. This is especially dangerous for the immunocompromised, pregnant women and young children. They all have a hospitalization and death rate from the virus that is much higher than that of healthy adults.

Yet despite the growing number of cases, the World Health Organization has largely played down the outbreak. On June 24, the agency failed to declare a public health emergency — just as it repeatedly failed to issue emergency and pandemic declarations for the coronavirus, until finally declaring a pandemic in March in 2020.

Historically found in West and Central Africa, the monkeypox virus began to spread internationally in early May, when the United Kingdom announced its first confirmed positive case. The global reaction since then has been incredibly slow. Case counts seem low relative to covid-19, and the world appears to be lulled into complacency, like a frog in gradually heating water. Today, the virus has spread across more than 70 countries on six continents with no sign of abatement. According to the WHO itself, cases have tripled in Europe in the past two weeks. We need to wake up to the fact that we are already in a boiling pot.

The available European data show that most infections have occurred in men who have sex with men (MSM), who are generally young adults. However, there are reported cases among household members, heterosexual contacts and nonsexual contacts, as well as children. About 10 percent of patients have been hospitalized for treatment or for isolation, and there has been one ICU admission.

Given the early predominance of cases in the MSM community, many countries are not testing others with monkeypox symptoms, leading to a risk of distorted infection numbers and wider uncontrolled spread — which in turn leads to a risk of many more individuals becoming infected with severe cases.

A new study also suggests that the virus might be mutating 12 times faster than expected, and could lead to 60,000 new cases per day in the U.K. alone by the end of 2022. Other models suggest that we could conceivably see 100,000 cases worldwide by August and 500,000 to 1 million cases by the end of September.

The WHO was created with the vision of coordinating global efforts to promote health and keep the world safe, precisely what we currently need. Health-care workers and front line personnel are in critically short supply, and there is inadequate conversation regarding targeted prevention. By not preemptively raising the alarm, the WHO is putting countless lives at stake — just as the delay in classifying covid-19 played a critical role in the failure to control that virus’s global explosion effectively.

We must enlist the full spectrum of prevention and diagnostics to curb the spread, preclude the development of local disease reservoirs in rodents, and prevent suffering and possible death, especially in the immunocompromised, pregnant people and young children.

Governments and health authorities worldwide should alert the public regarding protection measures and provide support for mitigation, rapid case identification, early diagnostics, contact tracing and isolation. While a reliable monkeypox vaccine exists due to prior research, it will take many months to ramp up production for the world.

Here in the United States, the federal government has already ordered 1.6 million doses for 800,000 Americans, but these will not be available until the end of 2022. By then, it will be too late unless we act now with other containment measures. The Centers for Disease Control and Prevention needs to lead by example and encourage science-based precautionary measures to protect Americans.

We at the World Health Network have taken action to issue an early warning. On June 22, we declared monkeypox a pandemic emergency and released public health guidance for steps to curb the spread. We invite the WHO to join us and are hopeful it will reconsider and act soon. WHO Director General Tedros Adhanom Ghebreyesus has recently acknowledged monkeypox’s growing threat.

We should all refuse to walk blindly, allowing the present to become prologue to greater catastrophe. Global health officials must advocate for and enact a unified, coherent approach to fighting the monkeypox pandemic before it reaches the proportions of covid-19. If we act, guided by the lessons of the past two years, we can avoid the mistakes that cost the world millions of lives.


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