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Scientists have been raising the alarm about monkeypox‘s potential to spill out of Africa and fill a gap left by smallpox since 2018.
But the warnings went unheeded.
A British scientist at a level four biosecurity lab – which works with smallpox-like viruses – first warned about its epidemic-causing potential four years ago.
They warned how the emergence of monkeypox could have ‘potentially devastating consequences’ due to declining smallpox vaccination rates leaving the majority of the world’s population completely unprotected from the virus.
The following year a group of international experts estimated that 70 per cent of the world was vulnerable to monkeypox because they had not been jabbed against smallpox.
It comes as another 12 Britons were diagnosed with the tropical illness on Thursday bringing the UK total to 90. The virus has been spotted in 19 countries outside of it usual range so far, making it the widest ranging outbreak ever.
Previously monkeypox has only ever been spotted in a handful of cases outside of central or western Africa and experts say they are surprised by the current outbreak.
But a World Health Organization report also warned about the tropical illness in 2020, saying the ‘epidemic potential’ of monkeypox was increasing with modern farming techniques and rising populations, which increase the chance of animal-to-human transmission.
Then, in November last year, experts ran a hypothetical scenario that found a genetically engineered version of the disease could kill 300 million people.
The final warning came in February this year — just weeks before the fresh outbreak.
A review conducted by smallpox vaccine manufacturer Bavarian Nordic warned that cases were rising rapidly in Africa.
Here MailOnline details the five crucial warnings that were missed:
September 2018: Porton Down scientist warns of potential ‘devastating consequences’ of monkeypox
Allen Roberts first raised the alarm about monkeypox in September 2018.
The scientist was working with ‘high consequence pathogens’ at the level four biosecurity lab Porton Down in Salisbury at the time.
This Government research site is used to work with smallpox and other viruses with biological warfare potential.
In the paper, he said the emergence of monkeypox would have ‘devastating consequences’.
Titled ‘Approaches to Handling High Consequence Pathogens’, he wrote that declining rates of smallpox vaccination had left the vast majority of world’s population vulnerable.
‘Only a fraction of the world’s population now retains immunity from previous vaccination, leaving the remainder of the population susceptible to this disease,’ he said.
‘Consequently, the risk of deliberate reintroduction of smallpox in a bioterrorism event, as well as the emergence of monkeypox, would have potentially devastating consequences.’
In 2018 a scientist working at Porton Down said the emergence of monkeypox could have ‘devastating consequences’ due to declining rates of smallpox vaccination across the globe
He also discussed the process of using monkeypox for conducting tests on potential smallpox vaccines on primates.
Tests on new vaccines to combat smallpox are tested on the closely related monkeypox due to the former being eradicated by a global health campaign and scientists considering it too risky to bring it back even for research purposes.
June 2019: Coalition of experts warn 70% of world is vulnerable to monkeypox
Dozens of British and international experts met at Chatham House in London to discuss how monkeypox ‘might fill the epidemiological niche vacated by smallpox’.
Members of the meeting included British and Nigerian virologists and experts on tropical medicine, as well as Public Health England, scientists from Porton Down, the US’s Center for Disease Control, and smallpox vaccine maker Bavarian Nordic.
Their meeting came after a series of monkeypox cases in the UK, Israel, and Singapore in 2018 and 19 which spread from travellers infected in Nigeria.
At what was described as an ‘ad-hoc conference’, the experts also warned how the eradication of smallpox left the world vulnerable to monkeypox.
Smallpox vaccines provide 85 per cent protection against monkeypox as the diseases come from the same family of viruses, called orthopoxvirus.
But with smallpox being eradicated just over 40 years ago, routine vaccination against it ended shortly after. In Britain, the last smallpox vaccines were given in 1971.
Publishing the results of the discussion in the journal Vaccine in 2020, experts said this meant 70 per cent of the world’s population is no longer protected against smallpox, and therefore, monkeypox.
‘Monkeypox is now a re-emerging disease,’ they wrote.
‘Vaccination and protective Variola minor [a minor smallpox strain] exposure contributed to smallpox eradication and likely reduced the number of other human orthopox infections.’
Dozens of scientists from around the world met in the UK in 2019 to discuss how monkeypox might fill the ‘niche’ left behind by the now eradicated smallpox
Concluding their paper, they called for more research on how monkeypox spreads and how to prevent it, including the development of vaccines and antiviral treatments, warning it had increasing potential to spread beyond central Africa.
‘With the cessation of widespread smallpox vaccination, increased study of the monkeypox virus, the human disease it causes, and its epidemiology are important,’ they said.
‘Global travel and easy access to remote and potentially monkeypox-endemic regions are a cause for increasing global vigilance.’
The experts highlighted how sex was a potential avenue of monkeypox transmission.
‘Sexual transmission has been hypothesised for some cases with genital and groin lesions,’ they said.
September 2020: WHO warns ‘epidemic potential’ of monkeypox is rising
Two years ago, a paper published by the WHO warned the ‘epidemic potential’ of monkeypox was increasing.
The article warned the end of routine smallpox vaccination could lead to the rise of monkeypox in people.
‘In a population with diminishing herd immunity against orthopoxvirus species, the epidemic potential of monkeypox will continue increasing,’ they said.
Mathematical modelling by the authors found monkeypox immunity in the Democratic Republic of the Congo (DRC), where the disease is endemic, fell from 85 per cent in the early 1980s to 60 per cent in 2012.
The authors of the WHO paper concluded their work by saying declining immunity as a result of the end of routine smallpox vaccination meant the virus posed ‘an ever-increasing threat for health security’
Smallpox vaccination ended in the DRC in 1980, but monkeypox cases have been rising since then with entire parts of the country now considered endemic for the disease.
The authors added previous flare-ups in Britain showed imported monkeypox cases could go on to infect others, as happened to a healthcare worker in 2018.
However, they said such cases were unlikely to lead to an epidemic as long as stringent infection prevention and control measures were followed.
But they also said rises in international travel could make dealing with monkeypox outbreaks increasing costly and a ‘poorly effective strategy’ to prevent disease.
They concluded: ‘With declining immunity to orthopoxvirus species, monkeypox can pose an ever-increasing threat for health security.
The study was written by experts from Institut Pasteur in France and published in the Bulletin of the World Health Organization.
November 2021: Monkeypox pandemic model warns virus could kill 300million
A pandemic/bioterroism preparation exercise ran a hypothetical scenario where a bioengineered monkeypox virus goes on to kill 300million in about 18 months.
The exercise was run by the Nuclear Threat Initiative (NTI), a nonprofit organisation that campaigns for greater controls on nuclear and biological threats, coincidentally chose May 15 this year as the start date for the pandemic.
This date has been seized by conspiracy theorists have seized as ‘proof’ monkeypox has been unleased intentionally.
The fact ex-Microsoft head and philanthropist Bill Gates, a favourite target of conspiracies about the Covid pandemic, made a $250,000 (£213,000) donation to the NTI back in 2018 further fuelled these unproven claims.
However, the NTI scenario was radically different from the current outbreak.
It used a fictional and a far more deadly monkeypox strain intentionally genetically altered to be resistant to vaccines.
Experts met in November 2021 to discuss how the world would respond to a hypothetical pandemic caused by monkeypox. The exercise included fake news reports on how the fictional virus was spreading in May 2022
The timeline of the Nuclear Threat Initiative’s fictional pandemic. In a statement this week, NTI said their choice of monkeypox for the exercise was based on recommendations from experts on potentially pandemic causing pathogens
In the scenario, terrorists managed to convince a scientist working at a virology lab to develop this virus and then go on to unleash in a fictional country.
A variety of other nations then go on to adopt different strategies in response as to the rapidly escalating pandemic.
By the end of the scenario, dated December 1, 2023, the new monkeypox virus had gone on to infect 3.2billion people, killing 271million of them.
The NTI issued a statement following the real monkeypox outbreak, explaining the scenario was one of many ‘worst-case’ exercises created to raise awareness about potential global threats.
They claim it was used to highlight gaps in national and international biosecurity and pandemic preparation.
They said there is no current evidence the real monkeypox outbreak is anything like their fictional scenario.
‘We have no reason to believe that the current outbreak involves an engineered pathogen, as we have not seen any compelling evidence that would support such a hypothesis,’ they said.
‘We also do not believe that the current outbreak has the potential to spread as rapidly as the fictional, engineered pathogen in our scenario or to cause such a high case fatality rate.’
NTI said they chose monkeypox for their scenario from a range of potential pandemic pathogens put forward by their health advisers.
Monkeypox was eventually selected due to it being such a different virus compared to Covid, which NTI said ‘encouraged exercise participants to consider issues beyond those that have already been highlighted by the current pandemic.’
February 2022: Scientists say monkeypox is a disease in ‘resurgence’
A monkeypox research review in the Neglected Tropical Diseases journal published just a few months before the current outbreak warned of a ‘escalation’ in cases, and of a disease in ‘resurgence’.
The team of European and American experts analysed 66 studies which covered both the West African monkeypox clade – responsible for the current outbreak – and the more deadly Central African strain.
They found that cases had increased 10-fold since the 1970s.
This map, published in the study, details the number of confirmed, probable, and/or possible monkeypox cases in the world between 1970–1979
And this map details the number of confirmed, probable, and/or possible monkeypox cases in the world between 2010-2019, demonstrating not only the rise in the number of cases but how far they had spread. DRC figure reflects suspected cases
‘There are mounting concerns about the geographical spread and further resurgence of monkeypox,’ they said.
‘Over the past five decades, monkeypox outbreaks have been reported in 10 African countries and four countries outside of Africa.’
They theorized the end of regular smallpox vaccination and deforestation leading to closer contact between humans and infected animals could be two factors behind the rise.
‘At the time when smallpox was rampant, no cases of monkeypox were reported,’ they said.
‘In our review of the literature, we found that unvaccinated individuals accounted for approximately 80–96 per cent of monkeypox cases.’
They concluded: ‘The waning population immunity associated with discontinuation of smallpox vaccination has established the landscape for the resurgence of monkeypox.’
‘This is demonstrated by the increases in number of cases and median age of individuals acquiring monkeypox as well as the re-emergence of outbreaks in some countries after an absence of 30–40 years.
‘The appearance of cases outside of Africa highlights the risk for geographical spread and the global relevance of the disease.’
The authors called for increased international support for the surveillance and detection of monkeypox cases.