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Monkeypox: what we know

Monkeypox: what we know

The virus is spreading and the World Health Organization has declared a public health emergency. How is monkeypox infecting people and who needs to be vaccinated first?

“At home and in isolation not because he has Covid. But two weeks ago James was diagnosed with monkeypox.”

ITV News

On 7 May, monkeypox – a disease typically found in the rainforests of central and western Africa – came to the UK.

“The puzzle is why a disease endemic to parts of Africa and transmitted largely by animals is suddenly spreading so widely between people.”

Sky News

The first case was in someone who had just come back from West Africa, but now it’s spreading in the community. 

Only Spain and the US have confirmed more infections than the UK, where there have been nearly 3,000 cases.

And the World Health Organization has sounded the alarm.

“We have an outbreak that has spread around the world rapidly through new models of transmission, about which we understand too little, and which meets the criteria in the international health regulations. For all of these reasons I have decided that the global monkeypox outbreak represents a public health emergency of international concern.”

WHO director-general Tedros Adhanom Ghebreyesus

So what do we know about the disease and the way it spreads?


Monkeypox has been around since at least 1958, but this outbreak is unusual.

For one thing it’s less deadly than it has been in the past. 

The West African strain of the virus spreading around the world has, in the past, had a case fatality rate of between 1 and 4 per cent.

But no one in the UK has died in this outbreak, and there have been just a handful of deaths globally.

The symptoms are different too. Although infectious lesions are characteristic of the disease, they have been more localised in this outbreak… They are regularly being found on the genitals or anus.

And most striking of all is who is being infected – and how.

“Now, to be clear, anyone can get monkeypox. The virus is similar to smallpox. But it can be spread through close contact, and for whatever reason a number of the patients are gay and bisexual men.”

NBC News

Research in the New England Journal of Medicine found that 98 per cent of infections have been in men who have sex with men. And 95 per cent of cases have been spread through sexual contact.

It is true that the virus can spread through coughing, hugging, and even sleeping in someone else’s sheets. But it’s much less likely to be transmitted that way.

And given those statistics it seems obvious that men who have sex with men should be prioritised when it comes to vaccinating people against the disease.

So why hasn’t it been that simple?

“There is now a danger that has become a threat to us all. It is a deadly disease and there is no known cure… If you ignore Aids it could be the death of you. So don’t die of ignorance.”

1987 Aids advert

The 1980s were a terrifying time for LGBTQ communities who faced the real dangers of HIV and an enormous amount of stigma.

HIV/Aids was labelled the “gay plague”. Tabloid newspapers ran headlines that said things like: “I’d shoot my son if he had Aids, says vicar!”

There are people in the LGBTQ community who worry that, at least when it comes to the stigma, history might repeat itself.

“It always seems to be easier to blame a group of folks who are marginalised that are on the periphery of what is considered traditional society. We just don’t want the same thing happening again with this virus and targeting it as a gay disease. Because we know it’s not.”

NBC News

When the head of the World Health Organization said that the outbreak was concentrated among men who have sex with men, he received hundreds of Twitter replies accusing the organisation of homophobia.

But monkeypox is overwhelmingly infecting men who have sex with men, even when you account for testing rates among different communities.

So that group needs vaccinating right now, because they are most at risk. 

It’s why the UK Health Security Agency is inviting high-risk men who have sex with men to be vaccinated first. And why New York City’s health department is doing the same.

It’s true that anyone can contract monkeypox. 

But there are especially vulnerable groups in this outbreak that need protecting today. 

From the disease – and also from the stigma.

Today’s episode was written and mixed by Xavier Greenwood.