We have not yet overcome a pandemic against which a large part of the world's population is not vaccinated or has only one dose of vaccine, and the WHO has already declared a new global emergency because of the abnormal and highly dangerous behavior of a virus that was taken for harmless. But was this a surprise? What real danger is there? What are the media not telling us about the things scientists are publishing and discussing?
A minor tropical disease?
Until very recently, many virologists had considered this virus to be a relatively mild version of smallpox, to whose family it belongs. Despite its rather unfortunate name, this smallpox virus actually circulates in populations of African squirrels, which are its natural reservoir.
Occasionally they are transmitted to humans, usually by direct contact with an infected animal, and then manage to circulate in a very restricted manner among humans. A very important detail is that this is not a virus transmitted through insect bites, unlike other viral diseases in worrying spread such as Chikungunya or Zika.
The virus can be transmitted by contact and through the air between humans, but until now the outbreaks were always very limited and if any cases appeared outside Africa it was because they had recently been in risk areas. In other words, monkeypox only managed to circulate effectively within its small area of the Congo and mainly within squirrel populations.
But now all this has changed. For some reason that is not yet clear, the virus no longer needs to be bound to its natural animal reservoir, now virtually all cases are among people who have never been to Africa. That is, the virus circulates on a large scale among humans far from its place of origin.
But its mode of spread is not the only thing that has changed. In fact, the signs and symptoms of the disease are no longer the same as in its original African version. Originally, patients developed pustules on the face that then spread centrifugally to other parts of the body in a manner similar to smallpox. Now, the first signs are hives and rashes on the lower body and genitalia.
In fact, the clinical signs are so different that it is feared that a large number of misdiagnoses are being made. Monkeypox is being diagnosed as herpes or herpes zoster (chickenpox, which is not a poxvirus despite its name), and this is probably negatively affecting efforts to contain the epidemic.
It is because of these disconcerting changes and the danger to the immunocompromised population posed by a virus family against which much of the population is not immunized (due to the end of smallpox vaccination) that the WHO is sounding the alarm bells. But how did it come to this?
Beneath zoonotic epidemics like Covid and smallpox there lies a similar social pattern
1980, WHO declares smallpox to have been eradicated
Monkeypox was described in humans in the 1970s, at the height of the smallpox vaccination campaign. The fact that the vaccination campaign conferred some incomplete immunity against monkeypox managed to keep monkeypox cases at a relatively low level, but the smallpox campaign ended in 1980.
WHO maintained a monkeypox surveillance mission between 1981 and 1986 and, using mathematical modeling, decided that local outbreaks were going to remain contained even in the absence of vaccination. So it withdrew all surveillance for over 20 years, and the organization itself, chorused by the media, insisted for decades that smallpox had been defeated forever. But... was it true?
A group of researchers went back to Congo in the late 2000s, and found that cases had been increasing all these years. The number of cases was 20 times higher than in 1986. On the mathematical models used by WHO, these authors said that:
This modeling analysis used available information to predict the future of monkeypox dynamics when the population was completely unvaccinated, but did not include statistical uncertainties and could not account for changes in the ecological reservoir and subsequent epidemiology. The model was suitable only for a static world. But as the authors pointed out, population and land use had been changing at a rapid pace in the area where monkeypox was endemic due to the increasing pressure on subsistence peasantry.
In other words, something similar to the origin of Covid was occurring: the needs and disasters of national capitalism were pushing peasants towards productive areas and practices that implied an increase in contact between humans and animals that acted as a natural reservoir of the virus.
Such increased contact could not bode well. And in fact, by facilitating replication, it ended up multiplying and worsening outbreaks, but also making the virus more dangerous.
However, the study was published in a high-profile journal in 2010 and immediately ignored.
The danger of underestimating known viruses
End-to-end whole genome of the smallpox virus family. Each little box is a different gene and the color coding indicates how conserved the gene is among different viruses in the family (top: beginning, in the middle the midsection, and below the end of the genome). In green are those that are well conserved, in red those that are lost or poorly conserved. It can be seen how the genome of the poxviruses (the smallpox viruses) has great variability at its ends, with entire sets of genes missing or repeatedly multiplied from one virus in the same family to another.
The fight against infectious diseases is a protracted war against organisms that continually adapt to new conditions and hosts. Winning a battle - as was the eradication of smallpox - cannot be mistaken for winning the war. Unlike organisms like us, pathogens - and viruses in particular - are shaped by enormous selective pressures.
Their entire genome and structure exists in response to relentless pressure to find new niches and expand. This is visible in, for example, RNA viruses such as coronaviruses or HIV, which promote and endure enormous mutation rates in their genomes.
In some cases, up to 80% of all virions (infectious particles) produced by infected cells become so full of harmful mutations that they render them completely defective, but this mad dash is what allows viruses to evade our immune systems by producing new variants faster than our immunity can catch up.
Poxviruses (the scientific name for the smallpox family) are DNA viruses very different from coronaviruses or HIV, and at first glance deceptively stable. Poxviruses can carry hundreds of genes and a large linear genome of over 100,000 DNA bases, which is enormous compared to the more notorious RNA viruses.
RNA is chemically unstable (bases can break RNA strands by reacting with the bonds linking bases to one another) and RNA viruses use machinery that is inherently less capable than their DNA counterparts of correcting replication errors in their own genome, which makes DNA viruses appear to have slower rates of evolution in comparison.
In reality, poxviruses "cheat." It has been known for years that the replication machinery of poxviruses tends to "skid" toward the ends of the genome and "splice" distinct pieces of DNA (recombination), causing large accordion repeats and gene deletions. This helps them to rapidly evade cellular defenses by accordion expansion of cell-attack gene families and mutation of these genes.
Poxviruses are much less stable and much more dangerous than they appear at first glance.
Nothing about this epidemic was or is really unexpected, the danger was known at the molecular level and the rise of the disease in Africa had been described as long as 12 years ago. No one should be surprised.
After 20 years of increasingly desperate warnings about the danger of coronaviruses, scientific alerts also ran up against a wall of inaction. Twenty years that could have been amply used to develop drugs and pilot vaccine production lines against specific virus families.
A solution that can only be global in an increasingly divided world
As far as the response to this announced catastrophe is concerned, the problems are manifold. It is known that the smallpox vaccine gives a certain level of suboptimal protection against the original version of monkeypox (about 87%), and any real and effective vaccination campaign would have to be truly global to be of any use.
And if the major powers, which are the ones that monopolize vaccine production, have neither been able nor had any real intent to ensure vaccination in much of the world today against Covid (only 16% of the population in the poorest countries has one or more doses), there is little prospect that they will change their position on an epidemic that has not yet affected their economies to the degree that Covid did.
Major pharmaceutical companies are still fighting over patents to this day while health workers in countries like Malawi are dying en masse:
"We saw our fellow nurses dying of COVID," says Milly Kumwenda, a nurse at Queen Elizabeth Central Hospital in the southern Malawian town of Blantyre, recalling a deadly wave of the disease in January 2021. After two cabinet ministers died of COVID-19, Malawi's president declared a state of national disaster. The aid agency Médecins Sans Frontières (MSF) rushed to help and launched an appeal to the rest of the world: "Malawi urgently needs access to the vaccine."
Very few doses arrived, in unpredictable spurts and often on the verge of expiring. By the time of the next wave in July 2021, only 1% of Malawians had been vaccinated. Many people had stopped seeking care by then because they had lost faith in the health system, says Loveness Gona, another nurse at the hospital.
In Malawi there are few ventilators, no antiviral infusions or monoclonal antibody treatments, and a chronic shortage of drugs to treat deadly symptoms such as blood clots and inflammation. These are some of the reasons why mortality rates among people hospitalized for COVID-19 in low-income countries have been more than twice as high as in wealthy nations.
Gona recalls coming to work to find corpses propped up in chairs in the hospital waiting room, with loved ones demanding proof. "In another place they would be alive," she says.
Long-term control of monkeypox will require vaccination of as many as possible of the 327 million people aged 40 years or younger living in the 11 African countries where monkeypox is endemic in an animal (rodent) reservoir. This effort should include childhood vaccination programs. Surveillance will be necessary to identify new animal reservoirs, which could become established in other countries as a result of infected humans inadvertently transmitting the virus to domestic rodents that have subsequent contact with wild rodents.
The smallpox eradication program was a 12-year effort involving 73 countries with as many as 150,000 national staff. Because of its animal reservoir, monkeypox cannot be eradicated. Unless the world develops and executes an international plan to contain the current outbreak, it will be another emerging infectious disease that we will regret not containing.
Emerging infectious diseases occur globally and continuing to hide behind national borders while stoking imperialist conflict is only going to make the situation worse.
The bottom line is that the massive impoverishment of the peasantry of the semicolonial countries, the lack of any interest on the part of the great powers to maintain epidemiological vigilance, the anti-human cost of the exacerbation of intellectual property and the inability of the system to respond in a coordinated manner to global risks, including health ones, continue to claim present and future lives.
Like war, epidemics express in a brutal way the contradiction between the development of the system (= growth of capital) and human development. A contradiction that is more and more openly presented as an antagonism between the survival of capital and human life.