The History of Now
Monkeypox was first discovered in a Danish monkey colony in Copenhagen in 1958. It has been mostly ignored by the West since then. The disease, which causes fever, chills, and rashes in the body, is an infectious poxvirus. It is found in ten African countries. It was not common in Europe or the Americas until recently. This trend has historically led Western public health officials and Westerners to ignore its spread.
Martin Hirsch, Harvard University immunologist and editor-in-chief of Journal of Infectious Diseases, says, "It's not in my backyard." "It's something that is only found in Africa and there's not much interest from Western health groups."
As news broke about a multi-country monkeypox epidemic, headlines were filled with sensationalism and public panic. Much of the media hype was tinged by racism and homophobia and suggested that the disease could be poised to spark another pandemic. There are reasons to be concerned--at least 2,103 cases were reported in 42 countries and the disease seems to be spreading faster than ever before. But monkeypox isn't a new threat. The disease is now being studied by scientists from Africa, who have been studying it for many decades. This can help Western countries pay more attention to it than they did in the past.
Monkeypox, which is believed to have circulated for thousands of years and has been misunderstood, is a widespread myth. Its name is a misnomer. Monkeypox is not a disease. The disease is primarily found in rodents, and monkeys are only incidental hosts. Monkeypox is more prevalent in central and west Africa. However, it's misleading for people to refer to the virus as "being African". This was stated by more than 20 scientists in a paper that outlined the need for a nondiscriminatory and non-stigmatizing term for the disease. This is why monkeypox will be renamed soon. The virus's continued existence in Africa is due to inequal access to global vaccine stocks and healthcare resources.
"Remember that the first monkeypox was found in Denmark and not Africa," Oyewale Tomori (virologist at Redeemer's University, former president of Nigerian Academy of Science) says.
Monkeypox is a cousin to the much more deadly smallpox virus. It spreads via direct contact with infected persons' bodily fluids, sores, or scabs. Although it is possible to be exposed through the airways via respiratory droplets, this is less common and understudied.
This current outbreak seems to be primarily affecting men who have sex without consent (MSM), a trend that is similar to the HIV/AIDS epidemic which disproportionately affected LGBTQ communities at its peak in the late 1980s. Although scientists aren't sure exactly why the disease is spreading, early research suggests that it may have spread to highly interconnected networks of sexual partners within the MSM community. This allows it to spread in ways it cannot in the general public, according Science magazine.
Poxviruses and monkeypox are part of a larger narrative on global health inequities, scientific progressivism and how science is presented in a linear and victorious manner that ignores the incremental nature of most scientific discoveries. Monkeypox's long-ignored history makes it both obscure and more visible, to the detriment to public health.
The history of monkeypox is not easily separated from the history of smallpox. Smallpox is thought to have appeared first around 10,000 B.C.E. Smallpox, one of the most deadly diseases in human history, claimed more than 300 million lives worldwide in the 20th Century. Communities in India, China and Turkey have been trying to stop the spread of smallpox for decades. They use iron needles that are dipped into smallpox pustules to poke people. These measures are known as variolation or inoculation. They involve immunizing patients by giving them a mild version of the virus. Inoculation was introduced to Europe only in the 18th century by Lady Mary Wortley Montagu. She had learned about the practice from Turkish women.
The smallpox epidemic that struck Massachusetts in 1721 prompted Reverend Cotton Mather, and Zabdiel Boylston, to try the procedure. Celebrations of the couple's perseverance tend to forget the contributions of Onesimus the enslaved man who introduced Mather at inoculation--a practice Onesimus had learned in West Africa. Many other details about him, including his birthplace and original name, are unknown. Elise A. Mitchell, Princeton historian, explains that "the silences surrounding Onesimus were produced at... four moments: [H]is historical history is obscured by Mather's records and the archives, as well as our historical narratives, and our sense of His historical significance."
The roots of Inoculation in non-Western cultures made it highly contested. It was condemned as anything from Orientalism to an African conspiracy. Boston's only doctor with a medical degree was the one who decried it. Mather was attacked by a bomber who attached a warning saying, "Cotton Mather you dog, dam you!" You'll get a pox from me.
The history of smallpox is largely centered on Edward Jenner, an English surgeon who administered the first vaccine in the world in 1796. Powel H. Kazanjian is an infectious diseases doctor and historian at Michigan. He believes that Jenner is the most important person in this story because he helps to tell the story of Western medicine’s authority.
The story that Jenner discovered vaccination is a common myth, and it's likely to be false. According to popular legend, Jenner was inspired by the "rosy, unblemished skin" of a local milkmaid. He believed that smallpox could be prevented by infection with cowpox. This "Myth of The Milkmaid", as Arthur W. Boylston puts it, ignores the work of John Fewster, a country doctor who discovered the protective properties of cowpox in 1760s. Boylston claims that Jenner's biographer created the milkmaid story in order to protect his subject and to allow a triumphalist narrative to grow, rather than one based upon scientific progress.
Hirsch says that the smallpox elimination effort was what made it truly heroic. It was a goal that was first set out by the World Health Organization (WHO) in 1959. Viktor Zhdanov, U.S.S.R., presented a theoretical basis for eliminating smallpox in Minneapolis at the World Health Assembly the year before. Zhdanov used a letter from President Thomas Jefferson in Jenner to try to get support: "It is because of your discovery... that peoples around the world will learn more about the disgusting smallpox virus only through ancient traditions."
The WHO director-general at the time estimated that to eradicate smallpox in endemic areas, it would take vaccination of approximately 80 percent of the population. It would also cost close to $100 million. The program was stalled for many years due to a lack of funding, vaccine donations, and staff. India was one example of a country that had to stop its ambitious eradication efforts after it failed to respond to emergency calls for vaccines.
The WHO revived the initiative in 1967 under the name of the Intensified Smallpox Eradication Programme. The new interest was triggered by a combination of factors, including the appointment and support of more Americans and WHO leaders who were optimistic about the project. The WHO's strategy shifted away from mass vaccination and became more focused on identifying new cases, isolating infected people, and vaccinating any close friends. Ten years later, Somalia was the last place where smallpox was endemic. In 1980, the WHO declared the disease eradicated.
This milestone was however costly. In his 1985 book, The Management of Smallpox India, Lawrence Brilliant, an American epidemiologist, described the extraordinary surveillance and containment strategies used by public health officials. Brilliant explained that Operation Smallpox Zero started in 1975 with house-to–house searches. This quickly grew to include room-to–room and house-to–house searches. Patients who had a fever and a rash were found guilty of smallpox. Informants were paid cash rewards for their help in identifying the victims. Guards were placed to protect isolated patients, and motorbike and Jeep teams combed all villages within a 10-mile radius of suspected or known smallpox cases. Everybody within a 1-mile radius of the smallpox cases was vaccinated, regardless of their previous vaccinations.
Paul Greenough, an historian from the University of Iowa, claims that the last steps of South Asia's vaccination campaign were rooted in intimidation and coercion. Many of the U.S.-based expatriate epidemiologists landed in India and Bangladesh. These epidemiologists were considered advisors, but they operated in impunity because of the lack of transportation, fuel and cash. Their sole focus on smallpox made their efforts to eradicate the disease seem hollow to the locals. Greenough describes a case in which a woman from Bangladesh refused to receive the vaccine until she was fed. Stanley Music, senior WHO epidemiologist, retorted that "She said that she didn't care if she died from starvation. Why should I care if her smallpox got?" She was vaccinated with her consent.
Music provided more information about the program's persistent approach in an unpublished dissertation:
Infected villages were attacked in a military-style attack at the beginning of developing a coherent containment strategy. The hit-and-run thrill of such a campaign saw children and women being pulled from the latrines, behind doors, under beds, and within latrines. When caught, people were pursued and vaccinated.
Officials concluded that the ends justified the means, with the fate of the SEP in South Asia in balance.
The smallpox vaccines offer some protection against the closely related virus monkeypox. Many countries have stopped vaccination against this now-extinct disease since the 1970s.
In 1970, a 9-month old boy from the Democratic Republic of the Congo (DRC), was the first to be diagnosed with human monkeypox. Following the identification of the cases, the WHO reported 54 cases from 1970 to 1979 and 338 cases from 1981 to 1986. This is likely due in part to increased surveillance and case identification.
Africa has seen a number of monkeypox cases in Africa over the past 30 year, despite waning coverage of smallpox vaccines. Hirsch says that these events in the U.S. "didn’t really raise any alarm."
The 2003 monkeypox outbreak in the United States proved to be an exception. Schyan Kautzer, three years old, was infected with the disease. After being bitten by one her prairie dogs, red welts appeared all over her body. According to Kautzer's mom, the bite on her finger kept growing bigger. She didn't sleep, she cried. She could not eat. She couldn't eat anything.
The Centers for Disease Control (CDC), recorded 71 cases of monkeypox during the outbreak. The majority of patients were found around prairie dogs. Human-to-human transmission was not suspected. Gambian giant pouched rats, likely Gambian giants from Ghana, were responsible for the outbreak. They were housed alongside a shipment of prairie dog dogs. The outbreak was quickly contained after the CDC prohibited the importation of African rodents into America.
Although Western countries have managed to avoid other monkeypox epidemics, African countries are not so lucky. A study that looked at monkeypox incidences in DRC between November 2005 and November 2007 found that they increased 20-fold over the 1980s. A severe 2017 outbreak in Nigeria was almost 40 years ago, after Nigeria's last case. The response from Africa was also minimal. Tomori questions, "Why should they care?"
Monkeypox, the latest example of a neglected disease in countries that are not yet affected by it, is the latest. Similar responses (or lack thereof) were seen with Zika, Ebola and many other infectious diseases. Kazanjian says, "That's the troubling and disconcerting thing." "We care only about the people of our own country."
He says, "Once the victim has changed, concern about the disease increases."
In a similar vein to Covid-19, Western countries have been purchasing smallpox vaccines from Bavarian Nordic, a biotech company that recently made lucrative deals with a number of unnamed nations. According to the Associated Press (AP), the WHO announced last week that it would share some of its 31 million smallpox vaccines. This has sparked speculation that the WHO will "distribute scarce vaccine doses only to rich countries that otherwise can afford them", according to the Associated Press (AP).
Africa is experiencing three-fold higher case numbers than normal. Conservative treatments are the norm. There are no vaccines or antivirals available in large parts of Africa. According to the Africa Centers for Disease Control and Prevention, there have been more than 1,400 deaths and over 1,400 cases in Cameroon and Central African Republic. Brook Baker, a Northeastern University law expert who studies access and medicine, says that public health officials are not clear on how poorer countries will get vaccines.
Baker predicts that "rich countries will protect themselves, while people in global south die."
The West-biased bias in media coverage of the outbreak is also evident. Images of Black monkeypox victims were prominently featured in news reports. This is because the outbreak has spread to Europe, the U.S. and other countries. Tomori states that this is not the pox of the United States. "Why aren't you using the image of someone who isn't from Europe?" These images, which were racialized, have created fear in Western audiences and perpetuated a myth of "African" disease and an uninfected continent. Tomori laughs at the "wild thing from Africa". "Newspapers are more successful when there is an exotic story to tell."
Poxvirus history has been marked by a certain myopia. Onesimus' early contributions to Boston's vaccination campaign, and the SEP's coercion of vaccines have all been overlooked. This myopia has been historically ignored and dismissed as Monkeypox.
These are very high stakes. The global monkeypox response is not only racist and homophobic, but also fraught with problems. There have been significant underreporting and testing bottlenecks. Scientists also worry that monkeypox may "take up permanent residence within wildlife outside of Africa," increasing the frequency and potential for new strains.
Tomori states, "The world is small." This is not an African thing. It could happen anywhere.