Monkeypox is a viral zoonotic disease, first identified in colonies of monkeys in 1958 and then in humans in 1970. It can be spread from animal to human and between animals. Commonly found in Central and North Africa in rainforest areas, it spreads through physical contact.

In most cases symptoms of monkeypox recede within a few weeks, but in some individuals, they can lead to medical complications and even death. Newborns, children, and people with underlying immune deficiencies may be at risk of more serious symptoms and death from monkeypox. There are preventive vaccines available.

Recent outbreak<

In the recent outbreak of monkeypox, the first case was confirmed on 6 May 2022 in an individual who had travelled from Nigeria to the UK. On 19 May 2022 a further 10 countries reported monkeypox cases, then more were recorded in several countries in Europe, North and South America, North Africa, and Australia.

Up to 23 June, the WHO reported 2,500 cases of monkeypox commonly found in Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Côte d’Ivoire, Liberia, Nigeria, the Republic of the Congo, and Sierra Leone.

By mid-June, the National Institutes of Health (NIH) in Islamabad stated that no case of monkeypox has yet been diagnosed in Pakistan. The news circulating on social media about monkeypox cases was incorrect. The ministry further said that the government is trying to procure testing kits for the NIH as well as for Aga Khan University and other health organisations.

Bioterrorism simulation in 2021

Many people discussed monkeypox as a WMD but the spread pattern does not fulfil this definition. A WMD must be capable of inflicting mass casualties, fundamentally altering the lives of generations – and spread quickly through a vast area.

Since May social media posts appeared stating that an NGO (non-government organisation), the Nuclear Threat Initiative (NTI) had conducted a monkeypox pandemic simulation in 2021. A report published by the NTI said that this simulation, which took place in March 2021, was entirely virtual and had no connection with the recently discovered cases of monkeypox.

Conducted together with the Munich Security Conference (MSC) as a tabletop exercise, the simulation examined gaps in national and international biosecurity and pandemic preparedness in order to improve capabilities and prevent biological events.

The exercise portrayed a deadly scenario featuring a recognised strain of monkeypox that appeared in the nation of Brinia and spread globally over 18 months. Ultimately, the exercise revealed that the initial outbreak was caused by a terrorist group who used a pathogen engineered in a laboratory with inadequate biosafety and biosecurity. The fictional scenario resulted in more than 3 billion cases and 270 million deaths worldwide.

The exercise took place on 17 March 2021 – one year before the current outbreak – and the second virus used in the simulation was monkeypox. The first actual monkeypox case that was confirmed on 15 May 2022 coincided with the starting date of the fiction timeline. However, the exercise has no connection to the recent monkeypox cases.

NTI and the 19 scientists involved in the virtual exercise have had to answer the following questions. First, why do they use monkeypox for this virtual exercise? Second, dates in the exercise and the first cases coincided with each other, albeit one year after the simulation.

The WHO response

NTI scientist and spokeswoman Ms. Yassif explained that the purpose of the simulation was “to draw leaders’ attention to the urgent need to improve international pandemic prevention and response capabilities.”

States, organisations and scientists must now decide how to handle two vitally important and concerning issues arising from the recent emergence of monkeypox: how the virus spread so fast outside Africa resulted in a global outbreak, and how prevalent are cases of spread between men who have sex with men (MSM). Other possible means of infection spread will also be of paramount importance.

A new report from the WHO, Multicountry Monkeypox Outbreak In Non-Endemic Countries, discusses the many challenges in maintaining high scientific, safety, security, and ethical standards in the life sciences. A Global Guidance Framework for the Responsible Use of Life Sciences is under development.

The work and recommendations of four working groups of experts are summarised in the WHO report. They advise that universities and other research institutions “should promote a culture of biosafety and biosecurity in research environments at every stage of basic and applied life sciences,” and “publishers should promote and practice a culture of bioriskmanagement in scientific and publishing.”

Many countries are ill-prepared for the future surge of infectious diseases and to prepare efficient vaccines. They must upgrade their production facilities or develop laboratories to deal with present and future outbreaks.

The outbreak of any emerging infectious disease is a big concern for the WHO and affected countries. The most important thing right now is to raise awareness and provide advice to limit the further spread of any infection. Countries worldwide should work on vaccines, surveillance, preparedness, and outbreak response activities for both affected and nonaffected countries.

Dr. Syed Javaid khurshid is on the Editorial Board of the Journal of Bioterrorism & Biodefense. His special interests are nuclear knowledge management, science, nuclear and biodiplomacy, mitigation of WMD, and implementation of the CWC and BWC.