Scientists Report Monkeypox Outbreak was Not Only Preventable, but Expected

Cases of monkeypox infections reported in the latest viral outbreak have surpassed 14,000 in the United States, according to the CDC, and some scientists believe the outbreak, which has strained supplies of the available vaccine, was predictable.

More than 30 years ago, scientists predicted that monkeypox infections would increase, creating something of an epidemic. In a 1988 publication in the International Journal of Epidemiology, scientists said, “The average magnitude and duration of monkeypox epidemics will increase.”

At the time of this prediction, NPR reported that monkeypox was a rare disease, with only a handful of cases reported each year in parts of Africa. Transmission of the disease was limited, which kept the number of identified cases to about 50 per year, NPR reported.

Today, there are tens of thousands of cases across the globe. In early August, the White House declared the viral outbreak a public health emergency. When the Biden administration made its announcement, there were half as many cases as the CDC now reports. Weeks before the declaration, the White House suggested that monkeypox is “not likely to become a major public health threat,” as BioSpace previously reported.

The outbreak has highlighted the urgent need for pandemic preparedness. And, with the monkeypox outbreak, the public health community across the globe has been caught unprepared.

On Thursday, Bavarian Nordic, the manufacturer of Jynneos, one of two approved vaccines for monkeypox, said it was uncertain its manufacturing capabilities could keep up with the demand for the medication. That could force the Denmark-based company to seek partnerships with other manufacturers to increase the global supply.

Sanofi makes the other monkeypox vaccine currently available, but that medication has some side effect concerns, particularly for those who are immunocompromised, which has increased the demand for the Bavarian Nordic drug.

The U.S. has stockpiled doses of the Bavarian Nordic vaccine, but that pile is being depleted due to increasing demand. Even before the outbreak, scientists warned that the U.S. was not stockpiling enough doses.

According to a report in Politico, scientists suggested the stockpile should contain enough doses for about 60 million people. In 2020, the stockpile contained only one-third of that recommended amount. One million doses were purchased that year to replenish expired lots, according to the report.

Because monkeypox was not a pressing threat at the time, some officials told Politico that funds were used to purchase other drugs for diseases that health officials believed were a greater risk. This isn’t the only time that the government’s stockpiles have been below recommended levels. At the beginning of the COVID-19 pandemic, there was a shortfall of personal protective equipment used by healthcare officials.

In 2021, the White House sought approximately $65 billion to lay the groundwork for future pandemic preparedness. The plan, which was part of the Build Back Better program, laid out urgent needs for public health officials and called for an improvement and expansion of vaccines, therapeutics and diagnostics against known threats.

Even as healthcare officials grapple with COVID-19 and monkeypox, there are concerns about other viral threats.

Earlier this month, a Langya henipavirus outbreak was reported in China. Langya henipavirus is a newly identified virus that comes from the same family as the Nipah and Hendra viruses. Both of those zoonotic viruses are known to be deadly. Other viral concerns include the Ebola virus and other hemorrhagic fevers, mosquito-borne pathogens such as Zika virus and rodent-driven diseases like Lassa fever.

The government aims to improve its response capabilities. Last year, CDC launched the Center for Forecasting and Outbreak Analytics, which was expected to come online this year. The center aims to provide government and public health decision-makers with accelerated access to data in order to mitigate any effects of disease outbreaks.