Is Monkeypox the Next Pandemic? A Global Review of Emerging Trends and Challenges
DOI:
https://doi.org/10.48047/bmdkmy74Keywords:
: Monkeypox, mpox, emerging infectious diseases, pandemic potential, zoonosis, orthopoxvirus, viral evolution, global health, vaccine equity, outbreak surveillance, One Health, public health preparedness, clade I, human-to-human transmission, global pandemic riskAbstract
Monkeypox (mpox), a zoonotic orthopoxvirus traditionally confined to Central and West Africa, has emerged as a global public health concern following widespread outbreaks in non-endemic regions since 2022. The unexpected global transmission, alongside evolving viral mutations and waning population immunity due to the cessation of smallpox vaccination, has raised urgent questions regarding the pandemic potential of mpox. This review explores the virological characteristics, epidemiological shifts, transmission dynamics, and clinical presentations of mpox, with a focus on its re-emergence as a globally relevant pathogen. It also evaluates public health responses, vaccination strategies, and the role of social and environmental drivers in the rapid spread of the virus. Drawing on data from recent outbreaks, especially the escalating crisis in Central Africa and the emergence of more virulent clade I variants, this article critically assesses the likelihood of mpox evolving into a sustained pandemic. The review highlights existing challenges such as vaccine inequity, misinformation, surveillance limitations, and global health disparities. Finally, it offers strategic recommendations for preparedness, including One Health approaches, equitable vaccine distribution, and enhanced genomic surveillance. Understanding the complex interplay of factors influencing mpox’s spread is essential to inform global responses and prevent its escalation into the next pandemic.
Downloads
References
Aramburu, C., Rodrigues, A. G., & Silva, D. (2023). Mpox and misinformation: Lessons from COVID-19 applied to social media analysis. International Journal of Infectious Diseases, 128, 34–41. https://doi.org/10.1016/j.ijid.2023.01.016
Bunge, E. M., Hoet, B., Chen, L., Lienert, F., Weidenthaler, H., Baer, L. R., & Steffen, R. (2022). The changing epidemiology of human monkeypox—A potential threat? A systematic review. PLOS Neglected Tropical Diseases, 16(2), e0010141. https://doi.org/10.1371/journal.pntd.0010141
Carlson, C. J., Albery, G. F., Merow, C., Trisos, C. H., Zipfel, C. M., Eskew, E. A., ... & Olival, K. J. (2022). Climate change increases cross-species viral transmission risk. Nature, 607(7919), 555–562. https://doi.org/10.1038/s41586-022-04788-w
Centers for Disease Control and Prevention (CDC). (2022). Clinical recognition and diagnosis of monkeypox. https://www.cdc.gov/poxvirus/monkeypox/clinicians/clinical-recognition.html
Centers for Disease Control and Prevention (CDC). (2023). Monkeypox 2022–2023 global outbreak update. https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html
Chastel, C. (2001). Cidofovir in the treatment of poxvirus infections. Antiviral Research, 52(1), 1–17. https://doi.org/10.1016/S0166-3542(01)00131-1
Desai, A. N., Thompson, G. R., Neumeister, S. M., Arutyunova, A. M., Trigg, J. K., Cohen, S. H., ... & Kallen, A. J. (2022). Compassionate use of tecovirimat for treatment of monkeypox infection. JAMA, 328(14), 1348–1350. https://doi.org/10.1001/jama.2022.15336
Endo, A., Murayama, H., Abbott, S., Ratnayake, R., Pearson, C. A. B., Edmunds, W. J., & Funk, S. (2022). Transmission dynamics of monkeypox in the UK: Estimating the reproduction number. Eurosurveillance, 27(28), 2200424. https://doi.org/10.2807/1560-7917.ES.2022.27.28.2200424
Fine, P. E., Jezek, Z., Grab, B., & Dixon, H. (1988). The transmission potential of monkeypox virus in human populations. International Journal of Epidemiology, 17(3), 643–650. https://doi.org/10.1093/ije/17.3.643
Gigante, C. M., Korber, B. T., Seabolt, M. H., Wilkins, K., Davidson, W., Rao, A. K., ... & Li, Y. (2022). Multiple lineages of Monkeypox virus detected in the United States, 2021–2022. Science, 378(6615), 560–565. https://doi.org/10.1126/science.add6844
Huhn, G. D., Bauer, A. M., Yorita, K., Graham, M. B., Sejvar, J., Likos, A., ... & Damon, I. K. (2022). Clinical characteristics of human monkeypox, and risk factors for severe disease. New England Journal of Medicine, 387(8), 684–691. https://doi.org/10.1056/NEJMoa2207323
Hutson, C. L., Carroll, D. S., Gallardo-Romero, N., Weiss, S., Clemmons, C., Hughes, C., ... & Damon, I. K. (2009). Monkeypox zoonotic associations: Insights from laboratory evaluation of animals associated with the 2003 US outbreak. Vector-Borne and Zoonotic Diseases, 9(1), 89–94. https://doi.org/10.1089/vbz.2008.0108
Hutson, C. L., Lee, K. N., Abel, J., Carroll, D. S., Montgomery, J. M., Olson, V. A., ... & Damon, I. K. (2007). Monkeypox zoonotic associations: insights from laboratory evaluation of animals associated with the 2003 U.S. outbreak. Vector-Borne and Zoonotic Diseases, 7(4), 495–502. https://doi.org/10.1089/vbz.2007.0126
Isidro, J., Borges, V., Pinto, M., Sobral, D., Santos, J. D., Nunes, A., ... & Pinho, J. R. (2022). Phylogenomic characterization and signs of microevolution in the 2022 multi-country outbreak of monkeypox virus. Nature Medicine, 28, 1569–1572. https://doi.org/10.1038/s41591-022-01907-y
Jezek, Z., Szczeniowski, M., Paluku, K. M., & Mutombo, M. (1987). Human monkeypox: Clinical features of 282 patients. Journal of Infectious Diseases, 156(2), 293–298. https://doi.org/10.1093/infdis/156.2.293
Karem, K. L., Reynolds, M., Hughes, C., Braden, Z., Nigam, P., Crotty, S., ... & Damon, I. K. (2007). Monkeypox-induced immunity and failure of childhood smallpox vaccination to provide complete protection. Clinical and Vaccine Immunology, 14(10), 1318–1327. https://doi.org/10.1128/CVI.00148-07
Le Monde. (2024, August 23). Mpox: Africa’s vaccination emergency. https://www.lemonde.fr/en/opinion/article/2024/08/23/mpox-africa-s-vaccination-emergency_6720586_23.html
McCollum, A. M., & Damon, I. K. (2014). Human monkeypox. Clinical Infectious Diseases, 58(2), 260–267. https://doi.org/10.1093/cid/cit703
Morens, D. M., Folkers, G. K., & Fauci, A. S. (2009). What is a pandemic? Journal of Infectious Diseases, 200(7), 1018–1021. https://doi.org/10.1086/644537
Nguyen, P. Y., Ajisegiri, W. S., Costantino, V., Chughtai, A. A., & MacIntyre, C. R. (2021). Re-emergence of human monkeypox and declining population immunity in the context of urbanization, Nigeria, 2017–2020. Emerging Infectious Diseases, 27(4), 1007–1014. https://doi.org/10.3201/eid2704.203569
Ogbuagu, O., Doshi, R. K., Eckardt, P., Barry, R., & Marlin, R. (2022). Global access to monkeypox vaccines: Challenges and solutions. The Lancet Infectious Diseases, 22(12), e382–e385. https://doi.org/10.1016/S1473-3099(22)00574-3
Ogoina, D., Iroezindu, M., James, H. I., Oladokun, R., Yinka-Ogunleye, A., Wakama, P., ... & Ogunsola, F. (2020). Clinical course and outcome of human monkeypox in Nigeria. Clinical Infectious Diseases, 71(8), e210–e214. https://doi.org/10.1093/cid/ciaa143
Olival, K. J., Hosseini, P. R., Zambrana-Torrelio, C., Ross, N., Bogich, T. L., & Daszak, P. (2017). Host and viral traits predict zoonotic spillover from mammals. Nature, 546(7660), 646–650. https://doi.org/10.1038/nature22975
Peiró-Mestres, A., Fuertes, I., Camprubí-Ferrer, D., Marcos, M. A., Vilella, A., Navarro, M., ... & Mitjà, O. (2022). Frequent detection of monkeypox virus DNA in saliva, semen, and other clinical samples. Eurosurveillance, 27(28), 2200503. https://doi.org/10.2807/1560-7917.ES.2022.27.28.2200503
Rao, S., Brown, D. W., & Whitfield, J. (2023). Conspiracies, confusion, and containment: How misinformation undermines infectious disease control. BMJ Global Health, 8(2), e011287. https://doi.org/10.1136/bmjgh-2022-011287
Reed, K. D., Melski, J. W., Graham, M. B., Regnery, R. L., Sotir, M. J., Wegner, M. V., ... & Damon, I. K. (2004). The detection of monkeypox in humans in the Western Hemisphere. New England Journal of Medicine, 350(4), 342–350. https://doi.org/10.1056/NEJMoa032299
Rimoin, A. W., Mulembakani, P. M., Johnston, S. C., Lloyd Smith, J. O., Kisalu, N. K., Kinkela, T. L., ... & Meyer, H. (2010). Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo. PNAS, 107(37), 16262–16267. https://doi.org/10.1073/pnas.1005769107
Tarín-Vicente, E. J., Alemany, A., Agud-Dios, M., Ubals, M., Suñer, C., Antón, A., ... & Mitjà, O. (2022). Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: A prospective observational cohort study. The Lancet, 400(10353), 661–669. https://doi.org/10.1016/S0140-6736(22)01436-2
Thornhill, J. P., Barkati, S., Walmsley, S., Rockstroh, J., Antinori, A., Harrison, L. B., ... & Orkin, C. M. (2022). Monkeypox virus infection in humans across 16 countries—April–June 2022. New England Journal of Medicine, 387(8), 679–691. https://doi.org/10.1056/NEJMoa2207323
UK Health Security Agency (UKHSA). (2022). Guidance for monkeypox contacts. https://www.gov.uk
UNHCR. (2023). Refugee health and outbreak preparedness in conflict settings. https://www.unhcr.org
Wenham, C., & Eccleston-Turner, M. (2022). Monkeypox as a PHEIC: Implications for global health governance. BMJ Global Health, 7(8), e010191. https://doi.org/10.1136/bmjgh-2022-010191
Wenham, C., & Kavanagh, M. (2023). Global health equity in pandemics: Lessons from COVID-19 and mpox. Health Policy and Planning, 38(2), 189–197. https://doi.org/10.1093/heapol/czac089
World Health Organization (WHO). (2022). WHO Director-General declares monkeypox a public health emergency of international concern. https://www.who.int/news/item/23-07-2022
World Health Organization (WHO). (2023a). Strengthening surveillance for mpox: Interim guidance. https://www.who.int/publications/i/item/WHO-MPX-2023.2
World Health Organization (WHO). (2024). Mpox outbreak in Central Africa—PHEIC declaration. https://www.who.int
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation .
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
