As monkeypox stokes here-we-go-again fears in a pandemic-weary world, some researchers in Africa are having their own sense of déjà vu. Another neglected tropical disease of the poor gets attention only after it starts to infect people in wealthy countries. “It’s as if your neighbor’s house is burning and you just close your window and say it’s fine,” says Yap Boum, an epidemiologist in Cameroon who works with both the health ministry and Doctors Without Borders.
Now, the fire is spreading. The global outbreak of monkeypox, which causes smallpoxlike skin lesions but is not usually fatal, surfaced on 7 May in the United Kingdom. More than 700 suspected and confirmed cases had been reported as of 31 May, from every continent other than Antarctica. It is the largest ever outbreak outside of Africa and is concentrated among men who have sex with men, a phenomenon never seen before. Public health officials and scientists are scrambling to understand how the virus spreads and how to stop it—and they are paying new attention to Africa’s long experience with the disease.
“We are interdependent,” Boum notes. “What is happening in Africa will definitely impact what is happening in the West and vice versa.”
Monkeypox is endemic in 10 countries in West and Central Africa, with dozens of cases this year in Cameroon, Nigeria, and the Central African Republic (CAR). The Democratic Republic of the Congo (DRC) has by far the highest burden, with 1284 cases in 2022 alone. Those numbers are almost certainly underestimates. In the DRC, infections most often happen in remote rural areas; in the CAR, armed conflict in several regions has limited surveillance.
The virus got its name after it was first identified in a colony of Asian monkeys in a Copenhagen, Denmark, laboratory in 1958, but it has only been isolated from a wild monkey—in Africa—once. It appears to be more common in squirrel, rat, and shrew species, occasionally spilling over into the human population, where it spreads mainly through close contact, but not through breathing. Isolating infected people typically helps outbreaks end quickly.
Cases have steadily increased in sub-Saharan Africa over the past 3 decades, driven largely by a medical triumph. The vaccine against smallpox, a far dea
