Last Thursday, the Biden administration officially declared the rapidly growing monkeypox outbreak to be a national public health emergency (PHE). It’s a declaration that the virus represents a significant risk to Americans and frees up resources to address that threat:

The declaration by Xavier Becerra, President Biden’s health secretary, marks just the fifth such national emergency since 2001, and comes as the country remains in a state of emergency over the coronavirus pandemic. The World Health Organization declared a global health emergency over the outbreak late last month.

Mr. Becerra’s announcement, at an afternoon news briefing where he was joined by a raft of other top health officials, gives federal agencies power to quickly direct money toward developing and evaluating vaccines and drugs, to gain access to emergency funding and to hire additional workers to help manage the outbreak, which began in May.

Currently, there have been over 6,000 cases of monkeypox reported in the US, and it’s hard not to get a feeling of, as Yogi Berra’s delightfully twisted term described, déjà vu all over again, after the declaration by the World Health Organization (WHO) that COVID-19 had become a pandemic nearly two and a half years ago. What do I mean? You’d think that after all this time dealing with the COVID-19 pandemic the US would be prepared if another pathogen arose with the potential to become pandemic itself, but the response to the monkeypox outbreak has thus far shattered that expectation, as this New York Times article suggests:

Supplies of the monkeypox vaccine, called Jynneos, have been severely constrained, and the administration has been criticized for moving too slowly to expand the number of doses. Less than a decade ago, the United States had 20 million Jynneos doses; by May, the vast majority of them had expired.

In echoes of the early coronavirus response, tests have been difficult to obtain, surveillance has been spotty and it has been challenging to get an accurate count of cases. The administration has also been faulted for not doing enough to educate people in the L.G.B.T.Q. community, who are at high risk, before gay pride celebrations in June.

“We have 5 percent of the world’s population and 25 percent of the world’s cases,” said Dr. Carlos del Rio, an infectious disease physician at Emory University in Atlanta. “That, to me, honestly, is a failure. We were caught sleeping at the wheel.”

Of course, monkeypox is a different disease than COVID-19. Whereas COVID-19 was a brand new disease caused by a new coronavirus to which the population was immunologically naive, monkeypox has been around for a while. Even so, back in May, when the first cases in the US were making the news, Dr. Novella expressed much the same sentiment as I am now:

Now, outbreaks understandably make people a little twitchy. I remember in February 2020 the “voices of reason” were saying about COVID (myself included) that we should be concerned, but it’s too early to panic. I don’t know if in retrospect that struck the right tone (without Monday morning quarterbacking), but it feels like we are in the same place now with the monkeypox.

However we deal with monkeypox (and right now I’m not particularly optimistic about our government response), the disease, showing up so soon after COVID-19 while the COVID-19 pandemic is still raging, provides an excellent “teachable” moment about conspiracy theories and antivaccine misinformation. Why? Because the very same conspiracy theories that arose about COVID-19 (in some cases slightly modified) are showing up about monkeypox, thus demonstrating that truly there is, as I like to say, nothing new under the sun in terms of conspiracy theories about disease outbreaks and vaccines.

First, however, what is monkeypox?

Monkeypox

As I mentioned, in contrast to COVID-19, monkeypox is not a new disease. It’s been around for a while and is relatively known. The monkeypox virus itself is a member of the Orthopoxvirus genus in the family Poxviridae, the same genus as the smallpox virus, to which it is closely related. Fortunately, monkeypox is less contagious and produces less serious disease than smallpox, which, before vaccination eliminated it in the 1970s, had long been a scourge of humanity, with traces of smallpox having been found in the head of the 3,000 year old mummy of Pharaoh Ramses V. For example, smallpox killed roughly one-third of those infected with it and often left survivors with horrible scars from the “pox” lesions on the skin that were characteristic of the disease. Since the eradication of smallpox was officially declared in 1980, monkeypox has emerged as the most important orthopoxvirus for public health.

In terms of symptoms, monkeypox causes fever, headache, lymphadenopathy, and then the characteristic “pox” rash with skin eruptions, which can number from a few to thousands, to the point that in especially severe cases sections of skin can slough off. The overall disease course usually lasts between 2-4 weeks, with poorer outcomes in those with underlying immune deficiencies, and potential complications include secondary infections, bronchopneumonia, sepsis, encephalitis, and infection of the cornea with ensuing loss of vision. The WHO reports that in modern times the case fatality ratio is around 3-6%.

A zoonotic disease, monkeypox can infect a number of animal species besides monkeys and human, including rope squirrels, tree squirrels, Gambian pouched rats, dormice, non-human primates and other species. Before the current outbreak, the disease had been mostly confined to central and West Africa, with a history dating back to 1970:

Human monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo in a 9-month-old boy in a region where smallpox had been eliminated in 1968. Since then, most cases have been reported from rural, rainforest regions of the Congo Basin, particularly in the Democratic Republic of the Congo and human cases have increasingly been reported from across central and west Africa.

Since 1970, human cases of monkeypox have been reported in 11 African countries: Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Cote d’Ivoire, Liberia, Nigeria, the Republic of the Congo, Sierra Leone and South Sudan. The true burden of monkeypox is not known. For example, in 1996–97, an outbreak was reported in the Democratic Republic of the Congo with a lower case fatality ratio and a higher attack rate than usual. A concurrent outbreak of chickenpox (caused by the varicella virus, which is not an orthopoxvirus) and monkeypox was found, which could explain real or apparent changes in transmission dynamics in this case. Since 2017, Nigeria has experienced a large outbreak, with over 500 suspected cases and over 200 confirmed cases and a case fatality ratio of approximately 3%. Cases continue to be reported until today.

However, the disease has been found outside of Africa dating back two decades, as in 2003 the first outbreak in the US occurred and was linked to contact with infected pet prairie dogs. Monkeypox has also been reported in travelers from Africa to Israel, the United Kingdom, and Singapore before the most recent outbreak.

As far as transmission, fortunately monkeypox is far less transmissible than SARS-CoV-2, the coronavirus that causes COVID-19, is. Its mode of transmission is also different in that its primary mode of spread appears not to be respiratory but rather, as the WHO notes, “through close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects.” In the current outbreak, sexual contact, particularly sex between males, is the primary mode of transmission:

“Right now, about 98% of monkeypox cases are in queer and gay folks and our sexual networks. Of course, that includes trans and non-binary folks,” says Joseph Osmundson, a biologist at New York University who identifies as queer and is helping to lead the effort to stop the outbreak.

Sexual contact is not the only way monkeypox is spread, points out infectious disease doctor Susan McLellan at the University of Texas Medical Branch in Galveston, Texas. But she agrees with Osmundson: It is by far the most likely way in this current outbreak, so far.

“Epidemiological data for the outbreak in Western Europe and the United States makes that clear,” she says. “We’re not detecting many cases in kids and individuals who aren’t sexually active. We’re detecting cases mostly in individuals from networks with a lot of sexual encounters.”

As several scientists have pointed out, although its mode of transmission is primarily through sex, monkeypox as it is spreading now is not just a sexually transmitted disease. It’s possible to get the disease through other means, such as face-to-face interactions and touching contaminated objects, but these routes of transmission are very rare and likely require quite prolonged contact.

Fortunately, those of us old enough to have been vaccinated against smallpox likely have some protection, and there is a vaccine against monkeypox. Unfortunately, that vaccine is not yet nearly as widely available as it should be.

On to the conspiracy theories…

Lab leak

As I pointed out when COVID-19 first hit, every time there is an outbreak of a new disease (or even a not-so-new disease), conspiracy theories declaring the outbreak to have been due to release from a laboratory, either accidental or intentional, of the pathogen responsible arise. These conspiracy theories arose for HIV/AIDS, Ebola, and the H1N1 pandemic, among others, and they appeared with a vengeance after COVID-19.

Indeed, I love to point out that the very first “lab leak” conspiracy theory that I encountered about COVID-19 came from James Lyons-Weiler in February 2020. Lyons-Weiler appeared on Del Bigtree’s video show and claimed to have “broken the coronavirus code”. In brief, he reported that he had found in the just-published nucleotide sequence of SARS-CoV-2 sequences from an artificial plasmid commonly used in molecular biology research to express protein from genes and to transfer genes from one vector to another. Naturally, because he is an antivaxxer, Lyons-Weiler claimed that this sequence came from a failed effort to make a vaccine against the original SARS virus that caused a major outbreak in 2002, thus letting him conveniently link a conspiracy theory that the coronavirus had been “engineered” in a lab with a chance to blame vaccines for the virus. If true, obviously, that would be strong evidence that SARS-CoV-2 had been engineered. However, for someone who before turning antivax crank had run bioinformatics core facilities Lyons-Weiler made a lot of rookie mistakes, and his analysis did not show what he claimed that it did, as I described in gory detail. Unfortunately, “lab leak” conspiracy theories about the origins of SARS-CoV-2 still proliferate and have been weaponized to great effect by conspiracy theorists, even though recent evidence strongly suggests a natural origin for the virus.

It should therefore be no surprise at all that soon after monkeypox started making the news conspiracy theorists claimed that it had escaped from a laboratory. They even blame the Wuhan Institute of Virology, just as “lab leak” conspiracy theorists blame the same institute for COVID-19 using similar distortions of science, with Tweets like this:

For instance, two weeks ago The Jimmy Dore Show aired a segment titled “Wuhan Lab Was Experimenting On Monkeypox Before Outbreak“, while John Campbell, someone who seemed semi-reasonable early on in the pandemic but long ago turned into a total COVID-19 crank, had posted a YouTube video about how the NIH and the WIV had been working on monkeypox, pointing to this NIH grant and a recent paper, “Efficient assembly of a large fragment of monkeypox virus genome as a qPCR template using dual-selection based transformation-associated recombination“.

As described at FactCheck.org:

Jimmy Dore, a frequent purveyor of misinformation on “The Jimmy Dore Show” on YouTube, produced a segment on July 20 with the headline, “Wuhan Lab Was Experimenting On Monkeypox Before Outbreak.”

During the segment, Dore showed a video of Dr. John Campbell, a retired nurse educator, discussing monkeypox and the Chinese study.

Campbell says in the video that the National Institute of Health and the Wuhan Institute of Virology were conducting experiments with monkeypox prior to the outbreak and misleadingly suggests viewers may “draw some parallels” between the origins of the monkeypox outbreak and the origins of SARS-CoV-2.

After playing a clip of Campbell saying the NIH and the Wuhan Institute had been studying monkeypox before the outbreak, Dore asked, “What are the odds of that?”

Dore continued, “whenever there’s a new outbreak now, 50/50 chance it was started in the Wuhan Lab funded by Dr. Fauci and the NIH,” referring to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Kurt Metzger, a comedian and Dore’s partner on the show, added, “not even a different virology lab accident, the same one.”

As I like to say, humans are pattern-forming animals, and we’re especially good at imputing causation from a pattern when that causation agrees with what we already believe.

I looked up the study, and—surprise!—it shows nothing like what Dore and Campbell claim that it shows. First of all, the scientists didn’t create a whole monkeypox genome, only a portion of it and then only to use to test a method known as “transformation-associated recombination”, which is used to assemble large pieces of DNA. Also, the monkeypox sequence used to assemble the partial genome is different from that of the monkeypox virus now circulating. The current outbreak is due to the West African clade virus while the viral sequence used in the research belongs to the Congo Basin clade.

Unsurprisingly, with the war in Ukraine raging, conspiracy theorists promoting pro-Russian narratives claiming that Ukraine had a number of bioweapon labs quickly pivoted to claiming that monkeypox had escaped from a Ukrainian lab, with headlines like “ECDC Bombshell: ‘Monkeypox Outbreak Appears To Have Leaked From Ukraine Lab’” and Tweets like this:

There is, of course, as usual zero evidence to support this claim, which is based on an anonymous source claiming knowledge of what the European Centers For Disease Control has concluded. Let’s just put it this way:

Richard Ebright, board of governors professor of chemistry and chemical biology at Rutgers University in New Jersey and a figure who has voiced lots of support for the COVID lab leak theory, echoed the point. “All indications are that the monkeypox outbreak involves a natural monkeypox virus,” he told Newsweek.

I’ve tangled with Ebright on Twitter before over lab leak conspiracy theories about SARs-CoV-2, and he’s a total conspiracy theorist. If he thinks your claim of a lab leak origin for monkeypox is nonsense, you’ve really wandered far into conspiracyland. The Ukrainian “lab leak” conspiracy theory is totally fake news, even more ridiculous than the claim that monkeypox came from WIV.

Same as it ever was, though. There is nothing new under the sun, including…

Plandemic 2.0: Monkeypox edition

Early in the COVID-19 pandemic, a “documentary” called Plandemic went viral. Its primary claim was of a massive conspiracy theory in which the entire pandemic was actually planned—”Plandemic”, get it?—all in order for the “global elite” to enslave us all with vaccines and pharmaceuticals. It was followed by Plandemic 2, in which Mikki Willis wove a conspiracy theory implicating an October 2019 pandemic preparation exercise held by Johns Hopkins University’s Center for Health Security in partnership with the World Economic Forum and the Bill & Melinda Gates Foundation that had envisioned a pandemic due to a fast-spreading coronavirus. The whole narrative involved linking together disparate events in a misleading manner to imply an overarching conspiracy that the current coronavirus pandemic had been planned.

In some cases, the “plandemic” conspiracy theory got really wild. In one version, it involved aliens teaming up with the global elite to release a two-stage “bioweapon” (COVID-19 and the vaccine, naturally) to cause global depopulation to about 10% of the current number of humans alive on the planet, all so that the aliens and elite could profit. I kid you not.

Cue May 2022 and monkeypox in the NY Post:

An eerily accurate simulation exercise at the Munich Security Conference in March 2021 centered on a monkeypox outbreak – and had the rare and potentially deadly “hypothetical” disease starting exactly when the real one did.

The Nuclear Threat Initiative (NTI), a non-profit founded by US media mogul Ted Turner and former Democratic Sen. Sam Nunn, gathered a panel of 19 experts — including government officials from the US and China, representatives from the World Health Organization and the UN, and researchers from the Bill and Melinda Gates Foundation and major pharma companies — to game out responses to a “12 Monkeys”-like bioterror attack.

The fictional scenario, sponsored by Facebook co-founder Dustin Moskovitz and his Open Philanthropies non-profit, hinged on the secret release of a lab-enhanced monkeypox virus that eventually killed 271 million people in a worldwide 19-month pandemic.

Sound familiar? It involves a lot of the same players, in particular including—of course!—Bill Gates. The main twist is that this conspiracy theory seems to have originated (or at least spread widely) in China on its social media platform Weibo before making the jump to the West, likely as a response to all the lab leak conspiracy theories about COVID-19 and the WIV:

A 2021 report on biosecurity preparedness planning by a US non-government organization, Nuclear Threat Initiative, which included a scenario of a monkeypox pandemic, has been taken out of context to suggest that the US government knew the outbreak was coming.

Nationalist influencer Shu Chang, who has 6.41 million Weibo followers, deliberately misconstrued the report and posted that it showed “a plan by the US to leak bioengineered monkeypox virus.”

There is, of course, no evidence that this exercise is any indication that the monkeypox outbreak was planned any more than the Johns Hopkins University/Gates Foundation exercise in 2019 was evidence that the COVID-19 pandemic was planned. Health experts and authorities plan for pandemics, and when they do they pick scenarios that seem plausible and likely. Given the SARS outbreak 20 years ago, in 2019 a coronavirus seemed most likely as the next big pathogen to cause a pandemic. Monkeypox has been simmering for years and in 2021 seemed like the next viral threat:

“The risks posed by monkeypox”, according to the NTI, “have been well documented for years” and cases have been on the increase, making it an obvious virus to choose for this workshop.

Outbreaks of infection are a fact of life, so an organisation predicting and planning for them is not in itself suspicious.

Same as it ever was…again.

But…it’s the vaccines!

Going back to James Lyons-Weiler and his attempt to blame COVID-19 on a failed attempt to develop a SARS vaccine, I also can’t help but add that the very earliest COVID-19 conspiracy theory I encountered, way back in January 2020, was that COVID-19 arose in Wuhan because the Chinese had ordered more influenza vaccines in fall 2019 than they normally would. This conspiracy theory then mutated into a version in which the flu vaccine was falsely blamed for increasing one’s chances of getting COVID-19, a claim that persists.

Fast forward to spring and summer 2022, when, to the surprise of no one who has paid attention to antivaccine conspiracy theories over the years, COVID-19 vaccines are being blamed for the monkeypox outbreak, because of course they are. This conspiracy theory tends to take one of two flavors. The first is a claim that the chimpanzee adenovirus vector used in the AstraZeneca COVID-19 vaccine is how monkeypox arose. The second is a more general claim not unlike the conspiracy theories about the flu vaccine and COVID-19 that COVID-19 vaccines weaken the immune system to make people susceptible to monkey pox.

Examples of the first can easily be found on social media:

Molecular biologists, virologists, and others with significant knowledge of molecular biology and virology are likely cringing at how obviously these claims are nonsense (as did I). However, the percentage of the population with sufficient scientific knowledge to immediately recognize these memes and posts as utter bullshit (there is no other word) is, alas, small. So they sound credible. Adenovirus and monkeypox are not just different viruses, they’re very different viruses, and the one used for vaccines is genetically engineered so that it is unable to replicate. Adenovirus-based vaccines use the virus as a tool to induce cells to make the desired antigen, in the case of COVID-19 vaccines the SARS-CoV-2 spike protein. The only viral proteins made are those absolutely necessary for the vector to serve its purpose of entering cells and forcing them to make the protein from the DNA code inserted into the virus’ genome. Also, not all of the adenovirus-based vaccines use the chimpanzee version of the adenovirus.

Finally, I particularly like this statement in a more general debunking of this claim:

Meedan added: “It should be noted that chimpanzees are not monkeys.”

Chimpanzees are from a group of primates known as great apes, see here.

The second version of blaming monkeypox on COVID-19 vaccines posits an immune suppression due to the vaccine that supposedly laid the groundwork for monkeypox to flourish. More recently, antivaxxers have also tried to blame COVID-19 vaccines for polio, but that’s a secondary claim:

Antivaxxer Robert F. Kennedy, Jr. is pushing this narrative on his Children’s Health Defense website:

Twitter last week censored Shmuel Shapira, M.D., MPH, for suggesting a connection between the monkeypox outbreak and mRNA COVID-19 vaccines, according to a Kanekoa’s Newsletter Substack post published Wednesday.

Shapira, who said he was injured after receiving his third dose of the Pfizer COVID-19 vaccine, said Twitter demanded he remove a tweet that said:

Monkey pox cases were rare for years. During the last years a single case was documented in Israel. It is well established the mRNA vaccines affect the natural immune system. A monkey pox outbreak following massive covid vaccination: *Is not a coincidence.

Shapira is a full professor of medical administration at Hebrew University and served as director of Israel’s Institute for Biological Research from 2013-2021.

Again, none of this should come as any surprise to anyone who’s followed the antivaccine movement for a long time. The claim that vaccines either suppress the immune system or cause autoimmune disease by cranking it up too much—antivaxxers can never make up their minds and craft their narrative depending on what they want to blame vaccines for—are oldie-moldy vaccine tropes.

It turns out that a lot of those claiming that monkeypox arose because COVID-19 vaccines had suppressed the immune systems of those who got them tend to cite two recent papers, one in The Lancet and one in Food and Chemical Toxicology, which they misrepresent as evidence that COVID-19 vaccines cause immunosuppression. The second one is easy to deal with. It’s by Stephanie Seneff, Greg Nigh, Anthony M. Kyriakopoulos, and Peter A. McCullough, and I discussed it in great detail when it was published in April, also noting that Seneff has been an antivax conspiracy theorist for a long time and that McCullough went full COVID-19 and antivax conspiracy theorist early in the pandemic. Both have been featured multiple times in this very blog, with Seneff having achieved her prominence back in 2015 when she predicted that GMOs would render half of all children autistic by 2025, which is now less than two and a half years away. (Early in the pandemic, she even blamed e-cigs and biofuels for COVID-19.) Let’s just say that that review article was an excellent example of Gish galloping and the use of a scientific review article published in a dodgy journal as antivax disinformation.

The first article was indeed published in The Lancet and is a retrospective cohort study from Sweden published in February. Its conclusion was that COVID-19 vaccine effectiveness waned over several months but that effectiveness against severe COVID-19 was better maintained. That’s it. It said nothing about immunosuppression due to the vaccine at all, but that didn’t stop Tucker Carlson from finding a comment that falsely claimed that the study did show immunosuppression from the vaccine:

Carlson cited a comment a Japanese physician, Dr. Kenji Yamamoto, published in a different journal, which claimed the Lancet paper “showed that immune function among vaccinated individuals 8 months after the administration of two doses of COVID-19 vaccine was lower than that among the unvaccinated individuals.”

After suggesting that the Lancet paper hid “a major finding,” Carlson pointed to one piece of data in table 3 of the paper for viewers to check themselves. “Among people around the age of 80 who have been double vaccinated — that would include people like Joe Biden — the per capita rate of medical incidences, including hospitalizations or death, is nearly twice as high as the rate of serious incidence for the unvaccinated,” he said.

Carlson added that the Lancet paper “also includes a chart showing negative vaccine efficacy for all ages after eight months for all participants in the study.”

Carlson, however, is distorting cherry-picked data from the paper.

“The paper we have published [does] not show any of the claims” Carlson made, lead author Dr. Peter Nordström told us in an email, because they were not statistically significant. The findings that are statistically significant and the conclusions of the paper are “presented in the summary of the paper,” he added.

Also:

As for the Japanese physician who claimed the Lancet data “showed that immune function among vaccinated individuals 8 months after the administration of two doses of COVID-19 vaccine was lower than that among the unvaccinated individuals,” Jewell said he found nothing to support that in the Lancet paper, as it also appears to be an erroneous interpretation of figure 2.

Yamamoto’s comment shows a misunderstanding of the figure, and it also incorrectly generalizes a specific and expected decline in immunity to the coronavirus over time following vaccination with a general decline in immunity to all things. There is no evidence of that in the Lancet paper, nor anywhere else.

This is, of course, a typical antivax technique. They love to cherry pick one line of one figure or table in a paper, especially when it’s unadjusted data, and misrepresent it to mean what they want it to mean.

Again, same as it ever was.

There is nothing new under the sun

I had thought about taking just one of the conspiracy theories about monkeypox and doing a deep dive into it, explaining in my usual painful level of detail why it’s a conspiracy theory. However, as I tried to decide which one to examine, it occurred to me that monkeypox is, as I said at the beginning of this post, an excellent “teachable moment” to explain again how there is nothing new under the sun in the world of disease and antivaccine conspiracy theories. Just as COVID-19 conspiracy theories were rehashed and repurposed versions of older antivax conspiracy theories, monkeypox conspiracy theories are so rehashed from COVID-19 conspiracy theories that in many cases they’re the same damned conspiracy theory.

The point is this. Once you start seeing the patterns, you’ll recognize the conspiracy theories. There is nothing new under the sun in antivax conspiracy land (or any conspiracyland, for that matter). It is, as David Byrne once sang, the “same as it ever was” and Yogi Berra once described as “déjà vu all over again”. What’s different is that these conspiracy theories have far more power and influence than ever before.

"Same as it ever was"

“Same as it ever was.’

Author

Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.