We Should Have Seen Monkeypox Coming
Nearly five years before an unusual cluster of monkeypox cases in the U.K. alarmed the world, doctors were dealing with an unusual cluster of monkeypox in another unexpected country: Nigeria. The virus is endemic to Central Africa, but Nigeria, far to the west, had not recorded a case of monkeypox since 1978. When an 11-year-old boy showed up with skin lesions in September 2017, doctors first suspected chickenpox. But no, tests pointed to the much more unusual monkeypox. From 2017 to 2022, Nigeria then found more than 500 confirmed monkeypox cases. Quite suddenly, it seemed, the virus had begun spreading somewhere new.
In Nigeria, too, doctors first that would be repeated around the world. Many of the patients were men, are also in men and also characterized by genital lesions. “It looks like déjà vu to me,” says Dimie Ogoina, a doctor at Niger Delta University Teaching Hospital, which treated the first and many subsequent cases of monkeypox in Nigeria in 2017. The virus was known to spread through droplets and any kind of physical contact with infectious sores and scabs—but sex, specifically, had never been high on the list of transmission risks. (Past cases were usually linked to contact with wild animals or household contact.) The unusual pattern and unusual size of the Nigeria outbreak should have been a signal that something had changed for monkeypox. But the world ignored it until too late, and a global outbreak is now well under way.
