“In March 2021, the Nuclear Threat Initiative (NTI) partnered with the Munich Security Conference (MSC) to conduct a tabletop exercise on reducing high-consequence biological threats. Participants included 19 senior leaders and experts from across Africa, the Americas, Asia, and Europe with decades of combined experience in public health, biotechnology industry, international security, and philanthropy (?)

The exercise scenario portrayed a deadly, global pandemic involving an unusual strain of Monkeypox virus that emerged in the fictional nation of Brinia and spread globally over 18 months. Ultimately, the exercise scenario revealed that the initial outbreak was caused by a terrorist attack using a pathogen engineered in a laboratory with inadequate biosafety and biosecurity provisions and weak oversight. By the end of the exercise, the fictional pandemic resulted in more than three billion cases and 270 million fatalities worldwide.”

I've been trying to find a way to approach the latest outbreak of Monkeypox virus (MPXV) and I thought that looking back thirteen months to the 'planning stage' might work, although I am sure preparations for the 'exercise' had been going on for some time before hand.

As shown in the top image, the 'attack' which introduces the Monkeypox virus (in the exercise) occurs on May 15, 2022 – Our current outbreak was announced May 13, 2022.

This could be considered coincidence except for two events which stand out. First, with respect to this odd coincidence of an outbreak occurring a year after preparedness planning had been completed is the odd coincidence that Canada suddenly began placing orders for smallpox vaccines after decades without.

On April 21, 2022, a year after the table-top exercise and a month before a Monkeypox outbreak had been announced, Canada purchased five hundred thousand (500,000) doses of small pox vaccine. Small pox vaccines have not been distributed in Canada for decades, but the vaccine has been shown to work against Monkeypox.

A second coincidence occurred during introduction of the 2020 biological terror; COVID-19. Oddly enough, it too was preceded by a very similar exercise held by the Centre for Health Security only few months before the publicized break out of COVID-19.

The CHS document describes the scenario thus;

“ Event 201 simulates an outbreak of a novel zoonotic coronavirus transmitted from bats to pigs to people that eventually becomes efficiently transmissible from person to person, leading to a severe pandemic. The pathogen and the disease it causes are modelled largely on SARS, but it is more transmissible in the community setting by people with mild symptoms.”  

Leaving the 'conspiracy theories' aside, I wanted to have a look at what is known, and unknown about the orthopoxvirus, Monkeypox. I will quote from the CDC and various medical journals linked below:

" Monkeypox virus (MPXV) causes disease in both animals and humans. Human monkeypox, which is clinically almost identical to ordinary smallpox (variola), occurs mostly in the rain forests of central and western Africa. The virus is maintained in nature in rodent reservoirs including squirrels.

MPXV was discovered during the pox-like disease outbreak among laboratory Java macaques in Denmark in 1958. No human cases were observed during this outbreak. The first human case was not recognized as a distinct disease until 1970 in Zaire (the present DRC) with the continued occurrence of a smallpox-like illness despite eradication efforts of smallpox in this area.

This virus and variola (smallpox) virus are the two members of the orthopoxvirus group that can produce a severe systemic illness with widespread vesiculopustular rash in humans.

In its final report on smallpox eradication, the WHO considered MPXV to be the most medically important orthopoxvirus in the post-smallpox era. It has one great advantage in comparison to variola: the existence of a wide range of hosts, which would preclude worldwide eradication through a massive vaccination program.

Person-to-person transmission of MPXV accounts for 10–30% of cases. Transmission is through large respiratory droplets during prolonged face-to-face contact, although transmission through contact with infected fomites or aerosols may occur. Person-to-person transmission of MPXV is less efficient than for variola virus and the longest recorded human chain of transmission is six generations.

Studies conducted in the 1980s suggested that household transmission from an index case occurred in 8–15% of contacts. These data were used to create a stochastic model for the spread of MPXV between humans, which indicated that MPXV was highly unlikely to sustain itself in human populations and therefore did not constitute a major public health problem.

However, when these studies were conducted, the majority of household members were vaccinated against smallpox, which provided cross-protective immunity to MPXV infection. Today, the majority of households are young and not previously vaccinated against smallpox, potentially increasing the risk for human-to-human transmission.

Most of the clinical features of human MPXV are very similar to those of ordinary smallpox;

After a 7 to 21 day incubation period, the disease begins with fever, malaise, headache, sore throat, and cough. The main sign of the disease that distinguishes MPXV from smallpox is swollen lymph nodes (lymphadenitis), which is observed in most of the patients before the development of rash.

Typical maculopapular rash follows the prodromal period generally lasting 1–3 days. The average size of the skin lesions is 0.5–1 cm, and the progress of lesions follows the order macules through papules, vesicles, pustules, umblication then scab and desquamation and lasts typically 2–4 weeks. Fatality rate is 10% among the unvaccinated population and death generally occurs during the second week of the disease."

In summary it would appear that a normally rare and difficult to transmit orthopoxvirus has become more easily transmitted and much less rare, having appeared in a dozen disparate locations around the world since the 13th of May. This is certainly an unusual strain of Monkeypox virus for it to behave and travel in this fashion, just at predicted during the 2021 table-top exercises.

Is this 'unusual strain' as deadly as the 'original', hard to spread Monkeypox, with a 10% fatality rate?

As of May 25, 2022 the media has not reported any deaths among the almost two hundred infections identified. It's early; the incubation period is 7-21 days and it's only been 12 days since 'the attack'.

Medical officers are still unsure about the ways the infection has spread since monkeypox is endemic in African countries and the majority of those infected have neither had any contact with African people nor traveled there. According to the WHO, the majority of cases have spread among gay and bisexual men through mass events"

Stay Informed and Stay Healthy!

Ted

(Updated June 01, 2022 & May 31, 2022)

Links

NIH, 1976, Vaccinia disease from Smallpox vaccination (.pdf)