BROOKE GLADSTONE This is On the Media, I'm Brooke Gladstone. This month, another virus hit the headlines as if we didn't have enough to fret over.

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NEWS REPORT The CDC is warning doctors to be on alert for an outbreak of monkeypox, a rare viral disease typically found in Africa but now discovered here at home.

NEWS REPORT Symptoms of monkeypox include fever, nasty, bubbly, rash, muscle aches, chills. There are now dozens of cases being investigated throughout Europe. That's all we need. [END CLIP]

BROOKE GLADSTONE As of Thursday, the CDC said that there were ten cases of monkeypox scattered across the U.S. But unlike the coronavirus strain we called novel in 2020, when we first saw it in humans, monkeypox is not new. Jon Cohen is a writer at Science magazine whose focus is infectious disease. He first covered monkeypox in 1997 during an outbreak of about 500 cases in the Democratic Republic of the Congo.

JON COHEN I had to hire my own airplane to fly to Kasai Oriental in Congo, and then I had to go on motorbikes for five days into the rainforest looking for cases of monkeypox. It was so remote that unless I brought it back or someone else who was there with the medical teams – there was no way it was going to get out of there.

BROOKE GLADSTONE It was speculated that the surge was a result of a drop off in vaccinations. For another virus, this one was smallpox.

JON COHEN Well, it's abundantly clear that theory is true.

BROOKE GLADSTONE Oh, it is true.

JON COHEN That's what's happening right now. The vast majority of people who are becoming infected in this outbreak were not vaccinated for smallpox. They're younger. I'm of a certain age where I was vaccinated. The United States stopped vaccinating in 1972. But if you were born before 1972 in the United States, you likely have a pockmark on your left arm or thigh. Mm hmm. It was a global campaign led by the World Health Organization to drive that virus into laboratory freezers. That's the only place it exists right now. Smallpox is the only disease humans have ever eradicated, and that's because it only was in humans. But monkeypox easily infects a lot of different species.

BROOKE GLADSTONE What's the relationship of monkeypox to smallpox?

JON COHEN They're distant relatives. Monkeypox isn't anywhere near as severe. Smallpox was far more lethal and devastated communities. It was a horrific disease. And this is not the return of smallpox.

BROOKE GLADSTONE In 2003, the U.S. had 47 cases of monkeypox that were linked to pet prairie dogs.

JON COHEN Yeah, there was an importation of small animals from Ghana that were infected with monkeypox. That spread to prairie dog pets – who knew? – that were sold at pet stores and people became infected by their pets.

BROOKE GLADSTONE Any deaths in that case?

JON COHEN No.

BROOKE GLADSTONE So 25 years on, monkeypox is back in the news. What's notable about its resurgence now?

JON COHEN It's never spread to several countries outside of sub-Saharan Africa at the same time. It's on every continent right now other than Antarctica. We've never seen this. Any time a virus behaves in ways that are different and new, everyone who studies viruses gulps. It's a gulp moment. What's this doing? But I want to stress something. It's not that deadly. It's not that easy to contract. The mutation rate is much, much lower than coronaviruses and other viruses that have RNA as their genetic material. This is a DNA virus. The DNA viruses, by and large, are thought to mutate at a much, much slower rate than RNA viruses. This is not COVID 22. Let's be real. It is something we need to be serious about and needs to be contained. It does cause serious disease in some people and can kill people, especially if they have immune compromised systems. So it's not trivial. But I saw a headline the other day that said "Panic." No, not time for panic.

BROOKE GLADSTONE Monkeypox has a incubation period of of several weeks and isn't even that easy to identify because doctors really haven't ever seen it here.

JON COHEN And it looks like a lot of other lesions. It looks like chicken pox. It looks like herpes.

BROOKE GLADSTONE So there's probably more of it than we know.

JON COHEN Oh, I think there's more of it than we know. The reality is that many people who develop rashes don't seek treatment. And for most people are just going to have a mild rash and they're going to recover. As the world goes on red alert about this, doctors and nurses everywhere are thinking monkey pox. And a few weeks ago they weren't.

BROOKE GLADSTONE About the strain that is circulating now. That one is not particularly lethal, right?

JON COHEN Yeah. The West African strain, which largely comes from Nigeria. But there are other countries we think has a 1% case fatality rate. But in the United States and in Europe, there are drugs that can theoretically treat this and the fatality rate may well be lower.

BROOKE GLADSTONE You said theoretically, and that strikes me as all too true because we have two different drugs that can treat it. One developed for smallpox.

JON COHEN We just haven't had much experience using drugs to treat monkeypox. And drugs were not available at the time that smallpox was circulating. So it's not as though we had old smallpox drugs that are now available. What happened was we had a fear of bio attack with smallpox. So drugs were developed to help us, should there ever be that horrible scenario of somebody somehow getting a smallpox virus and using it as a weapon. And those drugs were largely evaluated in animal models that used monkeypox sometimes to test them.

BROOKE GLADSTONE Right. And you said it's a misnomer, monkey pox, anyway, that it comes from small rodents. But how did it get the name Monkey Pox?

JON COHEN It was discovered in a Denmark research laboratory that had imported monkeys from Singapore that developed monkey pox. How they got infected in Singapore. Apparently, those monkeys were housed with other animals, potentially from Africa because there's never been monkey pox found in Asia. It's just a weird twist of fate.

BROOKE GLADSTONE Globetrotting monkeys. On a related note, I guess the Foreign Press Association in Africa has condemned the repeated use of images of African people with monkey pox by North American and U.K. news outlets as any other disease, the Foreign Press Association said, it can occur in any region in the world and afflict anyone, regardless of race or ethnicity. We condemn the perpetuation of this negative stereotype that assigns calamity to the African race and privilege and immunity to others.

JON COHEN So I think the African Press Association is making an important point. Show your own outbreak. Don't show ours as though this only happens here. But the challenge has to do with what's available and privacy issues. And if you go on to like Getty Images, where a lot of publications get images, there, there are pictures of Africans with monkey pox, but there also are pictures of hands from the 2003 outbreak in the United States. And at Science magazine, where I work, that's what we used for. The reason that this is not about an outbreak in Africa. There is monkey pox in Africa right now. But that's not why this is attracting international attention.

BROOKE GLADSTONE A disproportionate number of relatively few cases, as you've noted, seem to be among men who have sex with men. And therefore, the theory has been advanced that it's transmitted through sexual contact. Is there enough data to suggest that this is the case?

JON COHEN Monkey Pox has never been conclusively shown to be transmitted through sexual contact, but some of the earliest cases here were men who have sex with men, which is a small percent of the population at large. So it was odd that there were these clusters of men who have sex with men. And then it became clear that several of the cases were linked to a sauna in Madrid and to a gay festival in the Canary Islands and to a gay festival in Belgium. And there's a deep concern of ostracizing and blaming people. This is what happened with AIDS, right? Gay people got blamed for HIV. And the reality is HIV is largely transmitted through heterosexual sex. And the fact that it surfaced first in gay men doesn't tell you about how it's transmitted.

BROOKE GLADSTONE All right. So as an infectious disease reporter who's been observing the reporting on monkeypox over the decades, what are the hallmarks of good coverage that listeners should look out for?

JON COHEN Is a case confirmed or is it just suspected? And who's saying this? There are health officials in the United States at the state level or at the CDC level and other countries at the Ministry of Health. Pay attention to what they're saying. Listen to infectious disease doctors, especially if they've seen a case. There is a small group of researchers who have studied monkey pox for many years. They are authorities. Listen to them. As in all new diseases. Fear always factors in. Be wary of people who are praying and playing upon fear. Science is all about separating possibility from probability. What is likely. And people who have all the answers right now watch out because there are so many questions.

BROOKE GLADSTONE Thanks very much, John.

JON COHEN You bet.

BROOKE GLADSTONE Jon Cohen is a writer for Science magazine, where his reporting focuses on infectious diseases.