Monkeypox has taken the world by storm.
They have long been common in parts of central and western Africa, where people live near forest animals that carry this virus.
But now they have gone global - spreading in a way never seen before and on a scale that is unprecedented.
Almost 27.000 cases of the disease have been confirmed, mostly in men who have had sex with men - in 88 countries.
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The World Health Organization claims that this is a global emergency.
So can monkeypox be stopped?
Or are we now doomed to have a new virus spreading freely around the world?
We need to consider three things:
- Is the virus particularly tricky to deal with?
- Do we have the means to stop it?
- Is there a will to fight the disease that primarily affects gays and bisexuals?
Virus
There is nothing special about the biology of the monkeypox virus.
He is not an unstoppable force.
Covid probably is - it spreads so easily that it was probably impossible to stop even in the early days of the pandemic.
But monkeypox is more difficult to spread from person to person.
It requires close physical contact - such as through infected skin, prolonged face-to-face contact, or contaminated surfaces such as bedding or towels.
The two viruses are simply in different classes and past monkeypox epidemics have simply died out on their own.
And we've already overcome a much bigger challenge by defeating this virus's deadly cousin, smallpox.
"Monkeypox is easier because it's less contagious than smallpox so we're in a much better position," says Professor Jonathan Ball, a virologist at the University of Nottingham.
However, one of the problems is that some people have mild symptoms or symptoms that can easily be confused with sexually transmitted diseases or chicken pox.
This means that they can unknowingly be transmitted to other people.
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Resources
The virus has entered a group of people who have enough sex or enough intimate contact with enough partners for the virus to overcome its own incompetence and start spreading.
This virus is not classified as a sexually transmitted disease.
But a study in the New England Journal of Medicine estimates that up to 95 percent of monkeypox infections come through sex, especially sex between men.
Sex, of course, is full of all that intimate skin-to-skin contact that the virus uses to spread.
That leaves two options for stopping the disease - convincing people to have less sex; or to reduce the risk of infection when exposed to the virus.
Professor Paul Hunter, from the University of East Anglia, says: "The easiest way to stop it is to stop all highly active sexual networks for a couple of months until it goes away, but I don't think that will ever happen - how about you?"
Some people do adjust their sex lives in response to warnings about monkeypox, and the advice is aimed at those most at risk.
But Professor Hunter argues that the lessons of sexually transmitted diseases - from syphilis in the Middle Ages to the present day - tell us that people still have sex and that "vaccination is practically the only option".
Fortunately, the smallpox vaccine used to eradicate the virus is about 85 percent effective in stopping monkeypox.
Supplies are limited as they are kept only in case someone uses smallpox as a weapon, not to fight the unprecedented epidemic of monkeypox.
However, not everyone from risk groups will need to be vaccinated to stop the epidemic.
"Herd immunity" means that once a critical threshold of people is protected, the virus can no longer spread.
This will be much easier to achieve with monkeypox than with other diseases, such as covid.
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People
Although anyone can contract monkeypox, gay, bisexual, and other men who have sex with men are disproportionately affected in this outbreak.
This could make it easier to control the virus because, overall, it's a group that is well aware of sexual health.
It also allows resources to be directed to those who need them, such as vaccinating men who have sex with men instead of the entire population.
However, stigma, discrimination and harassment can deter people from seeking help, especially in countries where sex between men is illegal.
"Some countries don't have the infrastructure, and some may not be willing to test for monkeypox, because it's men who have sex with men," says Francois Ballou, from University College London.
Challenges remain, even in countries that support the rights of the LGBT community - lesbian, gay, bisexual and transgender.
Even a policy like asking people to isolate themselves, which we know well because of covid, can have unintended consequences.
"It's like going public - either to your wife or your parents, because suddenly you have to explain why it happened - so there's a huge pressure not to say who your contact was," says Professor Hunter.
Can monkeypox be stopped?
It already looks like some countries are managing to cope with the virus.
The UK says the number of infections appears to have stopped at around 35 cases a day.
But the number of cases continues to jump elsewhere, including in the US, which has declared a state of emergency.
But it will not be enough for rich countries alone to fight the virus, as it is now found in more than 80 countries that do not have a long history of the disease.
"It is very unclear to me whether it will be completely brought under control, because some countries will cope, while others may not," says Professor Balu.
The WHO's chief monkeypox technical scientist, Dr Rosamund Lewis, says it is "possible" to end the epidemic, but warns that "we don't have a crystal ball" and it is not clear whether the organization will be able to "provide enough help to countries and enough help to communities to stopped the epidemic".
Endemic countries in Africa, where monkeypox is always present, will continue to fight against the virus that persistently transfers from wild animals to humans.
Studies have shown that this problem has worsened since the smallpox eradication program ended, as few people under the age of 50 have been vaccinated.
The only thing that would stop it is a mass vaccination campaign, "but there is a big debate in Africa about whether that is appropriate or necessary," says Professor Hunter.
What will happen if we don't stop them?
There is concern that monkeypox could achieve a permanent presence in humans across the planet instead of just in countries with infected animals.
At the moment it is in men who have sex with men, but the longer the epidemic lasts, the greater the chances of the virus becoming more widespread.
There have been isolated cases in children and women, but they have not started their own epidemics in classrooms or workplaces.
However, the risk increases if the virus is given time to become better at infecting people.
We have seen how covid has evolved and variants like omicron have become much better at infecting.
"If the virus doesn't change, I personally doubt that it will spread among children or more widely among people who don't have many sexual partners," Professor Balu said.
"But the longer you wait, the greater the risk that it could change," he says.
Another problem is that monkeypox has the ability to infect a wide range of mammals, such as squirrels, rats, voles and monkeys in Africa.
There is a danger that the virus could take up residence in other animals and start to pass from one species to another.
The 2003 monkeypox outbreak in the US—which led to 47 cases in six states—was started among pet prairie dogs.
Fighting this monkeypox epidemic is possible, but the longer we let it spread, the more difficult it will be and the greater the risks.
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