Evolutionary consequences of delaying intervention for monkeypox

• Authors: Philip LF Johnson, University of Maryland, College Park; Carl T Bergstrom, University of Washington; Roland R Regoes, ETH Zürich; Ira M Longini, University of Florida; Elizabeth M Halloran, University of Washington; Rustom Antia, Emory University
• Journal Title: The Lancet
• Volume: Volume 400, Number 10359
• Publisher: Elsevier Ltd. | 2022-10-08, Pages 1191-1193
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/S0140-6736(22)01789-5
• Subjects: Health Sciences, Oncology; Biology, Biostatistics
• Keywords: Animals; Biological Evolution; Disease Outbreaks; Humans; Monkeypox; Zoonoses

Abstract

Since May, 2022, clusters of monkeypox infections have caused global concern. At present, this concern has been tempered by the fact that, even when uncontrolled, the number of infections is growing slowly, indicating a reproductive number (R) not much larger than unity. However, the effect of R on the probability of evolution might not be obvious. We suggest that, compared with zoonotic pathogens with large R values, those pathogens with R values just above 1, such as monkeypox virus, have a higher probability of evolution during the timeframe in which the number of cases remains low. Waiting until the number of cases is high would give monkeypox virus—or any emerging pathogen—the opportunity to adapt substantially to humans.