Protective suits, PCR tests, quarantine and contact tracing – in China we are currently experiencing a déjà vu. At a press conference last week, China’s Center for Disease Control and Prevention (CDC) presented guidance to contain a new outbreak of the disease. And this was not another wave of COVID. Rather, the CDC was addressing a potentially significant new public health problem in the country: monkeypox, which is becoming more prevalent. According to the World Health Organization (WHO), China is currently experiencing the world‘s highest increase in cases of the disease, now also known as “Mpox”. The country must act quickly to curb the spread.
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While the Mpox outbreak in America and Europe in mid-2022 was largely contained, Asia has developed into the new hotspot of the disease. Japan, South Korea and Thailand, all of which had sporadic imported cases over the past year, reported double-digit new cases a week in 2023 – meaning the virus has spread to local populations. However, according to the latest data reported to the WHO, China has surpassed all other countries in the world with 315 confirmed cases in the past three months. There should be more: The reports from Beijing, which are still irregular at the moment, mean that the true extent of the disease is currently unknown.
Mpox is less contagious than COVID, yet more than 88,000 people have contracted the disease since 2022, which can be painful and life-limiting for some. More than 150 people have died so far. Some countries have been more successful than others in containing Mpox outbreaks – and much of their success is arguably due to proactive measures such as vaccination campaigns. But the Chinese government has only just begun to take action. And that’s surprising.
“Compared to the response to COVID-19 […] the response is certainly dramatically different,” says Yanzhong Huang, senior fellow in global health at the Council on Foreign Relations. “Although it’s less likely [Mpox] evolved into a major outbreak in the country, unless a more active campaign is waged, a naïve attitude could encourage the spread of the disease in the population at risk.”
How the disease is now spreading
In May, the WHO said Mpox was no longer a Public Health Emergency of International Concern (PHEIC) because the number of cases in countries that had had major outbreaks in the past year – particularly America and Europe – had declined significantly. Mpox has been endemic to West and Central Africa for decades and is likely to remain so. “Overall, the situation is definitely different compared to last year,” said Krutika Kuppalli, infectious disease physician and chair of the Global Health Committee of the Infectious Disease Society of America. “We have a lot fewer cases, but we are seeing sporadic outbreaks in different parts of the world.”
By the time WHO lifted the PHEIC declaration, many Asian countries were already seeing increases. Japan was the first Asian country to report a significant increase in Mpox cases in March. In May, researchers in the country warned in a report that the disease could spread across Asia due to close ties between Japan and other Asian countries and low Mpox vaccination coverage in the region. Should the outbreak spread to Western levels, the researchers say, over 10,000 cases could be expected in Japan alone before Mpox is successfully contained.
It’s less clear what exactly is happening in China. According to data collected by the WHO, the country reported 315 new Mpox cases from May to July. Such a high number suggests that not all cases are due to travel. But – and this is reminiscent of the response to COVID – China is not as generous with its disease data as other countries. It does not publish weekly reports of new cases. Instead, the country has released an unprecedented report on the number of Mpox cases that occurred in June: 106. The Chinese government has not yet released the May data and has not yet provided any information on the cases in July.
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However, the WHO summarizes the number of cases from Taiwan, which has its own democratic government and its own disease protection, and Hong Kong under the term “China”. And there is no way for the public to separate the data again. So the number 315 includes the 106 cases that Beijing says it identified in July, as well as the number of infections in Taiwan and Hong Kong in May, June and July. This further obscures the true number of Mpox infections in China, although in the event of an infectious disease outbreak, it is crucial to get on top of things as soon as possible. However, the WHO continues to take political action here and adheres to the “One China” maxim. “We also need to know more about those infected,” says Kuppalli. “For example, demographics, clinical presentation, their immune status and how specifically they entered treatment. I think that kind of information is important.”
We know far too little
The lack of clarity about how the disease spread has even caused some Chinese to panic. The news that Mpox cases have even occurred in the country has been circulating for weeks. But it was only on July 26 that the Chinese health authority CDC and the Chinese Ministry of Health jointly published a guideline to prevent the spread of the disease. For example, it is required that all confirmed Mpox patients be transferred to a medical facility and quarantined there unless they only have mild symptoms. The rules also state that a three-week contact tracing will be carried out for each patient and close contacts will be asked to self-quarantine for three weeks. It also recommended that local authorities monitor Mpox virus concentrations in wastewater from certain areas.
What complicates monitoring the outbreak in China is that the current spread of Mpox – as in the West – is mainly seen in communities of men who have sex with men. Similar to the US and Europe, this association is consistently misinterpreted in China to suggest that Mpox is just an STD spread by homosexual men through sexual activity. It’s also dangerous because the country’s LGBTQ community is increasingly being targeted.
Many Chinese social media users who have seen men with skin lesions in public have posted photos to ask if it is an Mpox symptom. And the Chinese name for Mpox – Houdou – was circulated as a swear word against gay men. To effectively stop the spread of Mpox, public health officials must strike a delicate balance between destigmatizing the disease – by challenging the notion that it only affects gay men – and prioritizing the communities most at risk. “Working with those affected and using non-stigmatizing language and communication have proven extremely effective in containing the outbreak of the disease in the West,” says Kuppalli.
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