Many of the world’s new mpox cases are in China

Global health officials were spooked last year when mpox, a disease formerly known as monkeypox, began spreading beyond the parts of Africa where it is endemic. Its reach rapidly extended across Europe and America, mainly through sexual contact. Mpox can cause flu-like symptoms, painful blisters and, in very rare cases, death. This year cases have fallen rapidly in much of the world, thanks to vaccines and health education. But not in China.

In July and August the country said it had found nearly 1,000 new cases, more than half of the new infections reported worldwide in those months. This marked a sharp rise from zero infections early in the year. The mpox virus has spread across China, with 26 of the mainland’s 31 provincial regions reporting infections. Some 80% of cases lack a clear chain of infection, health officials say, implying that many others are not being recorded.

There are several reasons why China is an outlier. One is anti-foreign sentiment. In September last year Wu Zunyou, China’s chief epidemiologist, posted unhelpful advice on social media that the risk of infection could be reduced by “avoiding direct skin-to-skin contact with foreigners”. Officials have not approved any of the effective foreign vaccines against mpox (just as they have not permitted general use of foreign vaccines against covid-19). This is despite advice from the World Health Organisation that high-risk groups and health workers who treat mpox patients should get a shot. An mpox vaccine developed by a Chinese company is still undergoing trials.

Conservatism is a problem, too. Almost all mpox cases in China and elsewhere have been among men who have sex with men. In other countries, support groups for gay people have proved invaluable in raising awareness of the virus and getting people tested. But for years China has suppressed such groups, deeming them threats to public morals and political stability. Guidelines released by local governments say that mpox poses little risk to “ordinary people”.

On China’s social media many people use homophobic slurs when discussing mpox. Surveys show that few gay or bisexual men in China are willing to tell doctors about their sexuality, which makes it harder for them to get needed advice. In August officials said five women had been found with mpox (China’s previously declared infections had all been in men). Some netizens said the women had been tricked into marriage by “despicable” gay people.

China’s response to mpox recalls its initial handling of HIV, the virus that causes AIDS. In the late 1980s Chinese officials dismissed HIV as a foreign problem caused by decadent Western lifestyles. But in the 1990s many people became infected with the virus while selling their blood plasma. Only after the scandal broke did a nationwide campaign against HIV gain traction and successfully reduce infections.

With mpox, too, there are signs of a shift in official thinking. On September 20th the government reclassified the disease, putting it on the same level as HIV. This should unlock more resources for tackling it. Also last month Mr Wu, the epidemiologist, co-wrote a letter to the Lancet, a medical journal, warning that “the global spread of mpox could be exacerbated if local transmission is not controlled immediately”. He suggested that China should start using vaccines and try to reduce fears of the disease. Better late than never. ■

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