For the public health sceptic, monkeypox is the gift that keeps on giving. Hot off the press is a case that has rocked the worlds of virology and epidemiology, with the monkeypox virus facing accusations of plagiarism.

Plagiarism, the deliberate use of the words or ideas of others without attribution while passing them off as your own is considered one of the most serious violations of scientific ethics. The outcome for the monkeypox virus could be severe including removal from the prestigious BSV (Big Scary Viruses) list.

Specifically, the monkeypox virus stands accused of plagiarising COVID-19. To recap, COVID-19 was the virus which took top slot in the BSV list from 2020 until 2022. It has bobbed up and down below the top slot since then but has never left the top 10. Briefly, monkeypox took the top slot but that place is now held by the Ebola virus.

Monkeypox, in an effort to regain the top slot, even renamed itself ‘Mpox’ to appear more serious, less colonial and to appeal to a younger, more politically correct generation. But the virus still failed to regain the pole position. Now, in a determined bid for that coveted number one place and a return to popularity, monkeypox, having studied the COVID-19 virus carefully, has adopted some of the same tactics used by COVID-19.

COVID-19 is now considered a genius among viruses. Its progress from a ‘mild flu-like infection’ and one for which there was no ‘human to human transmission’, first noticed in Wuhan in late 2019 (the author was in Wuhan in late 2019 and he noticed nothing!), to becoming an existential threat to humanity is now a required case study at viral boot camps where other mild viruses are trained in the deadly art of making themselves seem more lethal than they are and bringing civilisation to its knees, socially and economically.

Key features of the COVID-19 playbook included:

Compulsory testing. Despite the purported deadly and debilitating nature of COVID-19 and its unmistakable symptoms, it was considered necessary to undergo a test to ascertain whether you were infected. Remarkably, as a result of testing, nearly everyone was shown to have COVID-19, even though many had no idea they had it.

COVID-19 excelled itself in encouraging the use of PCR for testing despite PCR not having been designed as a diagnostic tool. PCR testing proved incapable of distinguishing between fragments of inactive virus from active virus and, despite this being a known pitfall leading to excessive numbers of false-positive results, millions of pounds were spent on purchasing and distributing essentially useless tests to every locality in the UK.

The results were catastrophic for families and industry. Family events and holidays were missed, people self-isolated and grew depressed, obese and alcoholic. Skivers found ways of faking the tests to get a week off work and the only winners were the manufacturers of the tests.

Asymptomatic transmission. COVID-19 excelled by resurrecting the dubious phenomenon of asymptomatic transmission. This was closely related to the above in that you could be infected with COVID-19, the so-called ‘killer virus’ and unknowingly pass it on to others – especially your granny – because you did not know you had it.

This was virtually unheard of prior to COVID-19 but was an important aspect of the playbook as the only way to establish if you, unknowingly, had COVID-19 was (I think readers may have got there before me) to take a test. And, in case you need reminding, this was a test that was only tenuously related to actually being infected with COVID-19.

Long Covid. Once the initial excitement of the COVID-19 years was fading, the virus, disappointed by its fall from grace, reinvented itself in the guise of Long Covid. The prior existence of the well-established phenomenon of post-viral syndrome was swept aside in the wake of Long Covid. This was not any old post-viral syndrome; this was one caused by COVID-19 and had to be taken seriously.

Soon Long Covid became very popular among the middle and professional classes. Once established as a post-pandemic pandemic and mainly affecting a vocal and articulate stratum of society, it was not long before funding to investigate the phenomenon of Long Covid poured into the coffers of universities and research centres. The amount of money dwarfed the funding, for example, for ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), which may also be viral in origin.

Monkeypox in the dock

As posted in Global Health NOW, the newsletter of the Johns Hopkins Bloomberg School of Public Health with a link to CIDRAP, the newsletter of the Centre for Infectious Disease Research and Policy, University of Minnesota, a recent study shows that monkeypox, without attribution, has copied all three of the above tactics from the COVID-19 playbook.

The study, uninvitingly titled ‘Extensive cryptic circulation sustains mpox among men who have sex with men’, is published in Nature Communications. According to Laine Bergeson, writing in CIDRAP of May 18th, “Mpox infections may outnumber diagnosed cases 33 to one”. In other words, some men who have sex with men may not have any symptoms.

The finding is based on the observation that the extent of monkeypox infection which was confirmed in men presenting with symptoms was lower than the number who were identified following testing (using PCR) of men “who never presented with mpox symptoms or received an mpox diagnosis”. Again, we see evidence of an infection with apparently unmistakable symptoms only being identified following PCR testing.

Without blushing, the authors of the Nature article refer to “realistic modelling assumptions” which estimate that “undiagnosed infections may account for at least 31% to 44% of all transmission” of monkeypox. Modelling is rarely realistic. Not referred to in any of the articles above but referred to elsewhere, monkeypox has also made efforts to jump on the bandwagon established by Long Covid, with reports of long monkeypox emerging.

The Nature article also referred to the Jynneos vaccine for monkeypox having “72% effectiveness” against diagnosed infection. But, again, using another trick from the COVID-19 playbook, the authors are referring to relative and not absolute risk reduction.

One can only admire monkeypox’s ambition. Having borrowed asymptomatic transmission, compulsory testing, dubious PCR evangelism and inflated vaccine effectiveness claims from COVID-19, it now seems determined to establish itself as the next fashionable public health panic. No doubt we can soon expect calls for enhanced surveillance, emergency funding, behavioural restrictions and perhaps even socially distanced Pride marches. The only thing missing is nightly government press conferences featuring frightened ministers standing beside graphs nobody understands while solemn experts warn us that the next two weeks will be critical.

Professor Roger Watson is Distinguished Professor of Nursing at Southwest Medical University, China. He has a PhD in biochemistry. He writes in a personal capacity.