The spread of monkeypox was predicted by scientists in 1988 : Goats and Soda Their prediction stemmed from the eradication of smallpox. Here's what they said more than three decades ago — and how it foreshadowed events of 2022.

Scientists warned us about monkeypox in 1988. Here's why they were right.

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The world is facing the first international outbreak of a rare disease - monkeypox. Although there are only about 350 known cases, the virus is spreading in more than a dozen countries, places that have never seen monkeypox before. In the U.S., there are cases in California, Florida, Massachusetts, New York, Utah, Virginia and Washington. As NPR's Michaeleen Doucleff explains, the virus has emerged worldwide for a remarkable reason.

MICHAELEEN DOUCLEFF, BYLINE: Back in 1988, scientists made a bold prediction that over time, monkeypox would spread. Outbreaks in Africa would grow in size and frequency, and the virus could eventually spill over into other continents.

BOGHUMA TITANJI: And that has actually borne out because if you look at the past 10 years, the number of monkeypox outbreaks that have happened have potentially increased through that time.

DOUCLEFF: That's Boghuma Titanji. She's an infectious disease doctor at Emory University. She says back then, people typically caught the virus from an animal, like a squirrel, in Central Africa and then spread the virus to only a few people.

TITANJI: In West and Central Africa, there have been relatively small-sized outbreaks happening in Nigeria, in the DRC, in Cameroon, etc.

DOUCLEFF: But over the past few decades, these outbreaks have grown. For example, in the 1990s, there were about 50 cases reported each year. By 2020, cases in the region have likely shot up more than 100 times to over 5,000 cases each year. Anne Rimoin is another scientist who predicted this rise. She's an epidemiologist at the University of California Los Angeles. She knew cases were going to rise largely because of one uncanny reason.

ANNE RIMOIN: Eradication of smallpox.

DOUCLEFF: Yes, you heard that right. Monkeypox is spreading on four continents right now in large part because, in 1980, the world eliminated another virus - smallpox.

RIMOIN: It was really important. It was the greatest achievement in human public health history.

DOUCLEFF: Smallpox is one of the deadliest diseases in human history. Eradicating it has saved millions of lives each year because it's very contagious and kills up to 30% of the people infected. In contrast, this version of monkeypox kills fewer than 1%.

RIMOIN: So monkeypox in all of its iterations is much less severe than smallpox.

DOUCLEFF: But, as Rimoin explains, wiping out this killer did have a repercussion. It opened the door for monkeypox to emerge, possibly worldwide.

RIMOIN: Of course, we're going to see, you know, other viruses emerge that may fill that void, fill that niche. And that's what we're seeing.

DOUCLEFF: So why has that virus been monkeypox? Jo Walker is an epidemiologist at Yale School of Public Health. They says it's all about immunity. Monkeypox is closely related to smallpox, and being sick with smallpox or being vaccinated against it offers really good immunity to smallpox and to monkeypox. But for 40 years now, Walker says, immunity has been rapidly declining.

JO WALKER: So over time, new babies were born. And they didn't get the vaccine, and they didn't get infected with smallpox in childhood.

DOUCLEFF: And many people who were vaccinated have died. So the world's population, over time, has become more and more susceptible to monkeypox.

WALKER: And so we're actually at a point where population immunity against monkeypox is at the lowest it's been basically in thousands of years.

DOUCLEFF: And people all over the world, from Nigeria to Massachusetts, are much more likely to catch monkeypox and spread it. And what would have been a small outbreak decades ago has the potential to be a huge one today. There is a vaccine that can stop outbreaks quickly. Otherwise, there's a chance a virus that was once extremely rare could become much more common everywhere. Michaeleen Doucleff, NPR News.

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