ASMA KHALID, HOST:
Nearly 800,000 additional doses of the monkeypox vaccine will soon be distributed throughout the United States, according to health officials. This comes as the world is struggling to stop the largest recorded monkeypox outbreak in history. More than 18,000 cases have now been detected in at least 78 countries. NPR's Michaeleen Doucleff has an exclusive story about where this outbreak began. But first, Michaeleen, you have a story about the doctor who treated some of those first-known cases, and then he tried to warn the world that monkeypox had become an international threat?
MICHAELEEN DOUCLEFF, BYLINE: That's right, Asma. The story actually starts five years ago with a doctor named Dimie Ogoina. Back in 2017, he saw what's perhaps the most important patient of his career.
DIMIE OGOINA: They brought my attention to a young boy.
DOUCLEFF: An 11-year-old boy with a very strange rash that looked like blisters.
OGOINA: He had skin lesions that appeared very unusual, very large, affecting the face and all over the body.
DOUCLEFF: Ogoina is an infectious disease specialist at Niger Delta University in Nigeria. And when he saw the size of the lesions - or pox - he wondered if the boy had what was then a rare disease - a very rare disease.
OGOINA: The suspicion of monkeypox just came up.
DOUCLEFF: So Ogoina tested the boy, and he was right - monkeypox. At the time, Ogoina thought that this monkeypox outbreak would act the way it always had, the way it had been described in textbooks and scientific papers since the 1970s. That is, the virus came from an animal, like a rodent or a monkey.
OGOINA: There was this speculation that this young boy played with monkeys around the community.
DOUCLEFF: And that the virus doesn't spread very easily between people because it's not very contagious, especially between healthy adults.
OGOINA: It affects mainly children.
DOUCLEFF: Because when they're playing outside, they often come into contact with animals. So previous outbreaks were small, only a few dozen cases in rural areas. And Ogoina and other doctors thought that this outbreak back in 2017 would be the same.
OGOINA: So we felt, OK, could be the regular monkeypox that we know has been described in the center Africa.
DOUCLEFF: But a few weeks later, Ogoina started to become concerned. The outbreak began to grow very rapidly. Cases popped up not just near this boy but all over.
OGOINA: We are seeing cases just suddenly appearing across the country.
DOUCLEFF: The virus seemed to be spreading further and faster than expected. And it wasn't kids getting infected but rather men in their 20s and 30s.
OGOINA: Young men, active men. It was very, very unusual at that time.
DOUCLEFF: These men didn't fit the typical profile for monkeypox either. They weren't handling animals. They were middle-class men living in busy, modern cities. And their rashes weren't in the typical places on their bodies. Instead of being on their faces and extremities, the men had blisters around their genitals.
OGOINA: There were very, very extensive - very, very extensive genital lesions that appeared.
DOUCLEFF: Ogoina started to investigate these patients more and found that many of them had high-risk sexual behaviors - multiple partners, sex with prostitutes. Ogoina started to realize something huge - that the virus had changed, and for the first time, it was starting to spread through sexual contact.
OGOINA: We have already proposed that sexual route is something that we need to look - really look at.
DOUCLEFF: Interesting. So fascinating because it's so different than what you see in the textbooks, right?
OGOINA: Yeah, it's completely different. Why are they not affecting children? Why not females? Why not the elderly? Why are we having young men 20 to 40 years only?
DOUCLEFF: Ogoina knew these findings had massive implications. It meant the virus no longer needed to jump from an animal. Instead, it could now easily jump from human to human, and that meant the current outbreak in Nigeria would be extremely difficult to stop. It meant monkeypox was no longer just a threat to communities in West Africa but a threat to the world. So Ogoina tried to warn Nigerian health officials years ago. They wouldn't listen. At an international meeting, he tried to bring up the possibility of sexual transmission. Somebody told him to be quiet.
OGOINA: The way we had one meeting, somebody said I should not say it.
OGOINA: That he have experience - yes, one meeting like this, somebody said I should not say that it is not possible, we should not worry.
DOUCLEFF: Jump ahead five years later.
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UNIDENTIFIED REPORTER #1: Tonight, the World Health Organization sounding the alarm on the rapid spread of monkeypox.
UNIDENTIFIED REPORTER #2: More than 70 countries now reporting cases, the U.S. nearing 2,900 infections.
UNIDENTIFIED REPORTER #3: New York City is the epicenter of the outbreak in the U.S.
DOUCLEFF: For the first time in history, monkeypox is spreading across the world - and just as Ogoina predicted, through sexual contact.
KHALID: All right. Michaeleen, I mean, that, to me, is a wild backstory - this scientist who had all this important information, but he could not get anyone to pay attention to it. I mean, it's really mind-boggling.
DOUCLEFF: Yeah. You know, in fact, Ogoina's insights and knowledge go even further. He says the outbreak in Nigeria back in 2017 never actually stopped. Health officials just stopped looking for cases and the outbreak went underground. And eventually, it actually turned into this huge international outbreak we're fighting right now.
KHALID: So you're saying that the outbreak today is, in fact, the very same one that was in Nigeria back in 2017? How do we know that?
DOUCLEFF: Yeah. You know, there's new genetic evidence that hasn't been published yet showing that this outbreak - this international outbreak we have - started in Nigeria way back even years before this little boy showed up in Ogoina's office. Michael Worobey is studying this question. He's an evolutionary biologist at the University of Arizona. He says the data are really indisputable.
MICHAEL WOROBEY: Yeah, I think, in many ways, it's really clear. It's clear that there's been continuous cases or endemic transmission in Nigeria from 2017, maybe a little bit before 2017. And then something from there just got exported out.
DOUCLEFF: Exported out of Nigeria and really eventually all over the world.
KHALID: So this means that the world has essentially had at least five years to stop this outbreak, but it didn't.
DOUCLEFF: That's right. You know, Demir Ogoina - you know, the doctor in Nigeria - he calls it a lost opportunity. You know, the scientific community didn't pay attention to his data and his warnings. And in general, the effort to stop the outbreak in Nigeria this whole time has paled in comparison to the effort to stop monkeypox in Europe and in North America. For example, when the disease hit the West this year, there has been this rapid effort to vaccinate people, but the same hasn't been true in West Africa. To this day, Asma, Nigeria hasn't seen one monkeypox vaccine. So, you know, I really think this story shows us that, for the U.S. to control monkeypox, for the world to control monkeypox, the U.S. and the world has to pay attention and really care about what's going on in Africa as well.
KHALID: That's NPR's global health correspondent Michaeleen Doucleff. Thank you, Michaeleen.
DOUCLEFF: You're welcome.
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