Hoping that viruses will go away is not enough – what is needed is continuous vigilance

Telegraph

a day ago

In the public debate about pandemics, there is a belief as persistent as it is dangerous: the idea that epidemics end, that viruses – once contained – will disappear like a summer storm.
But virology and epidemiology teach us that viruses do not disappear. Viruses adapt and mutate. They lurk in the folds of health inequalities and gaps in global surveillance.
The latest alarm comes from Sierra Leone, which, after reporting its first two cases of mpox (formerly known as monkeypox) in January and declaring a public health emergency, is now facing a significant expansion of the epidemic.
According to official sources, the country has reported over 3,000 confirmed cases and at least 15 deaths, with infections concentrated particularly in Western Area Urban, Western Area Rural, and Bombali.
National health authorities, assisted by the WHO, Unicef, Africa CDC, and Gavi, have implemented a comprehensive emergency plan: strengthening surveillance, isolating cases, contact tracing, and launching awareness campaigns in schools and rural communities.
As a result, 61,300 doses of the MVA-BN vaccine are expected to arrive in the coming weeks, and hundreds of health workers are being trained on diagnostic, treatment, and prevention protocols.
This outbreak is becoming particularly worrisome due to the high vulnerability of children, who face a mortality risk up to four times higher than adults, especially in conditions of malnutrition or poor hygiene.
On a continental scale, Africa is witnessing a rise in cases, with over 50,000 reported since the beginning of the year and more than 1,700 deaths. A critical factor is the viral clade involved.
While full genomic mapping is still underway, the Africa CDC has reported that clade IIb, which has been associated with faster human-to-human transmission and potentially exponential spread, is likely the dominant strain in Sierra Leone.
Despite Sierra Leone's improved emergency response capacity, gained during the 2014-2016 Ebola outbreak, healthcare infrastructure remains under strain.
Patients often share beds, and clinical recognition delays persist, reflecting systemic pressures that could hamper containment efforts.
Viruses return when the world 'moves on'
Recent history, from Covid-19 to polio, shows that viruses do not 'die out' with a decree or a short-lived vaccination campaign.
Zoonotic viruses, in particular, have an inherent ability to remain in circulation between animal and human hosts, often with different symptomatologies, and to re-emerge under favourable conditions.
When surveillance loosens, when public health is underfunded, when the world 'moves on,' viruses return.
Mpox is emblematic in this regard. For decades considered a virus confined to parts of central Africa, it has found new vectors, new susceptible populations, and new routes of transmission.
Its recent mutations – linked to clade IIb – suggest adaptations to human infection that could make it endemic even in hitherto unaffected areas. Its apparent disappearance in high-income countries after the 2022-2023 wave is illusory: it was not a biological defeat, but a logistical suspension.
Yet there are examples of good health behaviour from which the whole world should draw inspiration.
In Tanzania in 2023, a small outbreak of Marburg virus – one of the world's deadliest pathogens, belonging to the same family as Ebola – was contained through a timely, transparent and coordinated response.
The Tanzanian Ministry of Health quickly put in place measures for contact tracing, case isolation, effective public communication and cooperation with WHO.
Similar efficiency was demonstrated in Rwanda, where preparedness for potential Marburg cases became a pillar of public health strategy, despite the fact that no outbreaks had occurred.
Both countries invested in decentralised surveillance systems, widespread health training, and integration of human and veterinary medicine-embodying the concept of 'One Health'.
These examples show that prevention is not a luxury of rich countries, but a strategic choice that is possible everywhere if supported by political will and real, non-paternalistic international cooperation.
The new mpox outbreak in Sierra Leone must be interpreted in light of a fundamental fact: the transmissibility of viruses knows no geopolitical boundaries.
Emerging diseases are now more than ever a global health security issue. A delay in diagnosis in Freetown can trigger an infection in Paris, London or Toronto within days.
Yet funding for surveillance and diagnostic laboratories remains concentrated in a few areas. Large regions of Africa, Asia, and Latin America lack sentinel systems capable of detecting new threats in real time. Where the first patient is not identified, the virus has already won the first round.
Continuing to hope that 'it won't happen here,' or that 'this time it is just a small outbreak,' is a mistake we have already paid dearly for.
The mpox emergency in Sierra Leone is not yet a pandemic, but it is already an opportunity: to invest, to coordinate, to train.
Epidemiological surveillance must become a structural and continuous investment, not an emergency response. We need a global network that not only responds, but predicts. One that recognises the global potential in seemingly minor outbreaks, and that funds local health systems not just to treat, but to monitor and to anticipate.
Hoping that viruses will disappear is an understandable but naive wish. The only scientifically sound response is permanent, equitable, multilevel surveillance. We can no longer afford to ignore weak signals. Every contained outbreak is a shared victory; every ignored outbreak is a global defeat waiting to happen.
Francesco Branda is an Adjunct professor at the Faculty of Medicine and Surgery at Campus Bio-Medico University of Rome
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