SCIENCE science.org 27 MAY 2022 • VOL 376 ISSUE 6596 903cause many infected people simply never
infect anyone else.
Monkeypox usually spreads through
close contact and respiratory droplets, but
in 2017 Nigerian researchers suggested
sexual transmission might have occurred in
several patients with genital ulcers. Those
are being seen now as well, says Fernando
Simón, who directs the Spanish Ministry
of Health’s coordination center for health
alerts and emergencies. Among the first
confirmed reported cases, “most have le-
sions exclusively perigenital, perianal, and
around the mouth,” Simón says. Some of
the first cases detected in Spain are MSM
or transgender people who had attended a
sauna in Madrid or a gay pride fes tival in the
Canary Islands. In Belgium, several cases
were linked to a gay festival in Antwerp.
No studies have ever found that semen can
transmit the virus. “So far, the most accept-
able hypothesis is that it is transmitted after
contact with lesions,” Simón says. MSM and
transgender communities have a high prev-
alence of HIV, but there’s no evidence that
compromised immune systems have played
any role in this outbreak.
Public health officials face a tricky bal-
ance as they seek to clearly communicate
the risks to the MSM community while
avoiding stigmatization. “Stigma and blame
undermine trust and capacity to respond
effectively during outbreaks like this one,”
Matthew Kavanagh, deputy executive direc-
tor of the Joint United Nations Programme
on HIV/AIDS, said in a statement this week.
Researchers have begun sequencing viral
samples, which can help trace how the virus
has spread and reveal mutations that might
make it more pathogenic or more transmis-
sible. It’s a laborious job: With more than
200,000 basepairs, the monkeypox genome
is about seven times the size of SARS-CoV-2’s
and more than 20 times larger than HIV’s.
The first full genome, posted on 19 May by a
team led by João Paulo Gomes at Portugal’s
National Institute of Health, showed that the
strain most closely resembles viruses carried
by travelers from Nigeria to Singapore, Is-
rael, and the United States in 2018 and 2019.
Sequences posted by the U.S. Centers for
Disease Control and Prevention (CDC) and
scientists in Belgium and Germany support
that conclusion. “We’re not seeing any evi-
dence that this virus has changed to become
more efficiently transmitted person to per-
son,” Jennifer McQuiston, the head of CDC’s
pox virus and rabies branch, said at a 23 May
press conference.
Because it’s a DNA virus, monkeypox has
far better genetic repair mechanisms than
RNA viruses such as HIV and SARS-CoV-2,
which means it changes more slowly. Still,
studies by Gustavo Palacios, a virologist at
the Icahn School of Medicine at Mount Si-
nai and co-workers suggest mutations are
frequent enough for investigators to create
virus family trees that can help clarify how
cases connect to each other.STOPPING THE OUTBREAK will require edu-
cating people and finding cases early to
reduce the chance they transmit the virus.
Vaccination could play a role as well. The
United Kingdom is already offering vac-
cines to health care workers and other con-
tacts of known cases—a strategy called ring
vaccination, which was key to the success
of the smallpox eradication campaign. The
U.S. has begun offering vaccination to some
contacts but is undecided about health care
workers caring for monkeypox patients.
Rimoin says ring vaccination doesn’t seem
warranted yet but that might change “if in
the next couple of days ... we see that there
are hundreds and hundreds of cases.”
One of the two available vaccines, manu-
factured by Emergent BioSolutions, was
designed as a smallpox vaccine and can
protect even after exposure to monkeypox
virus, when given within 4 days. But it con-
tains a live virus called vaccinia that repli-
cates inside the body; the similar vaccine
used during smallpox eradication some-
times caused severe side effects, killing one
in 1 million recipients.
The other vaccine, from Bavarian
Nordic—which the United Kingdom is
using—contains a nonreplicating form of
vaccinia designed to cause fewer side effects.
But it requires two doses, given 4 weeks
apart—a disadvantage for people who are
already exposed and need fast protection.
Both vaccines are in short supply and typi-
cally only available via national stockpiles.
Drugs exist as well. One, tecovirimat, in
2018 became the first ever approved by the
U.S. Food and Drug Administration (FDA)
to treat smallpox after it proved safe in hu-
man trials and effective in animals given
closely related viruses. FDA approved a sec-
ond drug for smallpox, brincidofovir, last
year. Although neither has been approved
for monkeypox, both showed promising re-
sults against the virus in animal studies.
But a report published on 24 May in The
Lancet Infectious Diseases reported no evi-
dence that brincidofovir had “any convinc-
ing clinical benefit” in three patients treated
in the United Kingdom over the past 3 years
and said the drug had serious toxicities.
Tecovirimat, in contrast, did not cause side
effects and appeared to lead to a decrease in
viral levels and a speedier recovery.
How far and fast the virus spreads in the
coming days will determine how aggres-
sively clinicians put these tools to the test.
“These are very early days,” Rimoin says. jNEWSA
larmed by the declining stature of
its universities, Japan is planning to
shower up to $2.3 billion a year on a
handful of schools in hopes of boost-
ing their prominence.
The scheme was approved by the
Japanese legislature on 18 May, although
many details, including how to pick the fa-
vored universities, are still up in the air.
But the move, under study for more than
a year, has rekindled a debate among aca-
demics over how to reverse Japan’s sink-
ing research fortunes. Several previous
schemes have yielded mixed results.
The new plan “aims to provide young
promising scholars with the research en-
vironment that the world’s top universities
are supposed to offer, to dramatically en-
hance international collaborations, and to
promote the brain circulation both domes-
tically and internationally,” says Takahiro
Ueyama, a science policy specialist on the
Council for Science, Technology and Inno-
vation (CSTI), Japan’s highest science ad-
visory body, which was heavily involved in
crafting the scheme.
But Guojun Sheng, a Chinese develop-
mental biologist at Kumamoto University in
Japan, is skeptical. “I am not very optimis-
tic that this [plan] will do much to curb the
slide in the ranking of Japanese research
activities or international competitiveness,”
he says. Sheng, who previously studied and
worked in China, the United States, and the
United Kingdom, says the new plan does
not address fundamental problems at Japa-
nese research institutes: too few women
and foreign scientists, a fear of change, and
lack of support for young scientists. To get
better results, “Japan has to change its re-
search culture,” he says.Japan tries—
again—to
revitalize its
research
SCIENCE POLICYLatest effort would
spend billions on a few
universities, but skeptics
give it long odds
By Dennis Normile