Report Simulating Deadly Monkeypox Outbreak Was Released Six Months Ago

Last year, current and former world leaders joined experts to conduct a tabletop exercise simulating a deadly monkeypox outbreak. And now, the results of that exercise are attracting fresh attention, with monkeypox making headlines after cases were reported in a dozen countries—including the U.S., U.K. and Australia—in a surprising outbreak of a disease that rarely appears outside of Africa.

The Nuclear Threat Initiative (NTI) partnered with the Munich Security Conference for its annual exercise on March 17, 2021—virtually due to COVID-19— and summarized the scenario, key findings and actionable recommendations in a report released in November.

The NTI's exercise scenario portrayed "a deadly, global pandemic involving an unusual strain of monkeypox virus that emerged in the fictional nation of Brinia and spread globally over 18 months," the report said.

In the scenario, the initial (simulated) outbreak was caused by a terrorist attack in May 2022 "using a pathogen engineered in a laboratory with inadequate biosafety and biosecurity provisions and weak oversight."

Monkeypox virus microscope image
Under a microscope magnification of 500X, this image depicts a section of skin tissue, harvested from a lesion on the skin of a monkey, that had been infected with monkeypox virus in 1968. Smith Collection/Gado/Getty Images

During the exercise, cases began to emerge in early June and the fictional pandemic ultimately resulted in more than 3 billion cases of monkeypox and 270 million deaths by the end of the exercise, the report said.

In the real world, the World Health Organization said it has received reports of 92 lab-confirmed cases of monkeypox and 28 suspected cases from a dozen countries between May 13 and 22. No deaths have been reported.

Cases have "mainly but not exclusively" been identified among men who have sex with men, the WHO said, and a leading WHO advisor has said the virus appears to have gotten into the population through sexual contact. The CDC and health experts have stressed that anyone can contract monkeypox through close contact.

Still, the NTI's decision to use monkeypox for the fictional scenario and the timeline outlined in the non-profit organization's report has led some to the conclusion that it "predicted" the current outbreak.

But Jaime Yassif, vice president of Global Biological Policy and Programs at NTI and the report's lead author, said the use of monkeypox as the virus in the exercise scenario was coincidental.

"We wanted to select a pathogen that would be a plausible fit for our fictional scenario, and we chose monkeypox from a range of options offered by our expert advisers," she told Newsweek. "The fact that several countries are currently experiencing an outbreak of monkeypox is purely a coincidence."

The NTI designed the scenario "to create an opportunity for participants to discuss urgently needed improvements in global capabilities to prevent and respond to pandemics" following the impact of COVID-19, Yassif added.

The exercise was co-chaired by NTI CEO Dr. Ernest J. Moniz, who is a former U.S secretary of energy, and Wolfgang Ischinger, Germany's former ambassador to the United States who was the head of the Munich Security Conference until earlier this year.

Participants included NTI founder and former Senator Sam Nunn, Dr. Beth Cameron, who previously served as the senior director for global health security and biodefense on the U.S. National Security Council, Dr. George Gao, the director-general of the Chinese Center for Disease Control and Prevention and Michael Ryan, executive director of WHO Health Emergencies Program.

"While COVID-19 has had devastating impacts globally in terms of loss of life and economic disruption, the world continues to face the risk of future high-consequence biological events whose impact could meet or even exceed the severe damage caused by the current pandemic," Yassif said.

Yassif said the report's key takeaway "is not the specific pathogen in our fictional scenario; it's the fact that the world is woefully unprepared to guard against future pandemics, and we need to take urgent action to address this vulnerability."

She explained that the key findings from the 2021 exercise included: weak global detection, assessment, and warning of pandemic risks; gaps in national-level preparedness and insufficient financing of international preparedness for pandemics.

"The international community needs a more robust, transparent detection, evaluation, and early warning system that can rapidly communicate actionable information about pandemic risks," Yassif said.

Governments around the world "should improve preparedness by developing national-level pandemic response plans built upon a coherent system of 'triggers' that prompt anticipatory action, despite uncertainty and near-term costs—in other words, on a 'no-regrets' basis."

The report recommended that national leaders, development banks, philanthropic donors, and the private sector establish and resource "a new financing mechanism to bolster global health security and pandemic preparedness," Yassif said.

"The design and operations of the fund should be catalytic—incentivizing national governments to invest in their own preparedness over the long term."