(Brownstone)—Public health responses are most effective when they are grounded in reality. This is particularly important if the response is intended to address an ‘emergency,’ and involves the transfer of large amounts of public money. When we reallocate resources, there is a cost, as the funds are taken from some other program. If the response involves buying lots of products from a manufacturer, there will also be a gain for the company and its investors.
So, clearly, there are three obvious requirements here to ensure good practice:
- Accurate information is required, in context.
- Those gaining financially can have no role at all in decision-making.
- The organization tasked with coordinating any response would have to act with transparency, publicly weighing costs and benefits.
The World Health Organization (WHO), tasked by countries to help coordinate international public health, has just proclaimed Mpox (monkeypox) an international emergency. They considered an outbreak in the Democratic Republic of Congo (DRC) and nearby Central African countries to be a global threat, requiring an urgent global response. In declaring its emergency, WHO stated there were 537 deaths among 15,600 suspected cases this year. In its 19th August Emergency Meeting on Mpox, WHO clarified its figures:
…during the first six months of 2024, the 1854 confirmed cases of Mpox reported by States Parties in the WHO African Region account for 36% (1854/5199) of the cases observed worldwide.
The WHO reiterated that there had been 15,000 “clinically compatible” cases, and about 500 suspected deaths. The implications of these 500 unconfirmed deaths, equaling just 1.5% of the malaria deaths in DRC over the same period, are discussed in a previous article.
Journals such as the Lancet have dutifully towed the WHO’s ‘emergency’ line, though intriguingly noting that the mortality could be far lower if “adequate care” had been provided. Africa CDC agrees, with more than 17,000 cases (2,863 confirmed) and 517 (presumably suspected) deaths of Mpox have been reported across the continent.
Mpox is endemic to central and west Africa, being present in species of squirrels, rats, and other rodents. While it was identified in monkeys in a Danish lab in 1958 (hence the misnomer ‘monkeypox’), it has probably been around for thousands of years, causing intermittent infections in humans between whom it is spread by close physical contact.
Small outbreaks in Africa mostly went unnoticed by the rest of the world, mainly because they were (as now) small and confined. Mass Smallpox vaccination may also have suppressed numbers still further a few decades ago, as Smallpox is in the same Orthopoxvirus genus of viruses. So, we may be seeing an upward trend of this generally milder illness (fever, chills, and a vesicular rash) over recent decades since Smallpox vaccination ceased. The Smithsonian magazine put an informative summary together in 2022, after the first out-of-Africa outbreak which was spread by sexual contacts within a limited demographic group.
So, here we are in 2024, on the tail of a massively profit-driving (and impoverishing) outbreak called Covid-19 that enabled the largest transfer of wealth from the many to the few in human history. The WHO’s announcement that 5,000 (or less) suspected Mpox cases is a Public Health Emergency of International Concern (PHEIC) allows it to fast-track vaccines through its Emergency Use Listing (EUL) program, bypassing the normal rigor required to approve such pharmaceuticals, and is suggesting Pharma start lining up.
At least one drugmaker is already discussing a supply of 10 million doses before year-end. The business case for this approach, from the corporate viewpoint, is well-proven. So are the harms in countries like DRC, as a mass vaccination program of this nature requires redirection of millions of dollars and thousands of health workers who would otherwise be addressing diseases of far larger burden.
The WHO is a large organization, and while some there have been on the hustings asking for money, others have been working hard to accurately inform the public (a core responsibility of the WHO, which retains some dedicated people). Like much of the WHO’s work in the past, this is thorough and commendable. Some of this information is summarized in the following graphics:
These charts provide data on confirmed cases, where someone with somewhat non-specific symptoms has been tested and shown to have evidence of Mpox virus in blood or secretions. Clearly, not everyone suspected can be tested, as Mpox is a very small issue for people facing civil wars, mass poverty, and vastly more dangerous diseases.
However, the WHO has absorbed a lot of money for outbreak investigation, and so have partner organizations, so we can assume there is a fairly good effort going on to detect and confirm numbers (or where has this money gone?).
In the past 2.5 years, the WHO has confirmed 223 deaths in the whole world, with just six in July 2024 (the time when the WHO Director-General warned the world of a rapidly increasing threat). Note here that 223 deaths are just 0.2% of the 102,997 confirmed cases. In Africa, just 26 deaths have been confirmed in 2024 among 3,562 cases (0.7%), spread across 5 countries (and 12 countries with cases). They are influenza-like mortality rates, not Ebola-like.
As severe cases are more likely to be tested than mild cases, the infection fatality rate may be far lower. We also don’t know (though someone does and should tell us) what the characteristics of those dying are. Most in Africa are reported to be children, so it is likely they are malnourished, otherwise immunocompromised (e.g. HIV), and have susceptibilities that could be addressed.
As is obvious from the third graphic below, nearly all the global deaths listed above were from the previous outbreak in 2022. This was a different clade (variant) and mostly occurred outside of Africa.
It is important to note a few things here. It is difficult to confirm all cases in areas with poor infrastructure and security. Mpox symptoms and signs are also frequently mild and overlap other diseases (e.g. chickenpox or even flu) so many cases may go unnoticed. Notification of results can also lag. However, the 19 confirmed DRC Mpox deaths amongst roughly 40,000 DRC malaria deaths so far this year is about 1 versus 2000. Whichever way you count it, it is not going to become much more significant. That is what the new international emergency looks like in actual data, or if you are the population of DRC at Mpox ground zero. It is likely you would not notice anything at all.
Why has the WHO declared an international emergency? Some claim it helps mobilize resources, which is a bit pathetic. Firstly, grownups should be able to discuss a situation that has persisted for two years in a rational manner and decide what might be needed, without banging a drum. Secondly, an outbreak that is killing a tiny fraction of malaria (or tuberculosis, or HIV) deaths, and far less than those currently dying in war, may not be an international emergency.
And what should be done? Diverting resources from DRC’s major priorities would undoubtedly kill far more than are currently dying from Mpox. It is quite probable that direct adverse events from vaccination alone will kill more than the 19 DRC Mpox victims confirmed this year. We likely undercount Mpox deaths, but we also undercount pharmaceutical deaths.
Perhaps a useful response would be to improve immune competence through nutrition, providing very broad benefits (but completely failing in terms of Pharma profit). Gavi’s half-billion dollars would provide vast and broad-based benefits if applied to sanitation. Perhaps limited, well-targeted vaccination may also help some communities, but there is no business case for such approaches.
What is clear, as noted above, is the following:
1. The data on Mpox, and other competing priorities, must continue to be shown in context, along with costs and opportunity costs of the response.
2. Those who will gain financially from vaccinating millions of people must not be part of the decision-making process (whether or not such a huge resource transfer can possibly be supported for such a small disease burden).
3. The WHO should continue to act with transparency, as the public has an absolute right to know what they are paying for, and the harm (and perhaps benefit) they can expect from it.
The number of Mpox deaths will rise as more are infected, and perhaps as some suspected cases are confirmed. However, we are facing a small problem in an area with far larger ones. It is posing low local risk and minimal global risk. It is not a global emergency, by any sane, rational, public health-based definition.
The rest of the world can respond by sending vaccines and lots of foreigners who need looking after, diverting local health and security personnel and almost certainly killing more DRC residents overall. Or, we can recognize a local problem, support local responses when local populations ask, and concentrate, as the WHO once did, on addressing the underlying causes of endemic disease and inequality. They are the things that make the lives of people in DRC so difficult.
About the Author
David Bell, Senior Scholar at Brownstone Institute, is a public health physician and biotech consultant in global health. He is a former medical officer and scientist at the World Health Organization (WHO), Programme Head for malaria and febrile diseases at the Foundation for Innovative New Diagnostics (FIND) in Geneva, Switzerland, and Director of Global Health Technologies at Intellectual Ventures Global Good Fund in Bellevue, WA, USA.
Two Storms, One Harvest
Every food crisis in living memory has been a one-shock event. The 2008 price spike was a commodity bubble. The 2020 shortages were a logistics failure. The 2022 grain scare was a war on one exporter’s ports. Each time, the system bent, adjusted, and recovered, and each time the experts assured us afterward that global markets are simply too big and too diversified to fail.
What nobody in Washington seems eager to discuss is that 2026 is shaping up to be something the modern food system has never actually faced. Two independent shocks, one climatic and one geopolitical, are converging on the same harvest cycle at the same time. Not sequentially. Simultaneously.
Start with the weather. The Pacific Ocean is currently building toward what forecasters now openly call a record event. NOAA’s Climate Prediction Center puts the odds of at least a strong El Niño near 88 percent, with roughly two in three odds it reaches “very strong” status, the tier reserved for perhaps three or four events in the entire satellite era. Every major global model now projects a median peak in Super El Niño territory, and most of them project it exceeding the 2015-16 event, which until now held the modern record. Sea surface anomalies were already brushing the super threshold in mid-July, months before these events normally peak. The atmosphere has already shifted into El Niño mode, and the event is forecast to crest in late fall and early winter.
This is not about “climate change.” It’s about the standard cycles of weather, and the cycle we’re currently in is one that has likely devastated societies in the past. We’re better prepared as a society today, but not all Americans are equally prepared.
Serious households have started doing the quiet math on their own. Grocery bills tell part of the story, and the forecast maps tell the rest, which is why long-term food storage has moved from fringe hobby to mainstream line item in the family budget, with established suppliers like Heaven’s Harvest seeing demand from people who five years ago would have rolled their eyes at the idea. That instinct is not paranoia. It is pattern recognition, and the pattern is worth walking through carefully.
Editor’s Note: Heaven’s Harvest IS a sponsor, but the warnings of this article are real and would be written even if we didn’t have a survival food sponsor. With that said, those who take advantage of what they offer can use promo code “Patriot” for 15% off.
The Fertilizer Clock Is Already Running
While the Pacific warms, the second shock has been unfolding in the Strait of Hormuz. The conflict with Iran turned the world’s most important energy chokepoint into a contested waterway, and the consequences reach far beyond the gas pump. Roughly a third of global fertilizer trade moves through Hormuz, and the disruption sent urea prices up 86 percent year over year by March, with a 53 percent jump in a single month.
The World Bank projects energy prices rising about 24 percent in 2026 and fertilizer about 31 percent. By its own accounting, fertilizer prices ran 35 percent higher in the first five months of this year than the same period last year.
Here is the mechanism the nightly news will not explain. Fertilizer is not a grocery item. It is a time-delayed input. The nitrogen a farmer in Iowa or Punjab could not afford to apply this spring does not show up as a problem this spring. It shows up as a thinner harvest six to twelve months later.
The World Bank’s own food security brief concedes that the effects of reduced applications earlier this season “are likely to become visible only later in harvest outcomes.” Translate that from institutional language into plain English and it means this. The damage is already done, it is already in the ground, and we are simply waiting for it to arrive on the shelf.
Now check the calendar. Six to twelve months from the spring planting season lands us squarely in late 2026 and early 2027. Which is precisely when the strongest El Niño in the instrumental record is forecast to peak, bringing its signature droughts to Southeast Asia, Australia, southern Africa, northern Brazil, and South Asia, the very regions that grow the world’s rice, sugar, and oilseeds.
The World Bank warns openly that a strong El Niño “could disrupt multiple crop belts simultaneously” on top of the conflict-driven input costs. Their baseline projection assumes the Middle East disruptions ease by autumn. What in the last two years of Middle East history suggests that assumption is safe?
The System Has No Slack Left
The comfortable answer is that global markets always adjust. But adjustment requires slack, and the slack is gone. Global cereal production is expected to decline from last year’s records even before El Niño does its work. The UN World Food Programme, hardly a den of right-wing preppers, is calling this the most significant disruption to its supply chains since Covid and the invasion of Ukraine, and its supply chain director put the stakes bluntly.
Today’s supply chain challenges are tomorrow’s hunger crisis.
There is also a political dimension that markets cannot price. When food gets scarce, governments do not behave like economists. They behave like politicians. Export bans, hoarding mandates, and panic buying at the national level turned the modest rice shortfall of 2008 into a global crisis, and analysts are already warning that import-dependent nations are the first dominoes.
The 2015-16 Super El Niño, a far weaker event than what is now forecast, threw tens of millions into food stress across Africa and Asia. This one is projected to be stronger, and it arrives with fertilizer already rationed by price and shipping lanes already contested by missiles.
What Joseph Knew
Scripture does not treat preparation for lean years as faithlessness. It treats it as wisdom delivered in advance to those willing to act on it.
Behold, there come seven years of great plenty throughout all the land of Egypt: And there shall arise after them seven years of famine; and all the plenty shall be forgotten in the land of Egypt.
Joseph did not respond to that warning with a hashtag or a committee. He stored grain during the years of abundance, and when the famine came, Egypt stood while its neighbors begged. The lesson is not that famine is certain. It is that the time to prepare is precisely when preparation still looks optional.
Nobody who filled a pantry in a year of plenty has ever regretted it, and nobody standing in an empty aisle has ever been glad he waited for certainty.
None of this calls for panic, and panic is the enemy of sound judgment anyway. It calls for the same unglamorous prudence our grandparents considered ordinary. Keep some cash margin, know your local growers, and put real food in deep storage while it is cheap and available, because the entire arc of this story is that cheap and available is a closing window.
Families looking for a straightforward place to start can visit Heaven’s Harvest and use promo code Patriot for 15 percent off long-term storable food. The forecasts may yet soften, the strait may yet reopen, and we should pray they do. But hope is a fine thing to hold and a foolish thing to eat.
