From a superficial research pass, it sounds like smallpox vaccine confers cross-immunity, which sets a pretty low limit to how bad this can get.
We all remember in the first days of COVID-19, when public health institutions denied that there was human-to-human transmission, and it turned out that it not only had human-to-human transmission it also had a very large R0 and a short serial interval. But I think the belief that new diseases start out with low transmissibility is actually correct; COVID-19 was an exception not because of bad luck, but because it was a lab escape of a virus which had been pre-evolved to spread in hACE2 laboratory species. That factor is unlikely to apply to monkeypox in this case, since it has known animal reservoirs and at least one known prior zoonotic transmission.
From a superficial research pass, it sounds like smallpox vaccine confers cross-immunity, which sets a pretty low limit to how bad this can get.
We all remember in the first days of COVID-19, when public health institutions denied that there was human-to-human transmission, and it turned out that it not only had human-to-human transmission it also had a very large R0 and a short serial interval. But I think the belief that new diseases start out with low transmissibility is actually correct; COVID-19 was an exception not because of bad luck, but because it was a lab escape of a virus which had been pre-evolved to spread in hACE2 laboratory species. That factor is unlikely to apply to monkeypox in this case, since it has known animal reservoirs and at least one known prior zoonotic transmission.