Is Southeast Asia and the Western Pacific ready for potential monkeypox virus outbreaks?

The new variant of the monkeypox virus (MPXV) clade Ib has recently spread to other African countries outside the Democratic Republic of the Congo (DRC), prompting the World Health Organisation to declare the outbreak as a public health emergency of international concern (PHEIC). This comes just two years after the initial PHEIC that was issued for the clade IIb outbreaks. Compared to the clade IIb outbreaks, clade Ib shows a demographic shift, including higher case fatality rates for younger individuals, indicating a possibility of additional transmission pathways through heterosexual and household contacts. Given that many countries in the Western Pacific (WPR) and the Southeast Asian region (SEAR) hold a disproportionate burden of endemic infectious diseases and have difficulties engaging key at-risk populations, an outbreak of the potentially more virulent clade Ib virus could have devastating impacts on the health care systems. Thus, strategy planning against the potential emergence of clade Ib MPXV in the regions is required, including surveillance systems for detection, modelling studies to perform risk assessments, implementation of non-pharmaceutical interventions, and vaccination, and regional collaboration to ensure equitable distribution of vaccinations.