After decades without cases, Nigeria experienced a large monkeypox outbreak starting in 2017 that continues to this day. Prior to this year, that outbreak spread beyond Nigeria’s borders eight times, with infected people traveling to the United States, the United Kingdom, Israel, and Singapore.

Chikwe Ihekweazu, the former director general of the Nigeria Centre for Disease Control, said his country sought help to try to decipher what was going on with monkeypox. But the requests didn’t get much traction.

As such, some critical questions about monkeypox — including the true case fatality of the West African clade of the virus, the one circulating now, as well as how many people, on average, each infected person transmits to — remain unclear.

“There wasn’t a lot of interest to support that work until now — sadly,” said Ihekweazu, who was recently named to head the World Health Organization’s new Berlin-based hub for pandemic and epidemic intelligence. “It never really received the interest it needed to answer some of these questions.”