How the CDC and Public Health Agencies Dropped the Ball on Monkeypox’s Response

Editor’s note, August 5, 11:45 a.m.: This article was originally published on July 29, 2022, before the United States declared monkeypox a public health emergency. The following story was updated on August 5 to reflect this statement.

Monkeypox has come a long way since the first human case was diagnosed in the Democratic Republic of Congo in 1970. In the decades that followed, the virus was mostly contained in a handful of African countries, only to break out this year in Europe and more and more. in the United States, with more than 26,000 confirmed cases in more than 80 countries.

On August 4, as efforts to contain the virus failed, the United States declared the outbreak a public health emergency. Health and Human Services Secretary Xavier Becerra told reporters the move signifies the administration is “ready to take our response to the next level to fight this virus.”

Despite this announcement, it is important to understand that monkeypox is not a worst case virus. If anything, it’s close to a best case scenario virus — at least in terms of controllability.

First, we got endless warnings that this was going to be a problem. As global immunity to smallpox waned – a closely related virus that also confers immunity to monkeypox – Nigeria has seen increasing cases of monkeypox, with outbreaks in recent years numbering in the hundreds. of patients. The United States experienced and contained a minor outbreak of monkeypox in 2003. It was not a virus that appeared out of the blue; it was on any list of disturbing viruses that surrounded and sometimes struck humans.

But nobody was too worried because monkeypox is not very contagious and has an effective vaccine. Although what is currently active is probably a new variant, which spreads more easily through very close contact with infected people, it is still not as contagious as a respiratory virus like Covid-19 can be. That means public health basics like contact tracing and ring vaccination of at-risk populations should have been more than enough to stop it.

Monkeypox was disease containment on easy mode, yet it seems very likely that we won’t be able to contain it, with over 7,100 confirmed and counting cases in the United States only. In doing so, we are accelerating many of the errors that were characteristic of our Covid response, which clearly shows that we have learned very little.

Some of the most egregious mistakes have been in communication, where people get sick because they are reluctant to tell them they are at higher risk.

Our troubled response to monkeypox

The way to contain a low-contagious disease for which a good vaccine exists goes something like this: make sure everyone knows the disease is spreading, identify who is most at risk, and make sure they can access care health if they have any. Test extensively, and when you find a case, contact the trace.

This means relentlessly seeking out people the sick person has been in close contact with and encouraging them to get tested as well. For some diseases with a long incubation period and an immediately effective vaccine, you can even vaccinate close contacts and thus prevent them from getting sick.

The American response to monkeypox is collapsing on almost all of these fronts. First, the tests: too often doctors tell people with symptoms of monkeypox that they shouldn’t be tested, or tests are delayed to the point of being almost useless because of the rules that the The sample for testing should be taken from a lesion, which may develop late in the course of the disease.

Then the vaccines: As a New York Times article revealed last week, 300,000 doses of monkeypox vaccine sat in Denmark for the better part of a month because the United States didn’t had not yet placed an order, even as those at risk struggled to access vaccination appointments. . The US government eventually purchased those doses overseas, but at this point it has shipped just over 600,000 doses, well below the 1.6 million that would cover those the CDC identifies as most at risk. Given this delay, the window to completely contain monkeypox has probably already closed.

Finally, as Jerusalem Demsas wrote for the Atlantic, our public health officials have replicated the failures of Covid in another crucial way: being too preoccupied with managing public opinion to provide the public with information precise about the situation.

A communication failure

According to an international study last month in the New England Journal of Medicine, 98% of documented cases have been found in gay or bisexual men. Although the disease is not a sexually transmitted infection like syphilis, which is spread almost exclusively through sex, transmission of monkeypox requires close physical contact and sex appears to be a major opportunity for the virus – 95% of documented transmissions in the study occurred during sexual intercourse.

Due to the lack of testing, it is difficult to say precisely what the share of monkeypox cases in the United States is in the population of men who have sex with men. And health officials rightly want to avoid spreading the false message that monkeypox can only spread through sex or among gay and bisexual men, lest we run out of cases in other populations. There are concerns that people have been turned away from testing for monkeypox under the impression that it is a ‘gay disease’ and that others may refuse to seek treatment because they fear being suspected homosexuals.

But there is no doubt that the current approach puts gay and bi men at risk and does not meet the needs of this community or any other.

And while it may seem obvious that the best way to serve the population of men who have sex with men is to provide them with truthful information, high-quality health care and priority access to vaccines, agencies public health agencies too often fail to communicate this clearly.

We can handle the truth

Many public health officials have instead pointed out that anyone can get monkeypox, a message that LGBTQ+ health journalist Benjamin Ryan called in The Washington Post “so blatantly misleading that it amounts to disinformation”. While it’s technically true that anyone can get monkeypox, some people are at very high risk – and they deserve to know about it.

In New York, as the city’s monkeypox outbreak spiraled out of control, medical professionals working there fought over whether to advise people to avoid anonymous sexual encounters in order to reduce disease risk. Instead, in an effort to avoid stigma against gay and bisexual men, the city’s public health department has issued advice on covering wounds and avoiding kissing if you have sex while you have monkeypox. As some physicians in the department have argued, this is not valid medical advice.

The shadow of the abysmal public health response to HIV hangs over any effort to advise on another epidemic that at this point appears to be spreading primarily among gay and bisexual men.

But the way to avoid the mistakes of HIV is not to say nothing or give poor medical advice to sway public opinion. It’s moving mountains to make vaccines available, while speaking clearly and simply about high-risk populations and advising sick people to avoid high-risk activities.

The WHO, at the very least, seems to be learning its lesson – last week WHO Director General Tedros Adhanom Ghebreyesus urged men who have sex with men to at least temporarily consider reducing their number of partners to protect themselves and limit the spread of monkeypox.

During Covid, we tried the approach where public health officials tell partial truths and limit information in an effort to reduce stigma or get better behavior from the public. What we’ve learned is that it doesn’t work. People don’t like to be manipulated and they turn to unofficial sources if they think the official forces don’t make it clear.

Public trust is a scarce and precious resource. Our plans to fight stigma, avoid panic, and educate the public must build that trust, not squander it, or we will be crippled when we need our institutions the most.

A version of this story originally appeared in the Future Perfect newsletter. Sign up here to subscribe!