Why has the US not been able to contain monkeypox?


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What is going on

As monkeypox cases continue to rise in the United States, public health experts are beginning to wonder if it’s too late to prevent the infectious disease — which has been endemic in parts of Africa for decades — from gaining a foothold in the U.S.

On Friday, there were 1,800 confirmed cases of monkeypox in the US, although experts say a lack of testing capacity means the actual spread of the virus is likely much greater. “I think the window to take control of this and contain it is probably closed, and if it’s not closed, it’s definitely starting to close,” said Scott Gottlieb, former Food and Drug Administration commissioner on TBEN’s “Face the Nation” on Sunday.

While some of the early challenges of the monkeypox outbreak reflect the same major problems of the coronavirus pandemic, most notably the limited availability of tests and vaccines, health officials say the comparisons between the two viruses only go so far.

Most importantly, monkeypox — while it can cause severe flu-like symptoms and debilitating pain — is rarely fatal. It’s not new either. Unlike COVID, which made scientists try to understand how it spread and how it can be treated, monkeypox was first documented in 1958. Monkeypox usually spreads through close, often intimate, physical contact, rather than through the air. There is also no need to wait months for vaccines to be developed. Vaccinations against smallpox helped eradicate the once devastating global disease and were also effective against monkeypox.

Why is there discussion?

Experts say that even the worst-case scenario for monkey pox is nothing like the catastrophic effects of the coronavirus, which has killed more than one million Americans and 6.3 million people worldwide. Still, many have expressed frustration that the US has struggled to contain the current outbreak with so many tools at its disposal.

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sen. Richard Burr, R-NC., accused the Biden administration of “not learning from the devastating effects” of COVID and other recent infectious diseases in responding to monkeypox. His criticism echoes that of a number of public health experts who say the US is repeating mistakes it made early in the pandemic by not scaling up testing and vaccine capacity fast enough, waiting too long before taking it seriously. respond and let bureaucratic blocks stand in the way of more proactive mitigation strategies.

While anyone can get monkey pox, most cases of the current outbreak have been detected in men who have sex with men, a factor that some say may have contributed to a perceived lack of urgency surrounding the virus. “Would Monkeypox get a stronger response if it didn’t hit queer people in the first place?” San Francisco Supervisor Rafael Mandelman said in a speech last week. There are also concerns that the awareness of infections in gay men could lead members of other groups to lower their vigilance, leaving more room for the virus to spread among the wider population.

What’s next

Federal and state health officials are working to expand the availability of testing and vaccines, but it remains to be seen whether that effort can happen soon enough to prevent monkeypox from spreading to a point where it can never be completely contained. If that happens, Gottlieb said, monkeypox could become a reality in the long run, as could a variety of other infectious diseases.


The US is flying blind without being able to measure how widespread the virus is

Monkeypox is unlikely to affect as many Americans as Covid-19. Nevertheless, an important lesson from the past decade of Covid-19, Ebola and Zika epidemics is that uncontrolled transmission means that a virus is not confined to a certain subgroup of the population and will lead to unpredictable health complications.” — Jay Varma, New York Times

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As with COVID, the global response is fragmented and self-destructive

“We must all refuse to walk blindly so that the present becomes the prologue to a greater catastrophe. Global health officials must advocate for a unified, coherent approach to fighting the monkeypox pandemic before it reaches the proportions of Covid-19. If we act, guided by the lessons of the past two years, we can avoid the mistakes that have cost the world millions of lives.” — Eric Feigl-Ding, Kavita Patel and Yaneer Bar-Yam, Washington Post

The right strategies are available, but leaders are unwilling to use them

“Government officials around the world have a responsibility to learn from the mistakes of the COVID pandemic and not to repeat them. The transcript of the past 2.5 years is right in front of them. Will they act in defense of public health, or will they once again surrender to their political acrobatics and be indifferent to human suffering? And are we as a world population treated like this by our governments?” — Muhammad Jawad Noon, Scientific American

The US will fail again and again until it builds a sustainable public health system

“The US is at a crossroads. … It could trigger an effective response to monkeypox and provide communities across the country with the infrastructure needed to advance health care for all. Or it can keep catching up with crisis after crisis, letting common infections rage in between.” — David C. Harvey, Stat

Allowing the virus to spread abroad made its arrival in the US inevitable

“Wealthy countries have ignored endemic monkeypox in West and Central Africa for far too long, despite having effective vaccines, which must be distributed equitably among the populations at risk worldwide. The crucial point is that all these efforts must take place now. We must stop underreacting to the world’s latest infectious disease threat.” — Monica Gandhi, The Atlantic

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Monkeypox is still manageable with the right strategies

“With any emerging pathogen, there is always a small chance of preventing small clusters of infections from spreading further. The United States has not done this for past epidemics, including HIV and COVID-19. Monkeypox should be a relatively easier virus to fight, but only if the United States takes the necessary steps now.” — Shan Soe-Lin and Robert Hecht, Boston Globe

Public readiness to respond to new virus has declined after years of battling COVID

“Some will certainly roll their eyes and skepticism will be high, higher than in the past when we talked about infectious diseases, but these are not reasons not to act.” — Michael Wilkes, KCRW

Monkeypox is a harbinger of much deadlier outbreaks to come

“The biggest concern for Americans isn’t the disease: it’s that our response to it shows how little we have learned from COVID-19 and how much remains to be done to mitigate the risks of future pandemics.” — Richard Danzig and James Lawler, Bloomberg

Many of the same logistical issues that hurt the COVID response have resurfaced

“The existence of a vaccine is just the beginning; rolling it out, deciding who needs it and where its own convoluted story is. That work must begin now, to stay ahead of a still-growing outbreak and to maintain confidence in vaccines and public health in general. The stakes are high.” — Melody Schreiber, The New Republic

Viewing monkeypox as a gay disease poses a danger to everyone

“The more I read and hear about monkeypox, the more I feel a little worse about how the media has anointed men who have sex with men as the biggest threat to our survival from monkeypox.” — John Casey, the lawyer

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Photo illustration: Yahoo News; Photos: Bill O’Leary/The Washington Post via Getty Images, Getty Images