Gregg Gonsalves is an associate professor of epidemiology at the Yale School of Public Health and associate professor (adjunct) at Yale Law School. He is a 2018 MacArthur fellow.
At the start of June, there were nearly 800 confirmed cases in countries where the virus is not endemic, with just over a dozen recorded in the United States. There are now more than 15,000 cases globally and more than 2,000 in the United States.
Monkeypox is not a new disease. It was discovered in the early 1970s and for years has been well-described by researchers in West and Central Africa, where the disease has been present for decades. There are tests to diagnose it, vaccines to prevent it, treatments to ameliorate its symptoms and clinical course.
Yet instead of deploying all these tools with urgency in early June, we succumbed to overconfidence. Ashish Jha, the White House coronavirus response coordinator, said at the end of May that “this is a virus we understand.” He added that “it is spread very differently than SARS-CoV-2. It is not as contagious as covid. So, I am confident we’re going to be able to keep our arms around it.”
Now, many scientists fear we cannot contain monkeypox in the United States or around the world and that we are going to have to live with it for a long time. While this outbreak thus far has mostly affected men who have sex with men, it is possible it could begin spreading in settings where there is close, physical contact, which is how the virus is transmitted. Monkeypox, unlike smallpox, can also infect animals, providing new mammalian reservoirs for the infection, which also becomes a possibility as this current outbreak continues to grow.
How did we get here? First, the rollout of monkeypox testing has been conservative, initially routed through state health departments, even as experts begged for testing to be made more widely available through major commercial diagnostic companies. Next, one of the key vaccines against monkeypox — made by a small company in Europe — has been in short supply, far below the volume needed for a full vaccination campaign — even though the United States has dibs on most of the world’s stockpile.
But this isn’t the whole story. Even in the context of a vaccine shortage, it’s unclear whether the U.S. government is clearing barriers to expedite certification and shipment of existing supplies or has any interest in ramping up production. The public health advocacy groups PrEP4ALL and Partners in Health at the end of June sent a scathing letter to the White House about its failure to ramp up vaccine production. A month later, there is still little movement forward. Meanwhile, doctors are complaining about the burden of paperwork required to access U.S. stockpiles of key drugs to treat the infections.
This is not the nimble, effective response to a new viral threat that we need. It reeks of a lack of leadership at the highest levels of our government, a bureaucracy that even in an emergency cannot move with requisite speed, and agencies that are unable to coordinate with one another and in some instances do not even know what one another are doing. Someone has to shake some sense into the folks at 1600 Pennsylvania Ave., where the buck is supposed to stop on matters of national concern. This crisis requires the engagement of multiple federal agencies and close coordination with state and local officials.
The recent announcement that the White House has created a division within the Department of Health and Human Services that will focus on health disasters such as a pandemic offers no solace. The move makes the administration look like it’s in a bit of a political panic. Instead of fixing problems at the Centers for Disease Control and Prevention and the Food and Drug Administration, and giving them the resources they need to get the job done, the administration is giving the impression, rightly or wrongly, that it is passing a critical portfolio of responsibility to a new government entity in the midst of two epidemics.
Monkeypox has arrived in the United States at a moment when people are fatigued by covid-19, but that isn’t an excuse for resignation. This epidemic is taking shape in our country right now, and we have a real chance to beat it down and limit the damage it will cause. To borrow from Oscar Wilde, to lose the battle against one pandemic is a misfortune; to lose against two looks like carelessness.