Most Americans do not have to worry about contracting monkeypox right now. But we cannot discount the possibility that it becomes a broader threat. That’s why the World Health Organization was right to declare the disease a global health emergency and why containing it must be a top priority for the Biden administration.
Monkeypox is very different from the coronavirus. Unlike the coronavirus, which is an extremely contagious respiratory pathogen, monkeypox is primarily transmitted through prolonged skin-to-skin contact. You are highly unlikely to contract monkeypox by dining in the same restaurant or working in the same office as an infected person; transmission occurs through intimate contact such as hugging, kissing and sexual intercourse. Bed linens and towels used by someone with active lesions can also harbor the virus, making household members vulnerable to infection.
The nature of transmission means that monkeypox won’t spread like wildfire the way that covid-19 has. We also have a vaccine that works against monkeypox after someone has been exposed, which is not the case for the coronavirus. If you’ve been exposed to covid-19, there’s nothing you can do other than wait to test positive. But if you’re exposed to monkeypox, getting the vaccine — if done shortly after exposure — could prevent you from developing the disease.
Moreover, while the coronavirus spread rapidly across every demographic, monkeypox is still overwhelmingly limited to one group of individuals: men who have sex with men. The largest study of cases to date, published in the New England Journal of Medicine, examined 528 recent infections across 16 countries and found that nearly all of them — 98 percent — were gay or bisexual men. Ninety-five percent were linked to sexual contact.
As a result, those who should be on high alert for monkeypox are men who have sex with men and who have multiple or anonymous sex partners. Those eligible should seek the vaccine and try to reduce high-risk activities before vaccination. Clinicians should have a low threshold for testing for monkeypox. The study found that some patients presented with only a single lesion, often in the oral, anal or genital areas, and 29 percent were diagnosed at the same time with a sexually transmitted infection. That means monkeypox can look like herpes or syphilis and that having another infection doesn’t rule out monkeypox.
Those not in this high-risk group do not need to seek the monkeypox vaccine or change their daily lives to avoid this virus yet. But public health officials must urgently ramp up their efforts because an infectious disease that begins in one community almost certainly won’t stay there. Already, there are cases of monkeypox reported in women, though, due to the lack of timely data reporting to the Centers for Disease Control and Prevention, the exact numbers are unknown. At least two children in the United States have been diagnosed with monkeypox, including a toddler in California.
The CDC says these cases in women and children are all direct contacts of infected men who have sex with men. So far, no one in the United States has died from monkeypox, though some have been hospitalized and many reported extreme pain from their lesions.
We don’t know if these survival statistics will hold up if monkeypox spreads to the wider population. Based on the experiences of countries where the virus has been endemic, monkeypox is particularly dangerous in pregnant women and young children. It could also pose a significant threat to people with immunosuppression and other severe underlying medical conditions. Preventing this virus from taking hold and spreading broadly must be a top focus.
The Biden administration has said that it will procure many more monkeypox vaccine doses. This is important, though I worry that it won’t be able to obtain the number of shots needed quickly enough. While the CDC estimates that 1.5 million Americans are eligible, so far only 300,000 doses of the two-dose vaccine have been shipped. The CDC should prioritize first vaccine doses so more people can have some protection faster. To better ration limited vaccines, we also need to understand the degree of protection against monkeypox among older individuals who were previously vaccinated against smallpox.
Federal health officials must also broaden testing. Testing capacity has been steadily increasing, though it remains limited to symptomatic individuals who have active lesions. A preprint study from Belgium showed asymptomatic infections are possible, though we don't know if asymptomatic transmission can occur. The United States must institute broad screening of high-risk individuals to detect cases early, identify contacts and stop the chains of transmission with vaccination.
Unlike covid-19, which was a novel disease when it first arrived in the United States, monkeypox has been around and studied for decades. We have all the tools to stop this virus from becoming yet another serious illness that Americans have to contend with in perpetuity.