The gaps in the nation’s monkeypox response

As if one pandemic weren’t enough, the U.S. is now dealing with an outbreak of monkeypox, a smallpox-like virus that causes flu-like symptoms and painful lesions that crop up all over the body. And despite its learned experience from COVID-19, as well as a recent public health emergency declaration, the government’s response to the latest disease of note has been criticized as lackluster, confusing, and too little, too late. Though the virus is rarely fatal and there is a vaccine available, monkeypox patients have described feeling alone in their quest to find treatment, or even secure a shot in the first place. Meanwhile, an effective antiviral known as tecovirimat, or TPOXX, is “tied up in red tape,” Scientific American reports, prolonging patients’ suffering and compounding doctors’ woes.

Below, pundits and health experts tackle the pressing, underlying question as it relates to the current outbreak: Where are the gaps in the nation’s monkeypox response?

Preparedness and response aren’t the same thing

Interestingly enough, the U.S. was ranked No. 1 for pandemic preparedness in the 2021 Global Health Security Index — but that doesn’t mean it knows how to respond to an out-of-control virus.

You see, “there is a significant difference between preparedness and response, even though the two are often conflated,” mused CNN‘s Dr. Sanjay Gupta. But “[p]reparedness alone does not guarantee a rapid response.” In the instances of both COVID-19 and now monkeypox, “we were too slow to respond,” Gupta continued. “It was as if we [were] sitting in a turbo-charged Ferrari, capable of massive acceleration, but instead only idling in the driveway.” There is no doubt that the U.S. is prepared for another pandemic — “[t]he question is will we use all those remarkable resources and respond …?”

And infectious disease epidemiologist Syra Madad agreed: “The fact is that the US, and the world for that matter, is just bad at responding to infectious disease outbreaks,” Madad remarked, also for CNN. Our emphasis on preparedness, which Madad describes as “knowing that an outbreak will occur and trying to mitigate or lessen its impact,” over prevention, described as “stopping the outbreak from occurring in the first place,” is telling. “If I had a jar of coins for the number of times I’ve heard or read the term ‘pandemic preparedness,’ I’d be a rich person,” she continued.

Letting stigma rule?

At the moment, monkeypox is primarily affecting men who have sex with men, though if only for the closeness of the community rather than any sort of predisposition. In fact, health officials have taken care to stress that the virus can spread to anyone in close, skin-to-skin contact with an infected individual — not just members of this or that demographic. And yet “we’ve seen homophobic conspiracy theories spread almost more quickly than the virus itself,” argued Washington Post columnist Katrina vanden Heuvel. The pattern harkens back to epidemics past: “Viruses begin in a vulnerable population that people in power don’t feel is worthy of their attention and care. Infected people are stigmatized and their suffering is ignored, allowing the virus to spread.”

“Then, only once it’s affecting broader populations — and thus impossible to contain — do those in power take action,” vanden Heuvel continued, citing cholera, tuberculosis, and HIV/AIDS as examples. “Even COVID-19 was exacerbated by racist scapegoating,” she continued. Ultimately, “[a]ny effective response to an epidemic” — such as monkeypox — “has to begin with leaders stoking compassion and action, not fear or indifference.”

Reorganize the CDC

If we, for lack of trying, allow monkeypox into the United State’s rolodex of endemic diseases, “it will be one of the worst public health failures in modern times not only because of the pain and peril of the disease but also because it was so avoidable,” former FDA Commissioner Scott Gottlieb wrote for The New York Times. Still, it’s imperative we understand that “systemic failings” also fall on the bureaucratic agencies whose job it is to guide the nation through dilemmas of public health — i.e. the CDC.

“The CDC should lead America’s response to viral emergencies,” Gottlieb continued. “But the agency isn’t a crisis organization.” It lacks the infrastructure to respond quickly, but Congress won’t “take meaningful action” to change that. In the future, the Biden administration must “get the CDC back to its disease control roots, by transferring some of its disease prevention work to other agencies.” The CDC would then be free to focus on outbreak control, which could make all the more difference if and when another dangerous virus knocks on our door.

Scrutinize the treatments

Monkeypox has spread to the point that “experts now fear it’s no longer possible to keep the disease from becoming endemic among men who have sex with men,” wrote Bloomberg health care columnist Lisa Jarvis. This therefore increases the urgency of “understanding whether tecovirimat — an antiviral treatment approved for smallpox — works to speed recovery from monkeypox,” as well as its unexpected side effects, if any. 

But “the CDC is still not collecting data that could definitively demonstrate whether the drug actually works,” Jarvis continued. And a “well-designed clinical trial” could reveal a lot about efficacy, as well as make it easier for doctors to access and prescribe tecovirimat, which currently requires medical professionals to submit a cumbersome “investigational new drug” application.

“Monkeypox might not pose a COVID-level threat,” Jarvis concluded, “but the expansion of cases and the need to ease patients’ suffering calls for the same urgency in mobilizing studies.”

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