Why hasn’t the U.S. been able to contain monkeypox?

As cases of monkeypox continue to rise in the United States, public health experts are beginning to question whether 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.

As of Friday there were 1,800 confirmed cases of monkeypox in the U.S., though experts say lack of testing capacity means the true spread of the virus is likely much wider. “I think the window for getting control of this and containing it probably has closed, and if it hasn’t closed, it’s certainly starting to close,” Scott Gottlieb, former commissioner of the Food and Drug Administration said on CBS’s “Face the Nation” on Sunday.

While some of the early challenges presented by the monkeypox outbreak echo the same major difficulties of the coronavirus pandemic, specifically limited availability of tests and vaccines, health officials say the comparisons between the two viruses only go so far.

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

Why there’s debate
Experts say even the worst-case scenario for monkeypox would look nothing like the catastrophic affects of the coronavirus, which has killed more than a million Americans and 6.3 million people worldwide. Still, many have expressed frustration that the U.S. has struggled to contain the current outbreak with so many tools at its disposal.

Sen. Richard Burr, R-NC., accused the Biden administration of “failing to learn from the devastating effects” of COVID and other recent infectious diseases when reacting to monkeypox. His criticisms mirror those of a number of public health experts who say the U.S. is repeating mistakes it made early in the pandemic by failing to scale up testing and vaccine capacity fast enough, waiting too long before mounting a serious response and allowing bureaucratic logjams to stand in the way of more proactive mitigation strategies.

Though anyone can get monkeypox, most cases of the current outbreak have been detected in men who have sex with men, a factor some believe may have contributed to a perceived lack of urgency around the virus. “Would monkeypox receive a stronger response if it were not primarily affecting queer folks?” San Francisco Supervisor Rafael Mandelman said in a speech last week. There are also concerns that the prominence of infections in gay men may lead members of other groups to lower their guard, creating more room for the virus to spread throughout the broader population.

What’s next

Federal and state health officials are working to expand availability of testing and vaccines, but it remains to be seen whether that effort can happen fast enough to block monkeypox from spreading to a point where it can’t ever be fully contained. If that happens, Gottlieb said, monkeypox may become a fact of life in the long term like a variety of other infectious diseases.

Perspectives
The U.S. has been flying blind without being able to measure just how widespread the virus is

“Monkeypox is unlikely to affect as many Americans as Covid-19. Nevertheless, an important lesson of the past decade of Covid-19, Ebola and Zika epidemics is that unchecked transmission means a virus will not stay limited to any one subset of the population and will lead to unpredictable health complications.” — Jay Varma, New York Times

As with COVID, the global response has been scattered and self-defeating

“We should all refuse to walk blindly, allowing the present to become prologue to greater catastrophe. Global health officials must advocate for and enact 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 cost the world millions of lives.” — Eric Feigl-Ding, Kavita Patel and Yaneer Bar-Yam, Washington Post

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