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Reviews | The US response to monkeypox has failed to contain the disease

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Remember this? Shortage of vaccines. Long queues at clinics. The number of cases is increasing every day. A widespread terror, fear and suspicion in the public. The government announces that everything is under control but this is not the case. The covid pandemic and the monkeypox epidemic are quite different, but early responses revealed similar and worrying shortcomings. Once again America and the world are racing to catch up with a faster moving virus.

Monkeypox, an infectious disease that can cause excruciating pain but usually not death, is caused by a virus related to smallpox. In May, it first emerged outside parts of Africa where it is endemic and spread rapidly through the social networks of men who have sex with men. The time to contain monkeypox was at the start. The United States now has 7,102 cases out of a global total of more than 25,000 cases in countries that have not historically reported it. Monkeypox is spread through very close and prolonged contact, such as sexual intercourse, and can persist on surfaces in heavily contaminated areas, where many viruses have long spread. It is not a contagion like covid, but there is a real danger that it will get out of hand and spread to other populations.

Unlike in the early days of the coronavirus pandemic, effective vaccines exist against monkeypox, but the most suitable one, the two-dose Jynneos, has been lacking, largely due to a bottleneck of manufacturing, and will likely remain so for months. In a recent preprint, scientists from the Yale School of Public Health estimate that there are 498,000 high-risk gay men in the United States. Under ideal circumstances, they predict that the rapid distribution of vaccines to a third of them, along with increased testing and contact tracing, could support the containment. But that would require at least 329,000 doses, almost all of the 336,710 the government had shipped by July 29. The total high-risk and vulnerable population could be even higher, estimated at 1.7 million by Rochelle Walensky, director of the Centers for Disease Control and Prevention, on Thursday. More doses are on the way and government experts are investigating a dosing method using a shallow injection into the skin to stretch existing stores. But the virus is also spreading fast and it may well be too late to contain it. Recent emergency declarations from the Biden administration, New York, California and the World Health Organization underscore that the crisis is far from over.

In the United States, much of the public health burden falls on the states, and they are overwhelmed and chronically underfunded, with many still reeling from the pandemic. The Biden administration has told Congress that a monkeypox response could cost $7 billion, but so far Congress hasn’t voted even a penny of the latest covid response request, let alone responded. the crying need for a more effective and robust pandemic preparedness system. We seem stuck in a pattern of panic and neglect, too often declaring an emergency about a virus after it’s gotten out of hand, rather than getting ahead of it.

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