US stumbles in monkeypox response

BY JOSEPH CHOI - THE HILL - 07/11/22 7

The U.S. has had a faltering response to the monkeypox outbreak, with confirmed cases jumping to 700 in the two months since outbreaks were first detected and clinics across the country struggling to meet the demand for effective vaccines.

Some public health experts and patients say more needs to be done and warn that mistakes made during the COVID-19 pandemic are being repeated. 

The monkeypox virus is less infectious than COVID-19 and is so far mostly affecting one community: men who have sex with men. But the U.S. has learned lessons from the coronavirus pandemic that should still help the nation control monkeypox, experts say. 

Leana Wen, a research professor of health policy and management at George Washington University as well as Baltimore’s former health commissioner, told The Hill that she has felt a sense of déjà vu.

“Probably the most significant one to me is the lack of testing. We saw during COVID that every case that was found was like the canary in the coal mine, that they really were just the tip of the iceberg,” Wen said. “And that was because there was such little testing available. Why haven’t we learned our lesson?”

Last week, one of the largest laboratory testing networks in the U.S., Labcorp, announced it would begin testing for monkeypox using tests from the Centers for Disease Control and Prevention. The company will be able to conduct about 10,000 tests daily.

In its announcement, Labcorp recommended that people contact their health care providers to initiate monkeypox testing and sample collecting, a more cumbersome process compared to COVID-19 tests, especially for people who don’t have a regular health care provider.

Wen said monkeypox testing should not be made into a complex process, noting that performing the test itself is fairly simple: Monkeypox tests involve swabbing the base of the characteristic lesions that form after infection.

More than 760 monkeypox cases have been confirmed in the U.S. as of Monday across almost 40 states, which is almost certainly an undercount as many may be unaware that they are infected or have not yet been tested.

Unlike COVID-19, monkeypox is not a novel virus, it does not spread as easily and is largely transmitted through close, skin-to-skin contact. And although it is currently affecting relatively few people in the U.S., advocates and scientists worry this outbreak may spread out of control.

Jay Varma, an epidemiologist who served as senior health adviser to former New York City Mayor Bill de Blasio (D), said in a recent interview that he feared monkeypox could become entrenched in the U.S.

“If we don’t really get ahead of this, then we are going to fall further behind and it will become a permanent part of our disease landscape,” Varma said.

De Blasio himself urged the federal government to ramp up access to monkeypox vaccines on Twitter Monday. 

New York’s gay community has been particularly hard hit by the outbreak. The state Department of Health said in a tweet on Tuesday that 111 people had tested positive in New York City as of last week, up from 55 a week prior.

New York City Mayor Eric Adams (D) made note of the unmet demand for monkeypox vaccines in a letter he sent to President Biden on Monday. Adams asked that the White House consider a different vaccination schedule that allowed for a longer interval period between the two doses of the preferred smallpox vaccine Jynneos so that more people could be immediately immunized.

In an NBC News report published last week, several gay men who tested positive for monkeypox detailed exasperating experiences in communicating with public health officials when attempting to get tested and share their possible close contacts. One man in New York said it took nearly a week before he was able to get tested and possible contacts’ names.

Clinics in major cities like New York and Washington, D.C., have quickly run out of available vaccine doses. 

New York gave no warning before announcing its own vaccine push late last month, running out of doses within hours with no word on when more shots would be available. On Monday, the New York City Department of Health and Mental Hygiene announced that an additional 1,250 doses would be made available.

Health authorities maintain that monkeypox does not pose a threat to the general public, and the mortality rate for the virus is low.

Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, said that this recent monkeypox outbreak could very well be a sign of an “age of epidemics” that the world is entering.

“As people interact more and more with wild animals — whether it’s in wet markets as food or moving into their habitats because of population growth — we are going to see people get exposed more and more to exotic pathogens,” Toner said.

Overall, Toner said he felt that the response has been adequate considering the limitations, noting the inherent difficulties in measures like contact tracing as well as the swift manner in which the federal government deployed vaccines and placed orders for more.

“I don’t think that they have been slow. I don’t think it’s the case that they haven’t learned lessons from COVID-19,” he said.

Still others say that the response has not been as streamlined as it could be. One senior Biden administration official, speaking anonymously, acknowledged to The New York Times last week that monkeypox testing has not been as fast or convenient as it needs to be. Contributing factors included negotiations with labs, ramping up testing supplies and training personnel, according to the official.