How We Can Fight Monkeypox Effectively
Controlling this outbreak is a steep challenge. We must be clear about how the virus spreads and who is at highest risk.
Even as Covid-19 continues to mutate and spread, much of the world is now facing outbreaks of another disease threat that no one expected to see: monkeypox. The United States declared monkeypox a public health emergency on Thursday, following the lead of the World Health Organization.
Globally, more than 26,000 cases to date have been diagnosed since May, more than a quarter of which have been reported from the U.S. Although no deaths from the virus have yet been reported in the U.S., Spain, India and Peru each recorded their first deaths during the past week.
The increased spread of monkeypox, including in countries where it hasn’t spread widely before, reveals a lot about this neglected disease, including its inaccurate and inappropriate name. “Monkeypox” is a misnomer (it doesn’t originate in monkeys) and many find the name to be stigmatizing. It really does need to change, and the sooner the better, but until it does I’ll use the name since that’s what people are most familiar with now.
As cases of the virus increase, it’s important to be clear about how we got here, how it spreads, and who is at risk of infection now. To contain this outbreak, we must act fast — and we must work together globally to find and stop health threats BEFORE they get out of control.
Unlike the novel coronavirus, which we hadn’t seen before it emerged, monkeypox has been spreading for more than three decades in Africa. Unfortunately, scientists’ warnings about the virus weren’t heard and they didn’t get the resources needed to better understand and stop it.
CDC has one of the world’s leading experts on poxviruses, and she has been traveling to Africa for years to try to learn how to curb outbreaks, but lack of funding held up the project. If we had addressed monkeypox then, we might well not be dealing with it now.
Based on what we’ve seen in this and past outbreaks, monkeypox is not nearly as transmissible as Covid. The data so far is clear. Close contact, including sexual and skin-to-skin contact, is the main driver of the current outbreak outside of Africa. This means it is circulating within social and sexual networks. But it could reach other populations, just as HIV did, and we need to stop the virus to protect the community it’s spreading in and prevent it from taking hold in vulnerable groups or new animal hosts and try to stop it from becoming endemic.
According to WHO, 98% of monkeypox cases have been among men who have sex with men, and those with multiple sex partners are at highest risk. A recent technical report from CDC echoes this data, finding almost all U.S. cases have been among men, disproportionately Black, Latino, and HIV positive men, and 94% of them reported sexual or close intimate contact with other men.
The CDC report, which includes demographic and transmission data as well as priority research questions, is great. I hope we’ll start seeing more briefings from them about this data, and that the media will highlight the actual risks of monkeypox to reduce fear and stigma.
Some have wondered whether the high proportion of cases in men who have sex with men is because of who we’re testing (or not testing). In the UK, test positivity remains high in men who have sex with men and low in other groups, such as women and children — indicating we’re likely not missing a lot of cases in those groups at this point. If the virus was easily able to spread via respiratory droplets or common touch surfaces, we’d likely see a much different demographic pattern of cases.
Although anyone can get monkeypox, not everyone is at equal risk. Failure to draw that distinction and focus our response effectively could make this outbreak much more difficult to contain.
The best way to keep people safe and to limit transmission now is to direct vaccines and treatments to the group at highest risk — men who have sex with men — and empower trusted messengers to communicate information and guidance. If the outbreak evolves, we’ll need to adjust our response and messages.
With monkeypox, we’re not starting from zero — we have knowledge and tools that can make an impact. So far, there haven’t been enough vaccines to meet the need, but commercial labs have increased test capacity and hundreds of thousands of doses of the Jynneos vaccine are said to be coming, though they may not be available for months.
We must work quickly to distribute vaccines, collect real-time data on effectiveness, communicate and engage stakeholders, and scale up production of vaccines around the world.
We must also make getting tools to outbreaks in Africa a priority. Countries on the continent should not be at the end of the line for tests, vaccines and treatments as they have been during the Covid pandemic.
Control of monkeypox would require:
- Rapid diagnosis, including a high index of suspicion by physicians
- Effective contact tracing to the extent possible
- Isolation of infectious people
- Vaccination of contacts and those in the social and sexual circles around patients.
Covid laid bare the weak state of public health in much of the country. We still need to fix data access, increase contact tracing capacity, strengthen community engagement, improve communication, and increase trust. These things take time.
The plain truth is monkeypox and Covid will not be the last health threats we see. Disease outbreaks happen frequently and we need to strengthen the ability of every country to rapidly detect and stop outbreaks. That’s why Resolve to Save Lives is partnering with countries to implement the 7–1–7 goal: Every new health threat detected within 7 days, reported with investigation begun within 1 day, and response fully in place within 7 days.
Although Covid and monkeypox are very different, both have revealed vulnerabilities in our public health emergency response systems and highlight the work we need to do to strengthen public health globally. We must stop the cycle of panic and neglect. Microbes outnumber us. Will we outsmart them?