US monkeypox response draws criticism

The public health response to the monkeypox outbreak in the United States has so far failed to prevent significant community spread of the disease, leading to calls for a reassessment of the strategy to contain it.

Since the outbreak’s first reported US case on May 17, the number of infections has climbed to over 5,000, with the majority occurring in men who have sex with men.

Although reporting of case numbers is scattered across different agencies, the US appears to be responsible for more than 25% of the global cases identified during the current outbreak, which the World Health Organization has classified as a “Public Health Emergency of International Concern”.

“You have to act fast”

Infectious disease experts were dismayed by what they saw as a lack of urgency from US public health officials in the early weeks of the outbreak.

“What I expected would have been a more forceful type of response based on the lessons we’ve learned from…COVID-19 as well as the lessons we’ve learned from the HIV response,” Dr. Wafaa El-Sadr, Founder and Director of ICAP at Columbia University Mailman School of Public Health, to VOA.

“The most important thing in an outbreak is to act quickly, mobilize and … you need to get all your resources together to work together really quickly to be able to do what is needed,” El-Sadr said.

In the face of criticism in late June, the White House announced the so-called “phase one” of a national monkeypox vaccine strategy that “is designed to help contain the spread of the virus immediately by making vaccines available to high-risk individuals nationwide.” The government said it would “roll vaccines quickly in the hardest-hit communities and stem the spread of the disease.”

Similar to smallpox

The monkeypox virus is in the same family as the deadly smallpox virus, but infections with the disease are usually much less severe and rarely fatal.

The disease typically presents with fever and body aches, followed by skin lesions that can appear anywhere on the body but are often found on the face and hands.

Although the disease is rarely fatal, the skin lesions can cause severe pain that lasts for several weeks.

International Reach

According to the World Health Organization, during the recent outbreak, diagnosed new cases of monkeypox were concentrated in Europe and North America, with more than 14,000 reported in the WHO European Region and nearly 6,800 in North America.

In contrast, there are far fewer cases in other regions tracked by the WHO. The agency’s African region has reported just 328 cases, and numbers are far lower in the western Pacific region (65th), the eastern Mediterranean region (26th) and the Southeast Asian region (6th).

It should be noted that case numbers are affected by countries’ ability to test and report active cases of monkeypox, meaning that in some developing countries the numbers reported to WHO may be under-reported.

More manageable than COVID

Monkeypox is the kind of disease that the US public health infrastructure should be able to combat effectively.

First, because it spreads primarily through close skin contact, it is far less contagious than the airborne virus that causes COVID-19.

In addition, effective tests are available to diagnose the disease, as well as a vaccine to prevent infection. There is also a highly effective treatment for infected individuals.

However, the public health response in the US has so far failed to fully capitalize on the opportunity to combat monkeypox.

In a July 15 letter to senior public health officials, including Health Secretary Xavier Beccera and CDC Director Rochelle Walensky, a group of doctors and activists complained, “Several unnecessary regulatory barriers to treatments, diagnoses and vaccines have people on it.” prevented the United States from accessing medical countermeasures needed to protect its health, thereby allowing the further spread of the monkeypox virus.”

delays and confusion

Although there are tests that can reliably identify cases of monkeypox, only laboratories affiliated with the Centers for Disease Control were authorized to perform them during the first few weeks of the outbreak, leading to significant backlogs in testing. They have since been made available to several large commercial laboratory chains, but the initial delay may have contributed to the early spread of the disease.

Although there is an effective monkeypox vaccine, US officials did not order new doses to expand the country’s limited supply until June, the month after the disease began to spread. In addition, U.S. regulators didn’t approve the use of a facility in Denmark where the vaccine is made until mid-July.

While the drug tecovirimate is known to be highly effective against smallpox and has also been successful against monkeypox, early in the outbreak the CDC required doctors to go through a cumbersome application process for each patient, which significantly slowed the drug’s distribution.

“Public Health Failure”

In a stunning op-ed published on the New York Times On Saturday, former Food and Drug Administration Commissioner Dr. Scott Gottlieb: “Our country’s response to monkeypox has been plagued by the same deficiencies that we had with Covid-19. If monkeypox now takes a permanent foothold in the United States and becomes an endemic virus to join our circulating repertoire of pathogens, it will do so not only because of the pain and dangers of the disease, but also because of one of the worst public health lapses in the world be modern because it was so avoidable.”

He continued: “Our mistakes extend beyond political decision-making to the authorities tasked with protecting us from these threats. We don’t have a federal infrastructure capable of handling these emergencies.”

CDC Director Rochelle Walensky has questioned criticisms of Gottlieb in the past. In early July, she said in a statement to CNN: “It is true that we still have work to do here and internationally and we are likely to see more monkeypox cases in the near future, but it is possible to significantly reduce the number of cases and contain the disease.” current monkeypox outbreak through education and increased testing and access to vaccines – all priorities on which we have made dramatic progress.

The CDC has made efforts to support case identification and contact tracing, as well as testing and “case confirmation” nationwide. In addition, the agency has expanded its outreach to medical professionals to help them identify cases of monkeypox and expanded its efforts to communicate information about the disease to the public, particularly to the most vulnerable populations.

CDC researchers are also studying the nature of the disease, including exactly how it is transmitted and the typical course of the disease once a person is infected.

On a global level, the CDC reports that it shares information with other countries to coordinate a global response to the virus. This includes working closely with the Nigerian government to attempt to sequence the virus’s DNA to better understand how it evolved.

window closes

Columbia University’s El-Sadr told VOA that while she is concerned about the response to the disease so far, she believes there is still a way to get it under control.

“We already have enough tools,” she said. “If only we could mobilize, communicate and leverage these tools, I think we would have a chance to stop this outbreak. But the window of opportunity is closing very quickly when it comes to outbreaks, so urgent urgency is needed.”

Failure, she said, could leave the US with the prospect of monkeypox becoming endemic in the country, meaning it would remain at a steady level in the country even if no more infected people arrived from other countries.