On May 18, the first case of monkeypox in the United States was diagnosed in Massachusetts. By Aug. 12 the number of US diagnoses of the rare virus had risen to more than 11,000 with cases present in every state except Montana and Wyoming. Most US experts believe that there are far more cases than those that have been diagnosed due to limited access to testing and a reluctance by many individuals to seek care because of stigma-related concerns about the disease. Such concerns range from the presence of unsightly lesions on the face and/or trunk and anal sores to monkeypox’s association with same-sex sexual encounters.
Surprisingly, public health officials and political leaders have responded to monkeypox by repeating nearly every mistake they made in 2020 with COVID-19: limited access to testing, inefficient management of vaccines, administrative roadblocks to accessing treatment, and poor communication with the public.
The lack of urgency in the federal government’s response combined with monkeypox’s impact on gay and bisexual men also hearkens back to the neglect shown by local, state, and federal leaders in the early days of AIDS.
As a result, the country is experiencing yet another public health disaster that could have — and should have — been avoided.
We can’t undo what’s been done. But moving forward, the government can take action to contain what is on the verge of becoming an endemic infection among gay and bisexual men:
Radically expand testing options for monkeypox. As was the case with COVID-19, federal officials originally restricted testing to the Centers for Disease Control and Prevention’s own laboratory rather than permitting commercial laboratories to develop and scale testing. In mid-July, the CDC announced that commercial laboratories would begin testing for monkeypox. But there is yet no at-home testing option, it remains difficult to schedule a test, and obtaining results can take days. Meanwhile, the CDC is still recommending that tests must be done on swabs from lesions. The CDC and the Food and Drug Administration should facilitate the development of diagnostic testing that is less invasive and can be deployed prior to patients developing painful lesions.
Lower barriers to treatment for monkeypox. Unlike the early days of COVID-19 and the AIDS epidemic, the federal government knows that the antiviral medication tecovirimat, also known as TPOXX, is an effective treatment for monkeypox. Yet the FDA has not approved TPOXX as a treatment. Clinicians who wish to prescribe it to patients must enroll them in a treatment protocol, which requires the completion of detailed and complex paperwork that can take up to five hours to fill out. An emergency use authorization for TPOXX could alleviate this burden.
Prepare now to vaccinate the 1.5 million gay and bisexual men at elevated risk as quickly as possible. The federal government’s mismanagement of vaccine distribution and access has been well documented. It is playing catchup in ordering available vaccines and manufacturing additional supplies. Meanwhile, anecdotal stories abound of gay men traveling to Canada to get vaccinated. First, there needs to be massive investment in ramping up vaccine manufacturing. US Senator Kristen Gillibrand of New York has rightfully called on the Biden administration to invoke the Defense Production Act.
While the nation waits for supply to catch up with demand, local and state public health officials should proactively partner with community-based organizations, online dating apps, and managers of institutions where monkeypox can be easily transmitted, such as prisons and congregate living facilities, to distribute vaccines as quickly and efficiently as possible once they are available.
Unlike the early days of COVID-19 and AIDS, when the monkeypox outbreak emerged, the federal government had every tool at its disposal to contain it: diagnostics, vaccines, treatment, and research on the virus dating back to the 1970s. Yet it failed to effectively utilize this knowledge or these tools.
As monkeypox continues to spread through the dense social and sexual networks of gay and bisexual men, the risk that the disease will become an endemic infection among gay and bisexual men and others rises daily.
The declaration by Health and Human Services Secretary Xavier Becerra earlier this month that monkeypox is a public health emergency is welcome. Congress must appropriate emergency funding to support the beleaguered health system’s efforts to contain the outbreak. Emergency use authorizations could enable more testing options, ramped up vaccine production, and easier access to treatment.
Finally, President Biden could speak to the nation about the importance of coming together to defeat this virus here in the United States and in Africa, where people have been suffering and dying of it for more than 50 years.
The initial failures in our response to monkeypox do not have to define our actions moving forward. There is still time to act.
Sean Cahill is the director of health policy research at The Fenway Institute. Dr. Kenneth H. Mayer is medical research director at Fenway Health and co-director of The Fenway Institute.