The recent monkeypox outbreak caught the United States by surprise, forcing public health authorities to play catch-up and finally issue a road map, centered on scaling up testing and distributing effective vaccines to communities at the highest risk of infection, for confronting the outbreak. But the window of dealing with monkeypox is closing, according to some public health experts.
“We could have gotten control of this if we had been more aggressive up front,” former Food and Drug Administration Commissioner Scott Gottlieb said earlier this week. “I think the window for getting control of this and containing it probably has closed. If it hasn’t closed, it’s certainly starting to close.”
The proliferation of cases outside the African continent caught public health experts by surprise. CDC has reported nearly 5,200 cases as of Sunday, and the outbreak has reached all but three states: Montana, Vermont and Wyoming. Globally, since the early cases were detected, the virus has infected over 14,000 people in at least 60 countries.
“I, along with folks at the CDC and many others, really thought initially that we could get our arms around this infection very, very quickly by using standard public health techniques of case finding and contact tracing,” said Dr. William Schaffner, an infectious disease expert at the Vanderbilt University Medical Center. “However, just as with COVID, the virus threw us a curveball.”
Monkeypox infection typically causes pustules and lesions on the skin of the arms, hands, feet, face, and inside the mouth. But the most recent outbreak has resulted from a spread that more closely resembles a sexually transmitted disease. In most cases, the lesions have appeared in the genital area, making it difficult for doctors to discern whether it is monkeypox without widely accessible diagnostic testing.
The Centers for Disease Control and Prevention’s messaging around the outbreak, how the virus is spreading, and which community is most affected has ramped up in urgency in recent weeks. CDC Director Rochelle Walensky is urging a wide range of healthcare providers to be on high alert for symptoms that could indicate monkeypox infection but could be misdiagnosed, such as a sexually transmitted infection. But in an effort to reduce stigma against the LGBT community, the agency has failed to issue guidance about the outbreak in a straightforward way that most effectively conveys warnings about it to those most vulnerable, Schaffner said.
“Initial messages about the population affected, namely gay and bisexual men, was not clearly stated. … The public health admonitions about what one can do to limit your risk also were not clearly stated,” Schaffner contended. “This is very straightforward. Don’t go to big rave parties where you’re going to be out and about and have skin-to-skin contact, some of a more intimate nature than others, with a lot of people.”
“I understand not wanting to create stigma, but being evasive about the group that is most affected is not useful to the members of the group, nor is it useful to the larger population, and you begin to lose credibility,” he added.
Walensky maintained that the U.S. has not missed its window to combat the explosion of monkeypox cases in recent months effectively, calling Gottlieb’s comments “misinformed and off base.” The federal government is working to scale up national supplies of Bavarian Nordic’s two-dose Jynneos vaccine for orthopoxvirus, the family of viruses that includes monkeypox and smallpox, rapidly, but there are not enough doses of the vaccine for everyone who wants one.
The Biden administration announced last week that it has ordered an additional 2.5 million doses of the Jynneos vaccine, on top of a previous order for 2.5 million doses, which will bring the total number of doses available in the U.S. up to 7 million by mid-2023. The Department of Health and Human Services has already shipped out the shots ordered so far by states and jurisdictions where appointments for vaccinations are snapped up within a day of becoming available.
