US could lose battle against monkeypox, scientists say
Longstanding weaknesses in the public health system give the virus a chance to take hold.
As epidemics spread, the monkeypox outbreak should have been relatively easy to quell. The virus only spreads effectively through intimate contact, and tests and vaccines were at hand even before the current outbreak.
Yet the response to states United States has been slow and coy, recalling the early days of the Covid pandemic, experts say, raising troubling questions about the country's preparedness for pandemic threats.
The first cases of monkeypox were reported in May, but testing will not be readily available until this month. Vaccines will be scarce for months yet. Surveillance is spotty, and the official case count is likely a gross underestimate.
There are already at least 700 cases in the United States, but experts say that the actual number is likely to be much higher. There will likely be many more infections before the outbreak can be controlled, if at this point it can be controlled at all.
"Why is it so difficult for something that's even a known pathogen?" asked Anne Rimoin, an epidemiologist at the University of California, Los Angeles, who first warned of monkeypox outbreaks more than a decade ago. "How many more times will we have to go through this?"
With increased travel and trade, new pathogens will appear more frequently, said Dr. Rimoin: "We've been pressing the snooze button on emerging diseases for decades. The alarm goes off and it's time to wake up. “
Barriers to preparedness are systemic, at all levels of government, rather than because of any one individual or one,” said Dr. Rimoin and other experts.
Even as the coronavirus pandemic enters its third year, the public health system in the United States remains a crippled patchwork, a bureaucracy underfunded apparently unable to act quickly and forcefully. Its shortcomings have persisted for decades, across many administrations.
The United States estimated in 2010, for example, that in the event of a bioterrorist attack, 132 million doses of a smallpox and monkeypox vaccine would be needed for those who cannot safely take an older generation vaccine with serious side effects. Yet two months into the current outbreak, the strategic national stockpile contains only 64,000 doses.
The situation "reveals the failure of the United States to take public health seriously," said Zain Rizvi, who studies access to medicines at advocacy group Public Citizen. "Do we sometimes run out of fighter jets?"
It is often unclear which agency is ultimately responsible for a particular aspect of the answer. The National Strategic Stockpile used to fall under the Centers for Disease Control and Prevention, for example. The Trump administration turned it over to another agency, but the C.D.C. still decides who gets vaccinated and when.
State and county health departments often set their own rules and priorities, sometimes at odds with guidelines federal. "The machine is so ossified," said Gregg Gonsalves, an activist and epidemiologist at the Yale School of Public Health. The "house is on fire, and it's like everything is moving at normal speed."
Longstanding weaknesses in the public health system give the virus a chance to take hold.
As epidemics spread, the monkeypox outbreak should have been relatively easy to quell. The virus only spreads effectively through intimate contact, and tests and vaccines were at hand even before the current outbreak.
Yet the response to states United States has been slow and coy, recalling the early days of the Covid pandemic, experts say, raising troubling questions about the country's preparedness for pandemic threats.
The first cases of monkeypox were reported in May, but testing will not be readily available until this month. Vaccines will be scarce for months yet. Surveillance is spotty, and the official case count is likely a gross underestimate.
There are already at least 700 cases in the United States, but experts say that the actual number is likely to be much higher. There will likely be many more infections before the outbreak can be controlled, if at this point it can be controlled at all.
"Why is it so difficult for something that's even a known pathogen?" asked Anne Rimoin, an epidemiologist at the University of California, Los Angeles, who first warned of monkeypox outbreaks more than a decade ago. "How many more times will we have to go through this?"
With increased travel and trade, new pathogens will appear more frequently, said Dr. Rimoin: "We've been pressing the snooze button on emerging diseases for decades. The alarm goes off and it's time to wake up. “
Barriers to preparedness are systemic, at all levels of government, rather than because of any one individual or one,” said Dr. Rimoin and other experts.
Even as the coronavirus pandemic enters its third year, the public health system in the United States remains a crippled patchwork, a bureaucracy underfunded apparently unable to act quickly and forcefully. Its shortcomings have persisted for decades, across many administrations.
The United States estimated in 2010, for example, that in the event of a bioterrorist attack, 132 million doses of a smallpox and monkeypox vaccine would be needed for those who cannot safely take an older generation vaccine with serious side effects. Yet two months into the current outbreak, the strategic national stockpile contains only 64,000 doses.
The situation "reveals the failure of the United States to take public health seriously," said Zain Rizvi, who studies access to medicines at advocacy group Public Citizen. "Do we sometimes run out of fighter jets?"
It is often unclear which agency is ultimately responsible for a particular aspect of the answer. The National Strategic Stockpile used to fall under the Centers for Disease Control and Prevention, for example. The Trump administration turned it over to another agency, but the C.D.C. still decides who gets vaccinated and when.
State and county health departments often set their own rules and priorities, sometimes at odds with guidelines federal. "The machine is so ossified," said Gregg Gonsalves, an activist and epidemiologist at the Yale School of Public Health. The "house is on fire, and it's like everything is moving at normal speed."
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