US Outbreak: How Monkeypox Spread in a Failed State

The new order of our times seems to be that everything must get worse. Because one plague was not enough, we’ve added another: monkeypox, a close relative of smallpox that causes flu-like symptoms and painful, pus-filled blisters. Making matters even worse, it’s spreading primarily in gay communities, giving new life to old bigotries and complicating public health messaging.

Formerly endemic to West and Central Africa, monkeypox is now circulating globally, including significant outbreaks in the US and Europe. As of August 1, the case count stands at some 30,000 worldwide and 6,000 in the US, though the numbers multiply daily. The disease spreads most easily by close physical contact, particularly with the rash or pus of an infected person, but may also be transmissible by air. Anybody can be infected, but the reported cases have overwhelmingly been in gay and bisexual men, who account for as much as 98% of the current outbreak, according to one study.

Last month, the World Health Organization declared monkeypox “a public health emergency of international concern.” Health officials are cautiously optimistic that we can still contain the outbreak if we act quickly and aggressively. However, in keeping with the American tradition of doing nothing until a problem is out of control and then doing less than the bare minimum, we are acting neither quickly nor aggressively.

President Biden has been contemplating for weeks whether to declare a national emergency. Taking this long to consider whether a situation is an emergency is almost comical. The whole point is to mobilize resources and stop the problem before it spreads. A small fire may not do much damage, but it gets bigger. New York, California, and Illinois, the states with the largest outbreaks, have declared public health emergencies.

Department of Health and Human Services Secretary Xavier Becerra told reporters, “We have done everything we can at the federal level.” Loosely translated, this means, “We haven’t done much of anything, nor do we plan to.” The federal government’s plan is apparently to leave the situation up to states and individuals.

Individual decisions do play a role in halting any disease. But relying on individuals alone, or on state and local health authorities, is not enough. Not everyone has the education they need to understand the risks, and access to vaccines and testing is dismal. By not taking swifter, more aggressive action, the federal government is leaving Americans at the mercy of states with fewer health resources or less interest in protecting the health of gay men.

What makes this all so frustrating is that monkeypox vaccines do exist. The US has hundreds of thousands, if not millions, of doses that it has simply not deployed. While monkeypox ripped through gay communities, the US allowed 300,000 perfectly usable doses of the Jynneos vaccine to sit in Denmark. The US has 100 million doses of ACAM2000, a smallpox vaccine that’s also effective against monkeypox, but it’s been slow to deploy those, too. Only after watching the outbreak spiral out of control did the government import and order more vaccines, but these may not be ready for months.

Vulnerable people in cities across the country have reported long lines, inadequate testing, and widespread misdiagnosis – if they’re able to get any medical attention at all. There are, of course, plenty of complicating factors. Healthcare professionals are badly strained from battling COVID-19 for more than two years. But the issues with vaccine shortages, shipments, and bureaucratic red tape could all theoretically be overcome by decisive executive action – if only we had a decisive executive in the White House.

Our system itself is the biggest obstacle. Capitalism simply isn’t designed to solve social problems. Its only purpose is to make money. If our society was oriented around solving problems, we would immediately increase vaccine production, ramp up distribution and vaccination efforts, and educate people. In 1959, the Soviet Union contained a smallpox outbreak in just 19 days. If we wanted to, we could do the same with monkeypox. But confronting a disease outbreak requires collective action, a dirty thought in US society.

The public health message here is also tricky. While there are increasing reports of spread into other communities, monkeypox still seems to be overwhelmingly spread by men with multiple partners. It appears that raves and sex parties have been especially fertile breeding grounds. In contrast to previous outbreaks, the rashes and blisters have often appeared on the genitals or in the anus, causing immense pain and difficulty sitting or using the toilet – and giving doctors some clues where the close skin-to-skin contact may be taking place.

None of this means that the population is dirty, or responsible for this public health crisis. All it means is that they need access to medical care, and need to be the focus of vaccination and education campaigns. Unfortunately, it’s provided an opportunity for the religious right to blame some of their favorite targets. The media has a hard time finding balance, either inferring that monkeypox is an STI for gay men – which isn’t true – or bending over backwards to avoid potentially politically incorrect facts, which may prevent the community from getting the attention they need.

Luckily, there are some silver linings. Monkeypox is not especially contagious. Its spread is nowhere near as fast as COVID, nor will it ever be. While some patients have experienced unbearable symptoms and lonely, month-long quarantines, other reports show this strain is relatively mild. Few have died, and none in the US. The disease doesn’t spread easily on contaminated surfaces and may be difficult to transmit asymptomatically. We already have effective vaccines available, and could halt a lot of spread by vaccinating vulnerable communities.

This is not a problem that we want to sit back and watch, as we have so far. Like COVID, the more monkeypox spreads, the more potential there is for newer, vaccine-resistant mutations to emerge. And the more it gets into other communities, the more vicious the anti-gay sentiment could become. By the time Biden decides whether it’s an emergency, it could become a catastrophe. We could solve the problem relatively easily – if, that is, we were capable of solving anything at all.

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