America has failed its first post-Covid test — and Covid isn’t even over. The country remains fully mired in the pandemic, with this summer’s caseloads among the worst since the novel coronavirus first surfaced. At the same time, we have been unable to apply the lessons painfully gleaned over the past two years to the next virus to come along, monkeypox. Doubly alarming, monkeypox presented none of the staggering challenges that Covid did.
On Wednesday, Centers for Disease Control and Prevention Director Dr. Rochelle Walenksy conceded that her agency “did not reliably meet expectations” in its “big moment” when it came to confronting the challenge of the pandemic. In addition to this welcome admission, she also prioritized quicker data-sharing and stronger messaging that the public can readily relate to.
The mistakes have spanned the entire process from diagnosing monkeypox to treating it.
But the bungled monkeypox response underscores just how vast the gap is between the CDC’s aspirations and its current reality. The United States has had to declare the monkeypox outbreak a public health emergency to emphasize the growing risk to Americans. At this point, the nation’s monkeypox cases, confirmed in 49 states, account for more than 30 percent of the world’s current disease burden.
The public health challenge posed by monkeypox should have never been this formidable. Unlike Covid, the monkeypox virus was not an emergent threat for which a playbook and vaccine did not initially exist. In addition, many of the tools we needed to fight it were exactly what Covid should have prepared us for: beefing up our national stockpile of vaccines, rapidly administering tests, coordinating between federal and local authorities, and providing messaging that is unalarming and tailored to both general and at-risk populations.
From its emergence, Covid was a true heavyweight foe. It was airborne and highly contagious, with an elevated incidence of morbidity and mortality. Little was known about its various modes of transmission, disease course and complications. Furthermore, there were no vaccines, proven treatments or experience with disease management. Even the existing science on similar coronaviruses was unhelpful because of critical differences in its genome and virulence.
But the monkeypox narrative was nothing like this. The repetition of these public health failings in the case of monkeypox does not augur well for the future. Deadlier, more transmissible, pathogens may soon arise and sweep through the country unfettered if we don’t elevate our public health game.
Fortunately, monkeypox causes a largely mild and self-limiting illness. It presents with a characteristic painful rash and various symptoms such as fever, headache, fatigue and muscle aches, any of which can occur days after exposure. The skin lesions, which may be widespread, few in number or confined to genital areas, begin as flat red marks but later become raised pustules that inevitably scab over and fall off. And despite climbing global cases, deaths due to monkeypox have been very rare, especially outside Africa.
The virus, which primarily circulates among rodents, was first identified in 1958 by Danish scientists who were studying monkeys in a lab. In 1970, a young boy in the Democratic Republic of the Congo became the first human to be infected. For a long time, the disease remained endemic to Central and West Africa. Outbreaks and calls for aid from countries went largely unnoticed and unheeded by the rest of the world, however.
Monkeypox “did not emerge strangely out of ether. It has been there in Africa and we should have been paying attention to it,” said Dr. Saad B. Omer, director of the Yale Institute for Global Health.
Furthermore, the virus lends itself to being controlled. Monkeypox is not hypertransmissible, with the predominant means of spread driven by sexual contact. Efficacious vaccines and antivirals already exist to limit transmission, shorten the disease and provide relief to the infected. And while we must be careful not to stigmatize an entire community, the outbreak is primarily affecting men who have sex with men, making containment efforts easier since cases are largely found among an identifiable group.
Despite these apparent advantages, the efforts to counter monkeypox have thus far been a blundering mess. “The response here has been fundamentally shambolic. The sad thing is that monkeypox should be Public Health 101,” said Dr. Abdul el-Sayed, a former Detroit health director and the host of the “America Dissected” podcast.
The mistakes have spanned the entire process from diagnosing monkeypox to treating it. Flawed testing criteria, limited testing availability and processing delays have not only let the virus run amok, but have also led to an underestimation of the outbreak’s true scale. Vaccines have been misallocated and grievously limited due to 20 million doses that expired while sitting in the Strategic National Stockpile, ordering delays and the Food and Drug Administration’s failure to inspect and approve Bavarian Nordic’s new facility in Denmark, where the majority of the 1.4 million shots ordered by the United States in early 2020 resided, before monkeypox cases took off. All of this has been topped off by poor communication, coordination and data-sharing between the CDC and state public health authorities.
So monkeypox is now an uncontrolled virus being superimposed on a public health system already reeling from the ongoing Covid pandemic. Its underfunding, bureaucratic rigidity, burnout among workers and politicization have been doubly devastating.
“We are already running out of Covid funding despite the fact that every year since the pandemic started, we have seen a huge spike in the fall,” el-Sayed said. “This is how a once-proud, once-strong system breaks.”
Even if the brakes are successfully applied to the milder monkeypox virus, its revelations about our public health preparedness and abilities post-Covid are frightening. And the stakes couldn’t be higher with globalization, ecological interferences and travel bringing humans into intimate contact with various animal species that can transfer worrisome pathogens to us. Further, as monkeypox has demonstrated, we have done a poor job of surveilling viruses endemic to other countries and responding swiftly when they move to our mainland.
In the end, monkeypox was a soft stress test for our public health system that we should have passed reasonably well after our jarring and humbling bout with Covid. The results, especially with more virulent bugs surely looming, are discomfiting.