Monkeypox: Have we learned nothing from AIDS or COVID?

This weekend, the World Health Organization (WHO) declared monkeypox a “public health emergency of international concern.” That’s a rare designation from the WHO, one they’ve reserved to describe just two other diseases — COVID-19 and polio. Yet once again, the nation seems blissfully ignorant to the early warning signs of an outbreak that bears striking resemblance to the start of COVID-19 and the AIDS epidemic.  

Monkeypox is surging. As of today, 16,000 cases have been reported across 75 countries. That marks a five-fold increase in total cases worldwide since the WHO met in June. In the U.S., across 44 states, 2,891 cases have been reported. The U.S. Centers for Disease Control and Prevention (CDC) “encourages” states to report cases of monkeypox and is increasing access to testing and vaccines, but like the early response to both COVID-19 and AIDS, our national response has been slow and uneven.  

Monkeypox isn’t as fatal as COVID-19 — the strain spreading now has an estimated mortality rate of one percent. But it can produce extremely painful skin lesions which can take several weeks to heal. Direct skin contact appears to be the most common way of contracting monkeypox — yet it can also be acquired by secondhand exposure through the shared use of clothing, towels or bedding with someone who has the live virus.  

While the vast majority of monkeypox cases are being reported in communities where men have sex with men, last week the CDC confirmed two American children tested positive for the virus, most likely through indirect contact. This further validates that monkeypox cannot and should not be viewed only as a sexually transmitted disease that exclusively impacts gay men. We made this mistake when the AIDS epidemic first started and it led to a stigmatization of the LGBTQ community — as well as a gross deficiency in virus mitigation messaging aimed at the broader public, as we later learned the AIDS virus was spreading among women, teens and the general public. 

Monkeypox has many of the same hallmarks as the coronavirus’ early stages. Case numbers are exploding — and we are dreadfully ill-prepared to contain it. 

Sen. Patty Murray (D-Wash.) raised concern over the U.S. response to the outbreak: “[O]ur work to protect families and strengthen our preparedness and response system is far from complete and cannot end with the COVID-19 pandemic,” she wrote to U.S. Health and Human Services Secretary Xavier Becerra. Late last week the Biden administration was “considering” calling monkeypox a U.S. public health emergency, though no “final decision” had been made. Rep. Adam Schiff (D-Calif.) expressed his desire to “light a fire under the administration” so that it would take swifter action to address the issue. 

The major difference, of course, between the early days of COVID-19 and monkeypox is that monkeypox already has a vaccine to combat it. The virus has been known to the scientific community since the 1950s — yet the U.S. failed to stockpile enough vaccines to treat the rapid case surge we are seeing now. The demand for vaccines is far outpacing supply, as hundreds have been seen waiting in line at clinics. Some centers have even had to temporarily shut down due to being out of vaccine shots. 

America’s public health infrastructure is woefully underfunded and understaffed. As cases spike, we have no national plan, insufficient vaccine supplies, inadequate access to testing and poor communication from the public health community. When our nation’s health leaders say the general public is at “low risk” when monkeypox shows every sign of becoming a public health crisis, we must do better and act with a greater sense of urgency. 

If COVID-19 proved anything it showed that a piecemeal response to a global health crisis is a recipe for disaster. We need our elected leaders to step forward, declare monkeypox a national emergency, and announce a coordinated approach to confront it. We need more vaccines, more testing centers, more education and more funding. If we don’t act now, we’ll simply repeat the mistakes of the past. 

Let’s apply the lessons we’ve learned from COVID-19 and AIDS and commit to stopping monkeypox before it’s too late. 

Lyndon Haviland, DrPH, MPH, is a distinguished scholar at the CUNY School of Public Health and Health Policy.