The monkeypox mistake the US government won’t stop making

For those of us at the forefront of the public health response to monkeypox, there was an overwhelming sense of whiplash watching the federal government roll out its new vaccine dose-sparing strategy earlier this month. This latest move is intended to finally get the country ahead of the virus — except it repeats the same strategic error we’ve seen time and again: it fails to fund implementation.

Since the earliest days of the monkeypox outbreak, sexual health clinics have been on the front lines, meeting patients’ needs and providing equitable care. They have worked tirelessly to stretch their shoestring budgets to provide testing, treatment and vaccines — even taking referrals from less-equipped primary care providers and seeing patients who have been turned away elsewhere. But the federal government has not provided the necessary funding to maintain these services that are critical to combating infectious disease outbreaks like this one.

We should have been able to contain monkeypox — it was detected early and already had tests, a safe vaccine and an effective treatment. But a chronically underfunded public health system, often lacking even basic supplies like testing swabs and syringes and depleted by two-plus years of the COVID-19 pandemic, failed this most basic test.

So, as federal health officials continue to tout their response to the outbreak in press conferences, clinics across the country are pleading for help and patients are suffering the consequences. It did not have to be this way. 

The strategic move to stretch our current supply of Jynneos, the safest vaccine for monkeypox, is just the latest example in this trend. The concerns over the safety and efficacy of this approach are real but equally concerning is the failure to consult the affected communities to implement this strategy in a way that builds trust and provides adequate resources. It involves a complex injection method that requires specialized training, unique supplies and new handling procedures — and there is little margin for error. However, thus far, there have been no resources or additional training provided to implement the new strategy.

Again and again, the government’s most meaningful steps to address this crisis have failed to make a difference to the patients who need them most because of a lack of funding. 

When the government first made the small supply of the Jynneos vaccine available, patients trying to register for an appointment quickly learned that the supply was depleted in minutes. Inside clinic walls, providers reached into their already overstretched budgets to create what new appointments they could, triage patients and reassign staff to deliver vaccines. Later, when the government finally relented to public pressure and expanded access to vaccines, it still failed to provide the dollars to clinics to deliver the doses quickly — stranding desperate patients, yet again. 

Similarly, when the federal government last month announced partnerships with private commercial laboratories like to ease the backlog of tests, clinics were forced to make difficult choices about whether to continue using the free, public labs or utilize commercial labs, the latter of which would require them to either pass on costs to patients — who are often uninsured — or eat the costs themselves. Many clinics have chosen the path with the least hurdles, opting to use the public labs.

And in recent weeks, as doctors raised issues with accessing the one available treatment for monkeypox, TPOXX, due to the extensive amount of paperwork the federal government requires to be filled out for each patient — 124 pages to be exact — the Centers for Disease Control and Prevention (CDC) updated its guidance to shorten the forms but didn’t provide clinics with the resources to provide tests or submit paperwork.

The pattern is unmistakable — but it is fixable.

With over 15,000 confirmed cases, we can’t afford to let monkeypox become endemic in the U.S. The new emergency declaration and federal monkeypox coordinators are promising steps toward righting the ship of this outbreak response. 

But the bottom line remains: Patients and communities won’t start to feel the full benefit of the strides the administration has worked hard to make until the federal government provides funding to implement its strategy. Absent that, we will see history repeat itself in slow motion with predictable outcomes as case numbers spiral and patients wait in pain.

David C. Harvey is the executive director of the National Coalition of STD Directors.