How the US monkeypox response failed to learn COVID’s lessons

The Biden administration’s failed response to the spread of monkeypox has highlighted America’s inability to respond to large-scale disease outbreaks. These problems are bipartisan and were also evident in the Trump administration’s flawed response to the COVID-19 pandemic. Solving them will require bipartisan cooperation.

The United States must fix its public health system or suffer the consequences of the next disease outbreak, which could be deadlier and more difficult to contain.

Treating monkeypox should not have proven as challenging as treating the coronavirus. Monkeypox, after all, was discovered in 1958, and the first human case was recorded in 1970. A vaccine, known as Jynneos, was approved by the Food and Drug Administration (FDA) in 2019 and is effective against both monkeypox and smallpox.

Before 2022, outbreaks of monkeypox were mostly limited to people in central and western African countries, people who had traveled to those countries, and people who had been exposed to imported animals. The Centers for Disease Control and Prevention (CDC) notes that prior to this year, monkeypox cases in the U.S. were “very rare.” Yet since May, there have been more than 19,000 confirmed cases in the United States.

COVID-19, on the other hand, materialized as a novel virus with no vaccine or known pharmaceutical treatments, and quickly spread to tens of millions of people. China’s obstruction and obfuscation of critical information, like human-to-human and asymptomatic transmission, made it more difficult to contain the disease. The development and distribution of a vaccine took more than a year.

The playbook for containing the spread of monkeypox should have looked similar to the world’s belated approach to COVID-19. A combination of vaccines and non-pharmaceutical interventions could have been effective at limiting the spread, especially if they had been deployed early in an outbreak. A robust testing regimen could have provided insights into whether confirmed cases were the full story or just the tip of the iceberg.

Yet the Biden administration has struggled to make testing for monkeypox widely available. The Washington Post reported last month that only about a dozen tests per day were being performed nationwide in early June. The administration has expanded testing capacity to try to meet the current demand. The woefully inadequate initial response raises the question of whether America’s public health system is irreparably broken.

The monkeypox outbreak at the moment is largely limited to a specific population — men having sex with men. Vaccinations should have been the first line of defense for the concerned population. Those who were unsure if they had the disease or had been exposed could protect themselves through vaccination and safer practices.

The Strategic National Stockpile had doses of Jynneos — but not enough to contain the emerging monkeypox outbreak. The United States had purchased millions more doses but they were in Denmark in the manufacturer’s factory waiting to be turned into vaccines. The FDA had to inspect the plant before the vaccines could be used in the United States. That finally occurred six weeks after the first U.S. case was identified. It is not immediately clear why the administration did not prioritize that effort. But the delay likely led to additional cases of the disease.

The Biden administration’s recent actions, however, are finally matching the urgency of the moment, including increasing access to vaccines and treatments. In particular, Washington has begun to address flaws in the public health infrastructure. In mid-August, CDC Director Rochelle Walensky announced changes to the organization in response to its abysmal performance during the COVID-19 pandemic, including improving communications and accountability within the organization and with the public, and publicizing scientific and data findings faster.

But not all the changes are productive. For example, the Department of Health and Human Services has elevated the assistant secretary for preparedness and response — the senior official charged with responding to public health emergencies — to the same level as the FDA and CDC, a bureaucratic change without much impact. Those two organizations had the worst track records responding to the COVID-19 pandemic and are not shining models to emulate.

When the monkeypox outbreak is over, we need a rigorous review to understand why America was slow to react to a disease outbreak … again.

A bipartisan solution should begin with an impartial evaluation of the flawed COVID-19 and monkeypox responses. Congress and the administration are not adequately positioned to do it because it would devolve into partisan fighting. Instead, President Biden and senior Republican and Democratic leaders should publicly support the creation of an independent, bipartisan commission. The National Commission on Terrorist Attacks Upon the United States (also known as the 9-11 Commission) is a good model to follow.

The United States must fix the broken public health system. The next disease outbreak may be deadlier, and we will not have the time to fumble another response.

Anthony Ruggiero is senior director of the Nonproliferation and Biodefense Program at the Foundation for Defense of Democracies (@FDD). He previously served in the U.S. government for more than 19 years, including as senior director for counterproliferation and biodefense on the National Security Council (2019-2021). Follow him on Twitter @NatSecAnthony. FDD is a Washington, DC-based, nonpartisan research institute focusing on national security and foreign policy.