Over the weekend Vox published about the millionth article informing us that our response to monkeypox is a total clusterfuck and bears an uncanny resemblance to our infamous COVID-19 clusterfuck.
Sure. Maybe. Generally speaking, though, I sometimes wonder how fast these newly-minted critics think a country should be able to roll out a massive testing and vaccine program for a new disease. But they never say. Nor do they ever hint at any real expertise in ground-level epidemiology and the obstacles it presents. The answers are just a vague faster and we're the richest country in the world for god's sake.
Accurate data is critical for public health, and the US doesn’t have it. The US declared monkeypox a public health emergency this month, but the decision may have come too late....Reliable demographic information is key to making the right choices for allocating limited tests and vaccines.
All of this feels like an uncanny echo of the early mishandling of Covid-19....Reporting lags on rising cases meant that lockdowns began too late to save tens of thousands of lives. Similarly, certain communities uniquely at risk, like Black and Hispanic people who lacked access to health care, were suffering higher rates of severe illness and death from Covid before policymakers had any way of knowing where to direct public health outreach.
....The delays and poor coordination between clinics and city health departments meant that contact tracing happened too late to contain the spread. If the spread had been caught earlier, patients would have been more likely to minimize their risk and seek out testing and treatment if they were exposed, and there would have been more advance warning on ordering a vaccine supply.
First off, here are the numbers:
You'll notice that there are two lines for the United States. The bottom one is just the normal raw data. The top one is lagged by two weeks to account for the fact that our first case showed up about two weeks after the first case in Europe. I am doing this out of a monumental abundance of fairness.
But even using the lagged figure, the US is roughly in the middle of the pack. If our response was terrible, then just about everyone's response was terrible.
So this is Point One: You have to compare the US to the real world, not to some idealized response in a white paper. All of the countries in this chart are advanced economies and we did about as well or better than most of them.
Then there's Point Two: In the entire Vox article, contact tracing is mentioned precisely once. But this is the whole ballgame. All that testing and all that data we collect is primarily to support a vigorous program of contact tracing, especially in a case like this where we already knew early on who the most vulnerable community was (men who have sex with men).
And that's where everything falls apart: despite the heroic efforts of a small group of people, we're terrible at contact tracing and all the data in the world won't change that. What we need is (a) great data collection, (b) a large group of extremely well-trained people, (c) lots of funding, and (d) a population willing to answer the phone and provide intimate data to a government bureaucrat calling about a disease.
We have none of that. A few other peer countries do better, but most of them don't really have it either. And in the US, we have another obstacle: even if we were great at A, B, and C, we are possibly the world's worst at D. Not only that, but thanks to the Fox News paranoia machine we're probably worse on this score than we were before the COVID pandemic. Our monkeypox case rate is currently rising faster than in most peer countries, and the reason is most likely our collective unwillingness to embrace contact tracing as a way of life during pandemics.
So, yes, we should collect better data. We should coordinate local, state, and federal officials more efficiently. We should get this kind of thing up and running faster. We should pour money into it.
But it will never make more than a small difference as long as Americans are widely suspicious of contact tracing. That's our big problem, not a lack of funding or commitment or basic epidemiological expertise. The fault, my friends, lies in ourselves, not the CDC.
POSTSCRIPT: Here's another chart showing cumulative deaths from monkeypox:
That would be zero for every country on the chart, including the US. Keep this in mind as you evaluate the priority given to monkeypox by the medical community. During the period shown in the chart, 70,000 people in these countries died from COVID-19.
Wrong.
CDC again wanted to do in house testing slowing it up.
Again couldn't be bothered to coordinate vaccine approvals asap.
Until anyone who wants a vaccine can walk in and get it and not the wild skin gamble shit it's not enough. And comparing to how we could be doing is JUST AS FAIR as comparing to Europe.
There seemed to have been quite a lot of that early in 2020.
https://www.motherjones.com/kevin-drum/2020/04/wsj-us-coronavirus-test-is-only-60-70-accurate/
The broad criticism is fair, IMO. We had the capacity to do significantly more but we didn't. That's what generally separates us from presumed cohorts.
First case: Chickenpox vaccine would be fairly effective (up to 85% efficacy) at protecting against Monkeypox, but there wasn't a public campaign to push for Chickenpox vaccinations where there wasn't enough Monkeypox vaccine.
Second case: But, we had a stockpile of Monkeypox vaccine and we didn't distribute the bulk of it; we slow-walked the stockpile rollout. We spend money on building a million+ dose stockpile, if not for rushing out to epicenters of an epidemic, then what? Throwing away when they expire?
Third case: We're relying on testing and the use of the Monkeypox vaccine as a post-infection prophylaxis. We should be getting the word out that everyone, but especially men who have sex with other men, should just go out and get either the Chickenpox or the Monkeypox vaccine.
We paid for million+ doses to put in a stockpile--but didn't have them yet. We were waiting for the production facility's paper work and inspection--which was fast tracked once the epidemic was recognized.
The question should be why was a monkeypox vaccine and stockpile even in the works??? The CDC recognized that it could be an emerging threat, so go the ball rolling a while ago.
And the chickpox vaccine does not help against monkeypox--it's the small pox vaccine that is 85% effective. That's not been rolled out because it has some side effects and monkeypox is not killing people.
With the declaration of an emergency, they can now modify how the monkey pox vaccine is administered and get 5 doses from 1 now.
I made three errors.
1. The vaccine for Monkeypox is the same as Smallpox, including the Jynneos vaccine (MVA-BN live, non-replicating).
2. Smallpox, not Chickenpox.
3. There were 28M doses available of the non-replicating Jynneos vaccine, but they expired by 2017. The US currently has bulk vaccines stored, but not finished in vials.
Two clarifications:
1. The CDC states that the ACAM2000 replicating Smallpox vaccine is 85% effective against Monkeypox.
2. There is a stockpile of 100M ACAM2000 vaccines in the US.
A few more details here:
https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html
The ACAM2000, the older vaccine which we have a lot of, can cause severe problems among immunocompromised people. The newer Jynneos one is now the recommended one. The US was looking to get a freeze dried version of the vaccine that will last longer and did not replenish the Jynneos stocks. There is not one available yet, and the US ordered more of the Jynneos one in 2021(?) with doses stockpiled in Europe in bulk form.
https://www.grid.news/story/science/2022/08/04/the-world-had-a-head-start-with-monkeypox-vaccines-it-has-largely-squandered-it/
Monkeypox is Obama's Katrina!
No, the 2003 US Monkeypox Outbreak was Bill Climpton's 9/11.
Gay men were all well aware of this threat going into the summer. This disease found the perfect vector to spread around the world. There was no amount of education or vaccine that would have prevented its spread. The boys are going to party no matter the risk. I read the story about the guy who got the pox and the clap during pride week in NY. And good for him! He had a blast. They all laugh it off after sharing the grim news with their friends. It’s fine. Lesson learned.
https://www.theguardian.com/world/2022/jul/23/i-literally-screamed-out-loud-in-pain-my-two-weeks-of-monkeypox-hell
Yikes! 😂
Good luck getting people to lower their amount of sex. Haha!
Number of deaths caused/averted is not the only metric by which healthcare should be measured. Nor is downplaying the seriousness of people's suffering a great way to engender trust.
A much worse thing: Senate Republicans refusing to put a cap on insulin costs for all who need it. Type I diabetes mellitus shortens life expectancy by some four years.
I have a very hard time believing that we'd have anything other than widespread monkeypox infection, no matter what the CDC did.
We are at the tail end of a pandemic where many Americans absolutely refused to be vaccinated. People are in no mood to hunker down again, and it seems very unlikely that enough people would race to get vaccinated that we could actually stop the spread, especially since there is no apparent risk of death.
90% of adults 28+ year old and higher had a flawed vaccine that is really like the flu shot. Your point is irrelevant. How many lives were really saved by it???? Not enough to matter.
A real vaccine stops spread permanently.
And I want it delivered in 15 min or less or it's FREE!!!!
Things are not perfect--but for God's sake, we had a vaccine developed already only because the CDC recognized it as a potential threat. As for covid, what we did on the vaccine front was miraculous. But that miracle was at the tail end of many years on investing in vaccine development by out government. I believe a fair amount of it was spillover from the search for a vaccine for HIV.
Actually, Moderna and BioNTech were both looking for vaccines for cancer. That work has continued and is starting to look pretty promising.
I've also see reports on how bad testing is. It certainly can be better--but right now we still are sampling the actual pox--there's no testing for asymptomatic people...
Side note: the "monkey pox" natural host is not monkeys. Apparently it is rodents--not sure which ones. The potential is for it to become endemic in our rodent population, which may lead to sporadic outbreaks.
Maybe I am missing something obvious, but contact-tracing would not seem to be that important UNLESS there is (more than remote) possibility of pre-symptomatic or asymptomatic spread. Aside from a couple few case reports, what I’ve understood is that there really needs to be contact with exudate (pus) from open sores of the rash.
If so, what’s the utility of contact tracing, in terms of slowing the spread?** Telling people who have painful open sores, probably on their genitals, oral or anal areas, that they shouldn’t have sex, particularly unprotected, until their sores are scabbed over? I think they know that sex with open sores is generally a bad idea, and if they don’t, would they *not* have sex because you’ve told them it’s monkeypox?
Unless the primary use case of contact tracing is “people with sores who might think it’s just gonorrhea, and are likely to ignore it and have sex anyway, but would forgo it if they knew it was monkeypox?”
It’s possible, because gonorrhea is a lot less painful than monkey pox, so it’s a plausible scenario, but seems like a pretty narrow usage to complain about the lack of contact tracing.
**There is a stronger case for telling people early they have/might have been exposed, if they can get their hands on TPOXX, or the vaccine, early enough. This doesn’t affect the SPREAD, again, unless asymptomatic spread is a thing.
In this case, the contact tracing is for both, partial isolation and ring vaccinations--but we've not been very good at doing that. I saw partial isolation because full on quarantine would be overkill in this case.
Nobody cares about gay pox. Period.
Working the refs works.
There's been a never-ending stream of criticism directed at our health officials from the day Covid first arrived. This was mostly emanating from the libertarian and MAGA right in the early days.
It gradually grew to suck in large elements of the center and center-left.
And so here were are with Monkeypox. And no doubt we'll be told they've dropped the ball on polio, too.
(And no, I'm absolutely not claiming the CDC/FDA etc are perfect. Or even close to perfect. Or above reproach. But put America's public health capabilities in a country with less fucked up politics, and I think you'd see very different results.)
Undoubtedly
Which lab intentionally leaked the Monkeypox?
My money is on Arthur Robinson's Oregon Institute of Science & Medicine.