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July 11, 2022

Why the US response to monkeypox is drawing comparisons to Covid-19

Daily Briefing

    Monkeypox is spreading rapidly throughout the world, including in the United States, but health clinics are struggling with testing challenges and short supply of monkeypox vaccines—problems some experts say is "reminiscent of the early days of the Covid pandemic."

    Monkeypox: The latest on the outbreak

    Monkeypox continues to spread

    According to Eric Feigl-Ding, an epidemiologist and co-founder of the World Health Network (WHN), Kavita Patel, a physician and former director of policy at the White House Office of Intergovernmental Affairs and Public Engagement, and Yaneer Bar-Yam, president of NECSI and co-founder of WHN, monkeypox "is now a pandemic" and "is undergoing community transmission of countries worldwide and spreading unchecked at an alarming rate."

    So far, monkeypox has spread to more than 70 countries, including to the United States, which has reported 700 cases of monkeypox as of July 7. Meanwhile, in Europe, the World Health Organization has reported that monkeypox cases have tripled over the past two weeks.

    And research shows the monkeypox virus is mutating quickly. One study found the virus could be mutating 12 times faster than anticipated and could eventually lead to 60,000 new cases in the United Kingdom by the end of the year.

    Meanwhile, another model has suggested there could be 100,000 monkeypox cases worldwide by August and between 500,000 to 1 million cases by the end of September.

    Why the US response to monkeypox is drawing comparisons to Covid-19

    Experts have noted that obstacles in testing for monkeypox are slowing the United States' response to the disease.

    Currently, there are around 70 public health labs set up by CDC that can identify the family of viruses that includes monkeypox. Health care providers must receive clearance from a state epidemiologist before sending a sample to a lab, then they can send the sample off, something physicians may not know how to do, some experts say.

    "If you're an average clinician, you may have never sent a sample to a public health lab," said James Lawler, executive director for international programs and innovation at the Global Center for Health Security at the University of Nebraska Medical Center.

    According to the New York Times, this testing process is the same process clinicians had to go through in 2020 for Covid-19 tests.

    "We clearly identified this as a major mistake that allowed Covid to get its footprint in the U.S. and spread undetected for a month, without any of us knowing," said Angela Rasmussen, a research scientist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan. "And now we're just doing the same thing all over again, because that's the way it's done."

    Rasmussen said CDC should have made tests available quickly to determine the extent of the monkeypox outbreak early on. "Our failure to do that has almost certainly allowed the outbreak to become much bigger than it could have been, and now I have serious doubts about whether it can even be contained," she said.

    Without adequate testing, "we don't have a sense if it is the tip of the iceberg," said Jennifer Nuzzo, an epidemiologist at Brown University's School of Public Health.

    CDC on Wednesday announced that Labcorp has started testing for monkeypox and can accept samples to its main lab in North Carolina from around the country. According to CDC, Labcorp is able to perform up to 10,000 tests a week, which will double the testing capacity in the United States.

    Vaccine supply has also been a problem, experts say. Currently, there are two vaccines available to protect against monkeypox—Jynneos and ACAM2000. Health officials have been prioritizing the distribution of Jynneos, which is given in two doses 28 days apart, as the vaccine has fewer side effects and can be given to the immunocompromised.

    However, the current national stockpile has just 64,000 doses of vaccine, and clinics across the country are reporting running out of doses quickly.

    "We're promoting vaccines and working closely with patients to find access," said Anthony Fortenberry, CNO at Callen-Lorde Community Health Center. "But right now, there's a very small amount of vaccine available, and it's much less than the demand is for it."

    On July 1, CDC announced it had purchased more doses of Jynneos, bringing the total number of doses that will be available in 2022 and 2023 to 4 million. So far, the government announced it has distributed 41,250 "patient courses" of the vaccine to 42 jurisdictions.

    "We're six weeks in, and we're still having problems with availability of testing and vaccine supply, all these issues that we saw with covid," said Gregg Gonsalves, an associate professor of epidemiology at the Yale School of Public Health. "Now, the prospects for containment are receding quickly." (Feigl-Ding et al., Washington Post, 7/7; Andrews, Kaiser Health News, 7/8; Mandavilli, New York Times, 7/8; Dreher, Axios, 7/11; Bendix, NBC News, 7/7)

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