Covid-19 has exposed many embarrassing flaws in the US public health system. The CDC struggled to get valid tests to doctors and medical clinics early in the pandemic. The disclosure was dangerous, and our government officials flew blind in their response. Public health officials initially told us to worry about the flu instead of Covid, reduced the cost of masks to the public in order to save supplies for health workers, and often failed to communicate effectively about immunizations or vaccines for children. Confidence in our public health authorities has plummeted in response to a growing perception that their pronouncements are untrue.
As Covid-19 numbers begin to decline, there have been many sobering conversations about how much public health has to learn from Covid and how much better it can do before the next emerging virus hits.
And monkey pox. After the first human case was identified in the Democratic Republic of the Congo in 1970, the virus has more than 20,000 confirmed cases in more than 60 countries, mostly contained in several African countries, before spreading to Europe and increasingly the United States this year. . Last week, the World Health Organization (WHO) declared monkeypox a global health emergency.
Let’s be clear: Monkeypox is not a worst-case scenario virus. If anything, it’s close to a best-case scenario virus — at least in terms of its control.
First, we received endless warnings that this would be a problem. As immunity to smallpox has declined worldwide, monkeypox has emerged in Nigeria, with hundreds of cases reported in recent years. In 2003, the United States experienced and prevented a small outbreak of monkeypox. This is not a random virus; it was on the list of dangerous viruses around and occasionally infecting people.
But because monkeypox is not highly contagious and there is an effective vaccine, no one is worried. Although what is currently active is a new variant that spreads easily through close contact with infected people, it is still not as contagious as a respiratory virus like Covid-19. This means that public health efforts, such as tracing links and vaccinating at-risk populations, should be sufficient to stop it.
Monkey pox is easily contained, but we may not be able to contain it, with over 4,900 confirmed cases and counting in the US alone. So we’re rapidly processing the many mistakes inherent in our Covid response, making it clear that we’ve learned very little.
Some of the most notable mistakes have been in communication, where people get sick because they don’t want to say they’re at high risk.
Our response to monkeypox
A way to contain a highly contagious disease with a good vaccine looks like this: Make sure everyone knows the disease is spreading, identify who is most at risk, and if they have it, get medical care. Test widely and contact the trail when you find what works.
This means constantly monitoring people who have been in close contact with the sick person and encouraging them to get tested as well. Some diseases with long incubation periods and effective vaccines can prevent immediate illness by vaccinating close contacts.
The U.S. response to monkeypox is failing on nearly every one of those fronts. First, testing: People who show symptoms of monkeypox are told by doctors not to get tested or, according to testing guidelines, are delayed until it’s almost useless and the test specimen is taken from the test. An injury that may occur at the end of the disease.
Next, vaccines: A New York Times article this week found that 300,000 doses of monkeypox vaccine were sitting in Denmark in a month because the U.S. had not yet ordered them, and even at-risk people were struggling to get to vaccination appointments. . The U.S. government eventually bought those doses from overseas, but the window to fully contain monkeypox appears to have closed.
Finally, as Jerusalem Demsas writes for the Atlantic, our public health officials are repeating the shortcomings of Covid in another important way: too much concern with managing public opinion in order to accurately inform the public about the situation.
Failure to communicate
According to an international study this week New England Journal of Medicine, 98 percent of documented cases were found in gay or bisexual men. Although the disease is not a sexually transmitted infection like syphilis, it is spread almost exclusively through sex, transmission of monkeypox requires close physical contact, and intercourse appears to be the main opportunity for the virus — 95 percent of infections documented in the study occurred during intercourse. relationships.
Because of a lack of testing, it’s hard to say exactly what proportion of men who have sex with men in the U.S. have syphilis. And health officials want to avoid spreading false news that monkeypox is possible the only spread sexually or among gay and bisexual men, so that it does not miss cases in other populations. People are refusing to be tested for monkeypox, thinking it’s a “gay disease” and fearing that others will be perceived as gay and may refuse treatment.
But the current approach is undeniably putting gay and bi men at risk and failing to meet the needs of that community or others.
Although it is clear that the best way to serve the population of men who have sex with men is to provide them with honest information, quality health care, and priority access to vaccines, public health agencies often fail to provide accurate information. it’s a.
We can decide the truth
Many public health officials have instead emphasized the possibility of monkeypox, with LGBTQ+ health journalist Benjamin Ryan calling the Washington Post “so much misinformation that it amounts to misinformation.” While it’s technically true that anyone can get monkeypox, some people are at higher risk and deserve to be aware of it.
In New York City, when an epidemic of monkeypox got out of hand, medical professionals there debated whether to advise people to avoid clandestine sex to reduce the risk of disease. Instead, in an effort to avoid stigma against gay and bisexual men, the city’s public health department issued advice on covering genital wounds and avoiding kissing while suffering from monkeypox. Some doctors in the department say this is medically incorrect advice.
The shadow of the public health response to HIV looms over efforts to advise on another epidemic, this one that appears to be spreading primarily among gay and bisexual men.
But the way to avoid HIV mistakes is to say nothing or give medical advice that influences public opinion. It’s moving mountains to make vaccines available, while being clear about which populations are at high risk and advising sick people to avoid high-risk activities.
The WHO, at least, appears to be learning its lessons – WHO Director-General Tedros Adhanom Ghebreyesus said on Wednesday urgent Men who have sex with men should consider reducing the number of partners, at least temporarily, to protect themselves and limit the further spread of monkeypox.
During Covid, we tried a partial approach where public health workers told the truth and limited information to reduce stigma or get better behavior from the public. What we’ve learned is that it doesn’t work. People don’t like to be manipulated, and they will turn to unofficial sources if official forces don’t tell them so directly.
Public trust is a scarce and precious resource. Our plans to combat stigma, panic, and inform the public must build on this trust, not squander it, or we will cripple our institutions when we need them most.
A version of this story was originally published in the Future Perfect newsletter. Sign up here to subscribe!