Friday, August 12, 2022

CDC and public health agencies are clouding the message about monkeypox

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Shreya Christina
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Covid-19 revealed many embarrassing flaws in the US public health system. The CDC struggled to get useful tests for doctors and health clinics early in the pandemic. Data reporting was appalling, meaning our officials flew blind in the attempt to piece together an answer. Public health officials initially told us to worry about the flu rather than Covid, subdued the value of masks to the public in an effort to conserve supplies for health professionals, and often failed to communicate effectively about: booster shots or vaccines for children. Trust in our public health authorities plummeted in response to the growing perception that their announcements did not match reality.

When the toll of Covid-19 started to decrease, there were many sober conversations about how much the public health sector needed to learn from Covid and how much better they needed to perform before the next emerging virus hit.

Then came monkey pox. After the first human case was diagnosed in the Democratic Republic of Congo in 1970, the virus was largely confined to a handful of African countries before breaking out this year in Europe and increasingly the US, with more than 20,000 confirmed cases in more than 60 countries. Last week, the World Health Organization (WHO) explained Monkeypox a global health emergency.

Let’s be clear: Monkeypox is not a worst-case virus. At least it’s close to a virus at best — at least in terms of its manageability.

First, we had endless warnings that it was going to be a problem. As global immunity to smallpox waned – a closely related virus that also confers immunity to monkeypox – Nigeria saw more and more cases of monkeypox, with outbreaks in recent years numbering in the hundreds of patients. The United States experienced, and featured a minor outbreak of monkey pox in 2003. This was not a virus that came out of the blue; it was on every list of troubling viruses around and occasionally affecting people.

But no one was too concerned, because monkey pox is not very contagious and has an effective vaccine. While what is currently active is probably a new variant, which spreads more easily through very close contact with infected people, it is nowhere near as contagious as a respiratory virus like Covid-19 can be. That means public health staples like contact tracing and ring vaccination of the at-risk populations should be more than enough to stop it.

Monkeypox was disease control in a simple way, and yet it looks very likely that we will fail to control it, with more than 4,900 confirmed cases and counting in the US alone. As we do this, we are accelerating many of the mistakes that have characterized our Covid response, making it clear that we have learned very little.

Some of the most glaring mistakes are communication, where people get sick because of a reluctance to tell them they are at higher risk.

Our troubled response to monkey pox

The way to contain a not very contagious disease for which there is a good vaccine looks like this: make sure everyone knows the disease is spreading, identify who is most at risk and make sure they have access to health care if they have it. Test extensively and when you find a case, contact Trace.

That means continuously tracking down the people with whom the sick person has been in close contact and encouraging them to get tested as well. For some diseases with a long incubation period and an immediately effective vaccine, you can even vaccinate close contacts and prevent them from getting sick.

The US response to monkey pox has been disastrous on almost every one of those fronts. First, Testing: Too Often People Are Showing Monkeypox Symptoms being told by doctors not to have a testor tests are delayed so long that they are almost useless by rules that the sample for a test must be taken from a lesion that may develop late in the course of the disease.

Then vaccines: As a New York Times article revealed this week, 300,000 monkeypox vaccine doses were in Denmark for the better part of a month because the US had not yet placed an order for them, even if high-risk people struggled to access vaccination appointments. The US government has finally obtained those overseas doses, but the window to completely curb monkeypox is probably already closed.

Finally, like Jerusalem Demsas wrote for the AtlanticOur public health officials have replicated the Covid failures in another crucial way: too busy managing public opinion to give the public accurate information about the situation.

A failure to communicate

according to an international study this week in the New England Journal of Medicine98 percent of documented cases were found in gay or bisexual men. While the disease is not a sexually transmitted infection like syphilis, which spreads almost exclusively through sex, monkeypox transmission requires close physical contact, and sex appears to be a high probability for the virus — 95 percent of the transmissions in the study. documented, took place during sexual relations.

Due to deficiencies in the tests, it is difficult to say exactly what proportion of monkey pox cases in the US is in the population of men who have sex with men. And health officials rightly want to avoid spreading the false message that monkey pox can do that nothing but spread through sex or among gay and bisexual men, lest we miss cases in other populations. There are concerns that people have been turned away from testing for monkeypox assuming it is a “gay disease”, and worrying that others may refuse to seek treatment because they fear they will be considered gay.

But there is no doubt that the current approach puts gay and bisexual men at risk and fails to meet the needs of that community or another.

And while it may seem obvious that the best way to serve the population of men who have sex with men is by giving them truthful information, quality healthcare and priority access to vaccines, public health agencies are too often not communicating clear about this.

We can handle the truth

Many public health officials have instead emphasized that anyone can get monkey pox, reported LGBTQ+ health journalist Benjamin Ryan mentioned in the Washington Post “so blatantly misleading as to amount to misinformation.” While it’s technically true that anyone can get monkey pox, some people are at high risk — and they deserve to know that.

In New York, when the monkeypox outbreak in the city spiraled out of control, the medical professionals who worked there fought over whether or not to advise people to avoid anonymous sexual encounters to reduce the risk of the disease. Instead, in an effort to avoid stigmatization against gay and bisexual men, the city’s public health department has advised to: cover sores and avoid kissing if you have sex while sick with monkey pox. As some doctors within the department argued, that is not medically sound advice.

The shadow of the terrible public health response to HIV looms with any attempt to advise on another epidemic that currently seems to be spreading primarily among gay and bisexual men.

But the way to avoid the mistakes of HIV is not to say nothing or give insufficient medical advice to influence public opinion. Making vaccines available is a challenge while speaking clearly about which populations are at increased risk and advising sick people to avoid high-risk activities.

The WHO at least seems to be learning its lesson – on Wednesday, WHO Director General Tedros Adhanom Ghebreyesus insisted men who have sex with men to consider at least temporarily reducing their number of partners to protect themselves and limit further spread of monkeypox.

During Covid, we tried the approach of public health officials telling partial truths and restricting information in an effort to reduce stigma or get better behavior from the public. What we learned was that it doesn’t work. People don’t like to be manipulated and they look to unofficial sources if they think official troops aren’t telling the truth.

Public trust is a scarce and valuable resource. Our plans to fight stigma, prevent panic and inform the public must build that trust, not waste it, or else we will be handicapped when we need our institutions most.

A version of this story was initially published in the Future Perfect newsletter. Sign up here to subscribe!

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