Caught out on one virus, US health agency heads down wrong path on monkeypox, observers say

The US Centers for Disease Control and Prevention, or CDC, has come under fire over its slow response to the monkeypox outbreak in the United States, and some suggest its tardiness mirrors mistakes made early in the coronavirus pandemic.

The CDC's recent admission that it mishandled the country's COVID-19 outbreak in the crucial early stages has prompted soul-searching within an organization that now faces a fresh test in the form of another rapidly spreading virus.

Health officials identified the first monkeypox infection in the US on May 17 in Boston, the CDC said. New York City identified a case the next day.

By Monday, there had been 15,432 cases in the US－the highest number in the world, but with no related deaths.

The infectious disease can be treated with a two-shot vaccine known as Jynneos. But after the first cases were announced, about 300,000 doses owned by the US became stuck for weeks in Denmark－where the vaccine is made－waiting for approval from the Food and Drug Administration, or FDA, which came in late July.

At the time of the first diagnosed case, the federal government's national stockpile amounted to about 2,400 doses of monkeypox vaccine in the US, according to The Associated Press. It needed tens of thousands more.

The federal rollout of vaccines was severely delayed because the FDA said it first needed to inspect Danish vaccine maker Bavarian Nordic's facility in Denmark where it fills vials. The vaccine is kept there because its freezers can keep it at minus 50 C.

Dawn O'Connell, head of the Administration for Strategic Preparedness and Response, which oversees the national stockpile, ordered 36,000 vaccine doses on May 20 and an additional 36,000 doses on May 27. It hasn't been enough.

Monkeypox infections rose during Pride activities in June, a month when gay men and women celebrate their sexuality with parties. Many contracted monkeypox, according to media reports.

More doses of the vaccine began arriving in the US in July. But the delay in shipments likely helped spread the virus that causes painful symptoms, public health officials said.

David Dowdy, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, told China Daily: "In retrospect, I do think that the CDC was a bit too slow to respond to the monkeypox outbreak. The main reason for this is that, unlike COVID-19, monkeypox is a disease that has been with us for decades－and without causing major outbreaks like the one we are experiencing now.

"Again, in retrospect, it's easy to see how the conditions were different this time, and how the current outbreak could have been anticipated a bit better, but I think there was some complacency because we hadn't seen major global outbreaks of monkeypox before."

Viral infection

Monkeypox, a rare viral infection, is spread through skin-to-skin contact. It also spreads if someone touches linen used by an infected person. Symptoms include a fever, a distinctive rash with bumps with zits on the body, aches and fatigue.

It had previously most commonly been seen in African countries. This year's outbreak began in Europe.

While it has mostly affected gay and bisexual men in the US, it also has affected some in the general population. A child in New York has contracted the virus, so too have 11 more children nationwide. A pregnant woman who delivered her baby this year also contracted monkeypox. Her baby didn't.

Several public health officials believe that the US made similar mistakes in monkeypox testing, treatments and vaccines as it did in the coronavirus pandemic.

In July, Scott Gottlieb, an FDA commissioner during the presidency of Donald Trump, heaped criticism on the US response to monkeypox in a New York Times opinion article he wrote.

"Our country's response to monkeypox has been plagued by the same shortcomings we had with COVID-19," he said.

"Now if monkeypox gains a permanent foothold in the United States and becomes an endemic virus that joins our circulating repertoire of pathogens, it will be one of the worst public health failures in modern times not only because of the pain and peril of the disease but also because it was so avoidable."

Dowdy, however, disagrees. "COVID-19 has killed millions of people, whereas that is unlikely to happen with monkeypox", Dowdy said, adding that everything should be done to curb the spread of monkeypox.

A simple test can easily identify monkeypox. But at the beginning of the outbreak, only tests that were produced by laboratories affiliated with the CDC were authorized for use, which created a backlog in testing.

Local officials also followed CDC guidance that stated tests could only be given to patients with visible lesions, or rashes－both signs of monkeypox. Then they could do contact tracing.

Lack of testing

The problems with monkeypox testing were reminiscent of the early days of the COVID-19 pandemic. The CDC developed its own test for the coronavirus that turned out to be faulty. This lack of testing let the coronavirus spread further, data shows.

Monica Gandhi, a professor of medicine at the University of California, San Francisco, told China Daily that "the problems with our testing platforms and unified messaging" hurt the response to COVID-19.

Today, several commercial laboratory chains are producing tests for monkeypox, but the initial delay in the CDC-affiliated tests may have contributed to its spread.

Another misstep by the CDC on monkeypox was made on medication, say doctors.

The medication tecovirimat is highly effective against smallpox and monkeypox. But, at the start of the outbreak, the CDC required doctors to go through a long-winded application process for each patient to get the drug. This further slowed down the distribution of the medication.

Hot spots for monkeypox, according to CDC data, include New York with 2,744 confirmed cases; California, 2,663; Georgia, 1,066; Florida, 1,372; and Texas, 1,079.

Officials in New York, the epicenter of the monkeypox outbreak, said the initial response was slow due to a lack of tests.

In July, Governor Kathy Hochul announced that the New York City Department of Health and Mental Hygiene had approved Quest Diagnostics to test for monkeypox in New York.

The city then sped up appointments offering the first dose of the vaccine to people at high risk. But it warned that appointments for the second dose would be delayed, until it had more supply. It should be given 28 days after the first dose. Many gay men got vaccinated.

San Francisco and Washington, DC, are following New York's plan. The vaccine is also being "stretched" to allow for more shots.

In a groundbreaking admission, Rochelle Walensky, director of the CDC, delivered a scathing assessment of her agency's response to the country's biggest public health emergency.

"To be frank, we are responsible for some pretty dramatic, pretty public mistakes, from testing to data to communications," Walensky said of the agency's response to COVID-19. "This is our watershed moment. We must pivot." She made the comments in a video on Aug 17 to the CDC's 11,000 employees.

Since the beginning of the outbreak, local health departments in all states have not had enough monkeypox vaccines to meet demand.

US health officials currently need to vaccinate 1.6 million people at high risk from the virus. In July, the White House announced tens of thousands of vaccine doses would soon be distributed.

In mid-August, the White House further announced a deal to expedite 2.5 million vials of monkeypox vaccine from Bavarian Nordic to the US by moving production to a company based in Michigan. The first doses will be ready at the end of the year.

"This partnership will significantly increase the capacity to fill and finish government-owned doses for the first time in the United States," White House monkeypox coordinator Bob Fenton said in a statement.

An additional 1.8 million doses will be available for order on Monday.

Global emergency

Monkeypox was declared a global public health emergency on July 23 by the World Health Organization. The US followed with an emergency declaration on Aug 4.

However, US clinics that care for LGBTQ people still get calls daily from patients who want to get vaccinated.

Demetre Daskalakis, White House national monkeypox response deputy coordinator, said on Friday that a new vaccination program is targeting people attending LGBTQ events.

The CDC plans to ramp up investigations into how the virus is transmitted, help doctors identify cases and strengthen contact tracing nationwide. It will also share key information with Nigeria and other African countries where outbreaks are common.

During the COVID-19 pandemic, Trump admitted to journalist Bob Woodward that he "played down" the severity of the coronavirus.

Following an initial review of her agency, Walensky vowed on Aug 12 that the CDC will be more transparent when communicating information to people and local health authorities.

She said the CDC had lost the trust of the public and must work to win it back.

Dowdy will be among those watching the agency's progress. "I think we need to wait and see what actual changes the CDC implements," he said.

"I think that improving messaging is an important first step, but I think that the CDC will be considering other changes as well."