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United States Must See Monkeypox Emergency as an Opportunity To Reestablish Global Health Security Leadership

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Nathan Myers
August 15, 2022

On Thursday, August 4th, the Biden administration declared the monkeypox outbreak in the United States to be a public health emergency. This comes after the World Health Organization’s July 23rd declaration of monkeypox as a public health emergency of international concern. The United States seems to be repeating a number of missteps taken during the beginning of the COVID-19 pandemic. As monkeypox has spread from Africa to four other continents, one of the errors has been the failure to exercise global leadership on the issue. One step that the United States can take is to coordinate international genomic surveillance and analysis.

Up until this point, the United States has fallen short in its own domestic surveillance efforts. The New York Times notes in regard to monkeypox “tests have been difficult to obtain, surveillance has been spotty and it has been challenging to get an accurate count of cases.” Meanwhile, the federal government is still reliant upon often underfunded state and local public health agencies to provide them the information necessary to get a full picture of the state of monkeypox in the country. Not only are state and local public agencies lacking in financial resources, but they lost a significant segment of their personnel during the COVID-19 pandemic as well, as many states had existing authorities taken from them. The U.S. federal government should set an example for other affected nations by taking affirmative actions to strengthen public health agencies at all levels.

As reported by Kaiser Health News, initial testing was done by the Laboratory Response Network, with which many physicians are unfamiliar. Five commercial labs were eventually brought into the mix, but the delay speaks to the need to integrate public and private labs and to streamline and simplify the collection and submission process. The United States was once a global leader in modeling the establishment of public-private partnerships to solve wicked problems. It must do this again within the public health sphere. Another way in which the United States should exert leadership is by combatting the stigma that monkeypox is predominantly affecting men who have sex with other men (MSM), as has been widely reported. A stronger domestic testing regime would provide meaningful data on the degree to which the virus is being spread outside of that particular population and how much more likely the MSM population is to contract monkeypox. Even in urban centers, rather than testing for monkeypox doctors have defaulted to testing for other sexually transmitted diseases, delaying diagnosis and treatment potentially exposing others to infection. The United States must establish an international role in making sure the mistakes of HIV/AIDS are not repeated and that prejudice does not get in the way of medical and public health intervention.

The United States should also set an example for demonstrating the equitable yet proportionate distribution of resources within its own borders. For example, public health officials in New York City are arguing that they must receive testing support proportionate to the threat they face, and not equal to less affected cities. The question of proportionate resources is also important given the limited U.S supply of the vaccine, Jynneos. Creating more robust surveillance in the United States will help to best target those limited resources where they are needed most. The United States should help to operationalize that principle internationally as well. This will involve streamlining the testing system so that positive tests for orthopoxvirus don’t have to go to the CDC to confirm they are in fact monkeypox. Increased use of genomic analysis could also be a valuable tool in this area.   

 The use of genomic analysis can help to answer outstanding questions regarding monkeypox, as well as address a number of issues hindering response to the outbreak. As reported in Science scientists are working to trace the spread of the virus and monitor for mutations by sequencing viral samples. However, this is a more laborious task due to the monkeypox genome being seven times larger than the SARS-CoV-2 virus. Internationally, seven African countries are using improved genomic sequencing capacity developed during the COVID-19 pandemic to track the spread of monkeypox across the continent. The World Health Organization sought to boost this capacity by training lab technicians from 20 different countries in monkeypox sequencing. Researchers in Portugal followed the example of Chinese scientists during the COVID-19 pandemic by sharing an early draft of the genome of the monkeypox virus.

During the COVID-19 pandemic, the United States fell unfortunately short in its use of genomic surveillance to try to contain and control the virus. However, that need not be the case with monkeypox or future outbreaks. Not only can the Biden administration coordinate an improved genomic surveillance system within the United States, but it can exercise international leadership to encourage the use of genomic surveillance to track and manage the global crisis. President Obama exercised global health leadership through the Global Health Security Agenda and other initiatives. Now is the time for President Biden to show that not only is the United States not turning a blind eye to monkeypox, but it is helping the world to see its way through the crisis.

Author: Nathan Myers, Ph.D. is a Professor in the Department of Political Science and Director of the Master of Public Administration at Indiana State University. His areas of research include public policy, public health emergency preparedness, and the governance of biotechnology. He is the author of “Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies.”  Myers serves as an academic advisor to the Continuity of Supply Initiative and assistant director of Indiana State’s Center for Genomic Advocacy. Email: [email protected] Twitter: @nagremye1980

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