Three Possible Futures of the Monkeypox Epidemic

The Biden administration made a decision last week to declare the monkeypox epidemic a public health emergency in the US, which should make it easier for the government to respond to the epidemic. It is a hoped-for pivot as well as an inflection point. The declaration gives us a chance to look at what has already been done, assess the opportunities that have already passed us by, and ask what is the best thing to do next.

The US is thought to be embarking on a giant Choose Your Own Adventure that could have wildly different results. It's difficult to reach the best end. It requires more than just an assessment of what can be created. What kind of world are we going to live in? Is it a society that learned the lessons of the Covid epidemic, about not neglecting preparedness, not reserving the products of research for rich nations, and not consigning some people to run the most risk because of race, geography, or gender? Is a society that learns from its mistakes a second time?

The boldest path is choice one.

The world learns from Covid and tries to stop the next threat.

In that option, "every country, whether they have a case or not, is stepping up to do the things that are necessary for containment: vaccinating populations at risk, making testing widely available, investing in therapeutic drugs," says Wisiam Goedel, an epidemiologist and assistant professor at the We had a similar situation with Covid. We have everything we need from the start.

Monkeypox wasn't a disease that came without warning. It was first identified decades ago as a rare disease that spread from forest wildlife to villagers who hunted the animals. During his time in the Obama administration, Thomas R. Frieden heard concerns about it. The CDC was worried about monkeypox getting out of control while he was in Africa. There wasn't enough money to do the research, to partner with African scientists, to better understand and control the transmission. A group of Nigerian scientists published a warning about the change in the behavior of the virus.

There is a chance to learn from the warnings and the Covid epidemic. The best way to bring the situation under control in the US will be by broad deployment of vaccines. Two faculty members and four PhD students from Brown and the Yale School of Public Health published a preprint last week that shows how much public-health intervention would be needed to stop monkeypox from spreading further. It would take 40 percent of cases to be detected through tests and 50 percent of contacts to be traced without the vaccine. If at least a third and a half of the men at the highest risk are given the vaccine, the epidemic can be brought under control.