A “slow and bureaucratic” response that saw monkeypox spread rapidly across the U.S. — with more than a thousand cases in New York alone — reveals how badly local health agencies are being hit by the Covid pandemic, advocates said.
Once a rare African virus, monkeypox has established itself among the fractured patchwork of city, county, state and federal agencies that make up the US public health infrastructure.
“Unfortunately, delayed action means that monkeypox has spread to the gay community and to other men who have sex with men,” said David Harvey, executive director of the National Coalition of STD Directors.
“This epidemic has become a public health crisis in America. We’re still in a very chaotic situation at the state and local level with an organized response.”
As an explanation for the chaos, many observers point to how Covid has changed the landscape for public health workers. Once considered neutral arbiters of information, many health officials have come under political attack following unpopular mask and vaccination policies.
Across the country, public health workers were harassed, threatened, fired, or simply burned out and left. The situation was not helped as resources that were once devoted to things like tracking infectious diseases such as tuberculosis or running routine vaccination clinics were suddenly diverted to Covid-19.
Sexual health clinics have also struggled as testing and staff resources have been dedicated to Covid-19, hurting organizations that have already suffered from years of underfunding.
The result is poorer health outcomes for many essential public health services: routine vaccinations for children have declined; overdose deaths exploded; and the US recorded a record high rate of sexually transmitted infections for the sixth year in a row.
As monkeypox spread, the Biden administration tried to respond by releasing about 1.1 million vaccines and increasing testing capacity, which has grown from about 6,000 to 80,000 a week. The World Health Organization declared monkeypox a global medical emergency this week, and the U.S. may follow suit by declaring monkeypox a national public health emergency, freeing up more resources for local agencies.
“The system is tired, it’s overworked, it’s underpaid, it’s understaffed,” said Laurie Tremmel Freeman, CEO of the National Association of County and City Health Officials. “All the same problems that plagued us during the pandemic are still with us and haven’t gone away.
“What adds to that, with monkeypox and beyond, is that we also have a workforce that has documented post-pandemic trauma.”
Public health advocates want the president and Congress to allocate more funding to the epidemic response and to sexual health clinics in general. Public facilities have proven to be the first line of defense against monkeypox, even though federal prevention funding for such work has dropped 41 percent since 2003.
“Local sexual health providers are being asked to respond to monkeypox amid America’s already out-of-control STI epidemic,” Harvey said. “We are at a tipping point: We need the Biden administration and Congress to immediately fund public health programs and clinical services for STIs.”
Although anyone can contract monkeypox, the virus has mostly affected men who have sex with men. Sexual health clinics have often responded on the front lines of the epidemic because of the way monkeypox can manifest its symptoms, with lesions around the genitals and anus – although sex is only one way monkeypox can spread. Any close contact with an infected person can spread the disease, including touching, kissing and hugging, as well as sharing cups, utensils, bedding and towels.
Although the virus, which belongs to the same family as smallpox, is rarely fatal, symptoms can be excruciating, with painful lesions and flu-like symptoms, according to the Centers for Disease Control and Prevention. Up to 10 percent of people reportedly require hospitalization, and many of them show up in emergency rooms because of severe pain, Freeman said.
The situation is made worse because testing for monkeypox is limited. There is no home test and results can take days. However, there is a vaccine that people at increased risk may be eligible for; they may also qualify for treatment with the drug tecovirimat, sold as TPOXX. But the barriers are significant, obtaining it can be difficult and tecoxiramit – usually reserved for people with severe symptoms – must be requested by doctors from the government’s national strategic national stockpile, which involves significant paperwork.
Also, people without insurance likely don’t have access to both a vaccine and a drug, Freeman said; about 12.7 percent of the LGBTQ+ community lacks health insurance, compared to 11.4 percent of the general population, according to an analysis by federal officials. Even if you have insurance, there are hurdles in the US health care system, such as trying to navigate between urgent care clinics, primary care providers and state health departments.
Freeman told a story about a local health department that requested information from its state about a monkeypox outbreak. The state responded to check with the CDC; CDC then reassigns local officials back to the state.
“There’s a lot of finger-pointing here,” she said. “We had to learn. We need to know more now than we did three years ago from our response to Covid [about] what should we do here