Monkeypox is spreading rapidly throughout the world, and the United States' response to the outbreak has been "plagued by the same shortcomings we had with Covid-19," former FDA Commissioner Scott Gottlieb writes in the New York Times. He argues this could lead to "one of the worst public health failures in modern times."

Why the US response to monkeypox is drawing comparisons to Covid-19

The US response to monkeypox

In May, there were around 100 confirmed or suspected cases of monkeypox in Europe. Some experts suggested the outbreak was already spreading not just in Europe but in the United States as well.

According to Gottlieb, that "should have been a code red for federal infectious disease response." But CDC didn't expand testing for monkeypox until late June.

"If American leaders wanted to quash the outbreak, the United States should have been testing all people who presented with what was presumed to be atypical cases of diseases like genital herpes and zoster infection," Gottlieb writes. That strategy may have required 15,000 tests a week, according to Gottlieb, but from mid-May until the end of June, only around 2,000 samples were tested in the United States.

The United States has also lacked a sufficient supply of monkeypox vaccine, similar to how it lacked a sufficient supply of testing equipment, ventilators, and masks at the start of the Covid-19 pandemic, Gottlieb writes. In mid-May, the United States had just 2,400 doses of Jynneos, the vaccine used to prevent monkeypox.

Gottlieb's proposals for change

According to Gottlieb, the United States needs to change the role CDC takes and have the agency "lead America's response to viral exigencies." As it stands, CDC "isn't a crisis organization" and "lacks the infrastructure to mobilize a rapid response and is too hidebound and process driven to move quickly," Gottlieb writes.

While CDC "has the boots on the ground that provide the frontline needs for attacking" viral outbreaks, including "its sophisticated tools for detection and surveillance," the agency "lacks … the authority and a national security mindset," Gottlieb writes.

To address this, Gottlieb writes that the Biden administration should transfer some of CDC's disease prevention work to other agencies within the federal government. For example, FDA could use its regulatory abilities to tackle smoking cessation, while NIH could address cancer and heart disease.

Then, CDC could focus its core mission on disease control, Gottlieb writes. If that were to happen, Congress "might be more willing to invest it with the robust authority to do that targeted mission well," Gottlieb writes.

"Time is running out. Diseases like Zika, Covid, and monkeypox are a dire warning that dangerous pathogens are on the march," Gottlieb writes. "The next one could be worse—a deadly strain of flu or something more sinister like Marburg virus. We've now had ample notice that the nation continues to be unprepared and that our vulnerabilities are enormous."

If monkeypox "gains permanent foothold in the United States and becomes an endemic virus," Gottlieb says "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." (Gottlieb, New York Times, 7/30)