Monkeypox is a public health emergency in the United States, with some 15,400 cases recorded. The virus has rapidly become a globalized threat, with more than 43,000 cases reported across 95 countries. The World Health Organization (WHO) declared the outbreak “a public health emergency of international concern,” its highest alert level.
But as the alarm and case counts grow, it is increasingly clear that the U.S. and the global communities are repeating some of the hallmark failures of other global health crises, such as the COVID-19 pandemic and the HIV/AIDS epidemic. From mounting stigma and misinformation, to botched testing and vaccine rollouts, to the widening inequities in care, the parallels between Monkeypox, COVID-19 and HIV/AIDS should cause officials to reevaluate and redirect their approach to this latest public health emergency.
For example, many news reports refer to monkeypox as a sexually transmitted disease that only impacts the gay community. Both parts of this statement are false, yet the misinformation continues to reverberate in a disturbing echo of the discrimination against LGBTQ+ communities during the HIV/AIDS epidemic. Monkeypox is spread through close contact including, but not limited to, sexual contact — and anyone can contract the infection regardless of sexual orientation. Cases have also been reported by women, infants and incarcerated people. However, evidence of discrimination is emerging. For example, some commercial lab technicians have reportedly refused to draw blood from people who might have monkeypox.
Currently, in most states the monkeypox vaccine is allotted to “high-risk populations.” For example, New York City’s criteria includes men who have sex with men and who have had “multiple or anonymous sex partners.” Ongoing stigmatization of one’s personal and intimate sex life could deter people from seeking testing or care for monkeypox. The approximate 21 days of isolation after infection is difficult and demoralizing for anyone, but particularly for those who cannot share or discuss their diagnosis.
Currently, 98 percent of monkeypox cases are being reported in men who have sex with men. There is a clear imperative for health officials to develop monkeypox messaging and outreach not just for the LGBTQ+ community, but with the LGBTQ+ community. The early failings of COVID-19 vaccination practices are also appearing. Online portals to schedule monkeypox vaccinations have crashed. We are leaving behind the 21 million people in the United States who lack access to the internet. Offline and multilingual options to secure tests, vaccines and care are essential for any public health outreach.
We must also be vigilant and monitor inequities in access to vaccines, particularly around which communities receive them and whether there is a pattern to who receives the ACAM2000, a vaccine that is more available than JYNNEOS but is effective and has more side effects.
The infrastructure of the public health response to monkeypox is inadequate. Monkeypox testing has been highly inconsistent and subject to huge regional variations, with delayed results and numerous bureaucratic hurdles for clinicians and patients. This is devastatingly similar to the early response to COVID-19 in the United States, in which our early testing failures led to hundreds of thousands of preventable deaths.
Furthermore, decades of disinvestment in primary care and public health have resulted in missed opportunities for reaching more at-risk individuals and creating pathways to care that are not specifically linked to particular groups.
Lastly, one of the most appalling aspects of both HIV/AIDS and COVID-19 has been the global disparities in access to testing, vaccines and care. Monkeypox has spread in East and West Africa for several decades. When the infection started to reach white Europeans and Americans in larger numbers, global attention and mobilization of resources were suddenly given to the issue. News outlets and commentators must not contribute to stigma and xenophobia by painting monkeypox as an “African” disease. Even the name “monkeypox” is highly misleading and problematic. Monkeypox does not come from monkeys; the reservoir for it is in rodents. The WHO is rightfully working to rename the disease.
COVID-19 vaccines and HIV/AIDS treatment went to high-income, largely white countries and communities first. Wealthy nations hoarded COVID-19 supplies and blocked the technology transfer that would have allowed low- and middle-income countries to produce their own tests, vaccines and treatments. Not providing access to these life-saving resources in low-income countries was largely an oversight, and today only one in five people in low-income countries have received COVID-19 vaccines, as opposed to three out of four people in high-income countries. Similarly, people living with HIV in London or New York had access to high-quality, affordable and life-saving HIV/AIDS medications decades earlier than their counterparts in Kampala or Mumbai. This resulted in tens of millions of deaths and a “lost generation” in many hardest-hit countries, particularly in sub-Saharan Africa.
We cannot accept the status quo any longer. As high-income countries ramp up vaccine and treatment production, we must ensure that there is global equity and ethical responses. We are now repeating the mistakes of the past, but we have time to change course. Our response to the monkeypox outbreak will be successful and equitable if we heed the lessons from HIV/AIDS and COVID-19.
Dr. Ranit Mishori is a senior medical adviser at Physicians for Human Rights and a professor of family medicine at the Georgetown University School of Medicine.