Why Monkeypox Wasn’t Another COVID-19
Thanks to public health and a little luck, this disease didn’t become a pandemic.
When you’ve lived through two-plus years of a pandemic, it can feel weird to see “disease” and “good news” in the same sentence. But here we are, watching a disease decline, with cautious optimism. Two weeks ago, the World Health Organization announced that monkeypox cases in Europe had fallen so fast, the outbreak could be eliminated there. And while the U.S. recently experienced its first monkeypox death, cases here have fallen by 40 percent between the middle and end of August. In other words, it’s too early to declare victory and dust off our hands, but the situation is generally improving.
This news shows that public health officials — and the public itself — got some important stuff right in combating this serious illness. But monkeypox is also a reminder that humans will encounter many potentially dangerous new diseases. COVID wasn’t the first, or the last. What stops most diseases from becoming pandemics is as much about luck as it is about human intervention.
This spring, many of us braced ourselves for the worst. Monkeypox seemed mysterious, and cases of it were soaring. But a positive outcome was not surprising to the scientists who study the disease. “One of the difficulties I’ve faced in public communication is trying to get people to understand that none of us who work in public health thought the sky was going to be falling from monkeypox,” said Jay Varma, a professor of population health sciences at Weill Cornell Medical College. “We were just concerned that a lot of people were going to suffer needlessly … because we had a diagnostic test, a drug to treat this and a vaccine to prevent it all stockpiled.” Monkeypox was, in other words, a serious disease that needed attention to make sure vulnerable groups were protected, but it was never likely to become the same kind of massive problem as COVID-19.
In August, scientists surveyed more than 800 men who have sex with men, trying to find out how monkeypox — and the education campaigns surrounding it — had affected their lives. According to results published by the Centers for Disease Control and Prevention, about half of the men made some important changes to their behavior. Of the 824 surveyed, 48 percent reported reducing their overall number of sex partners, 50 percent said they had reduced their one-time sexual encounters and 50 percent said they had reduced sex with people they met on dating apps and in sex clubs. Those voluntary behavioral changes as well as the public health campaigns that inspired them have been particularly crucial to curbing monkeypox, said Varma and Rodney Rohde, a professor of clinical laboratory science at Texas State University.
That’s because other studies have shown that while one-night stands account for only a fraction of sex happening daily among men who have sex with men — about 3 percent of daily sexual relationships — those interactions are responsible for about half of daily monkeypox transmissions.
Vaccination campaigns have also been important, but the behavioral changes seem to be more widespread in the high-risk community than vaccination has been, Varma said. “The original guidance from the CDC has been refreshingly frank and honest and transparent about what are the behaviors that put people at highest risk and what are the ways in which you can minimize your risk, without questioning whether sex is an essential activity to life,” he said.
But had the monkeypox outbreak happened just a few years ago, it might not have been on the radar of anyone outside the most affected communities. Dr. Sonja Rasmussen, a Johns Hopkins University professor of genetic medicine who worked at the CDC for 20 years, remembers a former director at the agency often saying that when public health did its job well, we never heard about it.
New diseases are popping up and entering the U.S. all the time, according to Rasmussen and the other experts I spoke with. But SARS-CoV-2 aside, most of them are swiftly and effectively shut down by the hard work of public health. “Remember that MERS outbreak … when there were two cases in the U.S.?” she asked, referring to the time in May 2014 when a particularly deadly cousin of COVID cropped up in unlinked cases in Indiana and Florida. “People would say, ‘I don’t even remember that.’ And … that’s because we dealt with it.”
We’re more likely to hear about these diseases now because everyone is much more primed to pay attention after a couple of years of COVID. But the reality is that thousands of people nationwide are working to ensure those diseases don’t spread unnoticed, that the highest-risk populations are treated, and that we don’t end up constantly marinating in preventable pandemics. That’s the good news.
The bad news: Not every pandemic is a preventable one. “We did get a little lucky [with monkeypox],” Rohde said. Yes, there’s pain involved and some risk of death, but if and when this disease is nipped in the bud, that will be in part because the virus makes itself relatively easy to prune. It’s not a respiratory virus that people can easily spread to strangers at the bus stop. The mode of transmission, primarily through sex, limits who can spread to whom. The transmission rate is also different from that of COVID, he said. And the mode of transmission means the virus affects primarily a high-risk group rather than all of society, so it’s easier to change behavior and administer pharmaceutical treatments. Monkeypox is also a DNA virus, not an RNA virus like SARS-CoV-2, so it mutates less than COVID and can be prevented with older, existing vaccines. Those are the kinds of outbreaks humans can stop from turning into pandemics. Of course, both scientists and the public have to take action when they pop up, but it’s relatively easy to manage.
Most new or new-to-us diseases that appear will have more in common with monkeypox than with COVID. They’ll be dealt with. And you’ll forget you ever saw them on the news. But, eventually, another pathogen will come along that’s more challenging just by its nature – another fast-spreading, fast-mutating respiratory virus that hits everybody all at once. “I am concerned as we move away from COVID that we’re going to say, ‘That’s our pandemic. We don’t need to fund [public health infrastructure] anymore,’” Rasmussen said.
Unfortunately, one of the biggest takeaways from this monkeypox outbreak and how it was handled is a paradox. You don’t need to assume that every new disease you hear about will be another uncontrollable pandemic, so you can let that tension go. But, at the same time, that doesn’t mean another pandemic won’t happen in your lifetime. Somebody needs to be on the job, paying attention.
“It doesn’t matter if you’re tired, if you’re fatigued, if you’re done with it,” Rohde said. “Those [infectious diseases] don’t care. They never get tired.”