Monkeypox: A Rise and Fall

In my email this morning was my New York Times daily newsletter. I don’t always read the NYT newsletters, but this on peaked my interesting because the title was “What happened to monkeypox?”, and I recently got my first dose of the monkeypox vaccine. By the way, the actual vaccination was very easy, and I barely felt anything. In fact, the doctor who gave it to me remarked on how well I did and that I didn’t even flinch. However, that was two weeks ago, and there is still a raised red blemish where I received the injection. Supposedly, this is the most common side effect, and the only one I had with the first dose. I go back at the end of the month for my second dose.

 

Anyway, so back to the newsletter titled “What happened to monkeypox?”. Back in June, monkeypox regularly made headlines as a major new disease outbreak. Since then, it largely disappeared from the news. So, what did happen? The simple answer is that the virus receded. Since a peak in early August, reported monkeypox cases in the U.S. have fallen more than 85 percent. Monkeypox shows us how effective a well-received vaccination rollout can accomplish so much. 

 

The NYT gave several explanations for why there was a decline. Ultimately, monkeypox in the U.S. has been contained to a narrow demographic, mostly gay and bisexual men with multiple partners. It was never very deadly; there were just 28 confirmed deaths globally out of more than 72,000 reported cases. Experts say that four factors explain monkeypox’s decline. First, vaccines helped slow the virus’s spread (despite a rocky rollout). Second, gay and bisexual men reduced activities, such as sex with multiple partners, that spread the virus more quickly and the third reason is related, the Pride Month effect. Monkeypox began to spread more widely around June, when much of the world celebrated LGBTQ+ Pride. Beyond the parades and rallies, some parties and other festivities involved casual sex. As the celebrations dwindled, so did the increased potential for monkeypox to spread. And finally, the virus simply burned out. Monkeypox mainly spreads through close contact, making it harder to transmit than a pathogen that is primarily airborne, like the coronavirus. The monkeypox virus is self-limiting virus, which makes it less likely to grow into a larger outbreak.

 

Much of this explanation may sound familiar after more than two years of Covid: A virus can be tamed by vaccines and behavioral changes. Two more reasons worth noting. First, public health officials provided a clearer and more unified message. During COVID, officials sometimes gave unclear or misleading guidance because they did not trust the public with the truth. At first, officials were cautious about labeling monkeypox as a “gay disease” because of the response to the AIDS epidemic and the discrimination and stigma it created for the gay community. The initial response was slow because of this. 

 

After the World Health Organization’s director general said that men who have sex with men should consider limiting their number of sexual partners, public health officials began tailoring their warnings toward gay and bisexual men. The C.D.C. and New York City’s health department echoed the guidance. A factor that the NYT did not seem to mention in its report is that gay men are more likely to listen to health warnings because of the lessons learned during the AIDS epidemic. And it appeared to work. Monkeypox cases began to decline. That shift in public messaging enabled two of the four factors I explained earlier, as officials targeted gay and bisexual men for vaccine drives, and men who have sex with men limited riskier activities. But the clearer guidance came after weeks of criticism, exposing a habit of unclear messaging that keeps the country vulnerable to health crises.

 

While Vermont was a leader in their COVID response, largely keeping the numbers low during the pandemic (with a few exceptions), they were lacking in their monkeypox response. There is one major reason and one anecdotal reason, that is my opinion only. The major reason is that there were very few cases of monkeypox in Vermont. The anecdotal reason is that we have fewer gay men. Lesbians outnumber us greatly. The initial Vermont response was that only gay men who had come into contact with someone exposed to monkeypox should receive the vaccination, which seemed to me like it would be too late. Eventually, the state health officials widened the access to any gay men in the state. However, while COVID vaccines were readily available, monkeypox vaccines were available at pop-up clinics organized by LGBTQ+ organizations in Vermont and Planned Parenthood. I went to a Planned Parenthood office for mine. As an aside, I have never met a nicer, more helpful, or more efficient medical practice than this Planned Parenthood.

 

As for monkeypox’s decline, no one know what might happen next as human behavior is unpredictable. That uncertainty opens the possibility that monkeypox could spread again. People most in danger of contracting the virus may skip the vaccine because its spread has slowed, or they could resume risky activities too soon before cases are low enough to stop another outbreak. Or another major event, like next year’s Pride Month, could bring monkeypox back.

And the virus still regularly spreads in western and central Africa, where it was first found in humans and has never been fully contained — putting it one flight away from the U.S. or Europe. Here’s the good news: This year’s outbreak has made officials take monkeypox more seriously. So, if it does come back, the country may be more prepared to deploy vaccines and take other steps to fight it. But success depends on how people react.

 

Another bright side is that if there is an outbreak of smallpox (unlikely but not impossible), many gay men would be vaccinated against smallpox as well, since JYNNEOS (the vaccine’s proper name) pretexts against both smallpox and monkeypox.