Monkeypox in the US: What does the future hold?

The slight recent reduction or leveling-off of cases in the U.S. has not been reported in other nations.

For people who have been infected and for whom gender data is available to the CDC, 17,189 cases are men, 408 cases are women, 36 are transgender men, 117 are transgender women, 155 are people with another gender identity, and there is one person with multiple gender identities.

There have been 28 possible cases of children under 12 being infected with monkeypox, though the CDC says some of those cases remain under investigation.

Dr. Patrick E. H. Jackson, infectious disease expert at the University of Virginia, agreed with the CDC, telling Medical News Today that “[m]ost people who do not have identifiable sex or occupational risk factors are unlikely to benefit from vaccination.”

However, he added “that people should consider vaccination based on their specific risk factors.”

“There are some people who may want to get vaccinated for monkeypox who are not men who have sex with men — for example, people who are not [men who have sex with men] but have sex partners who are [men who have sex with men], sex workers who are not [men who have sex with men], and some laboratory workers.”

So far, demand for the vaccine has not been as robust as it could be, said Dr. William Schaffner of the Vanderbilt University School of Medicine in Nashville, TN.

He told MNT that “it took a while to get it available, but it’s been available, [and] it’s not as though there’s been a huge demand. The requests have been steady, but there’s nothing overwhelming.”

“So our health departments have not been swamped, and they’ve taken to trying to do much more outreach to the affected population […] to try to get them to come in and take advantage of the vaccine,” he pointed out.

Dr. Schaffner suggested what may be behind the low demand for vaccines. “I think some of the things that we’ve heard,” Dr. Schaffner added, “are that this is not really a fatal disease, sometimes very mild,” and so people may not feel a sense of urgency.

Dr. Schaffner further cautioned: “Remember, there are a lot of people who are still in the closet, and coming out to a public health venue to actually request the vaccine — even though this is done in complete confidence — might make many, at least, some of those people, uneasy because it exposes them potentially to being revealed. Asking for the vaccine basically says, ‘I’m a member of this community,’ and they may not all be ready to do that.”

“We still have a lot of work to do to normalize being proactive about sexual health and empower people to protect themselves,” said Dr. Jackson.

“I worry that the recent reactionary turn in our political discourse, particularly aimed at transgender individuals, will only heighten that stigma and make addressing the sexual health of all people even more challenging,” he added.

Moreover, in his opinion, “there was always going to be little appetite on the part of political leaders and the general public to mobilize more resources to fight a new infectious disease after two years plus of the COVID-19 pandemic.”

“The fact that the large majority of cases of monkeypox have occurred among [men who have sex with men],” continued Dr. Jackson, “has only made it easier for some politicians, who were engaging in an intensifying attack on the LGBTQ community even before this outbreak, to ignore the problem.”

“This is, unfortunately,” noted Dr. Jackson, “a recurring theme in the field of infectious diseases: The burden of almost any infectious disease falls most heavily on marginalized communities.”

Dr. Schaffner, nevertheless, takes heart from the fact that “[t]his is a population to which public health has been devoted for years because of HIV, and it has very, very, good relationships with leaders and community organizations.”

The CDC writes:

“Our current assessment for the most likely longer-term scenario is that the outbreak will remain concentrated in [men who have sex with men], with cases slowing over the coming weeks, and falling significantly over the next several months. We have moderate confidence in this assessment.”

As to the long-term future, though, the agency is less optimistic, citing a number of unknowns going forward.

“I agree with the CDC,” said Dr. Schaffner. “I don’t think this is an infection we can eliminate.”

“But it is an infection,” he continued, “that may join the other infections that are transmitted largely through sexual intimacy that occur in our population.” However, “the longer it continues in our population, the more likely it is to spread beyond the currently affected communities.”

“And so down the road,” predicted Dr. Schaffner, “our strategies for diagnosis, treatment, and certainly prevention may well have to change.”

“At the moment, they continue to be focused on this community because that’s where the vast majority of cases still are,” he said.

“Monkeypox,” concluded Dr. Jackson, “is not a new disease, but when it appeared to be confined to Africa, very few people cared enough to develop vaccines and treatments.”

“The world is only getting smaller, and we will inevitably see both the emergence of novel diseases, like COVID-19, and outbreaks of known diseases in new areas, like Ebola and monkeypox,” Dr. Jackson warned.

“Western governments need to start taking global health more seriously, if not out of humanitarian motivations, then out of pure self-interest. If we don’t learn to fight infectious diseases abroad, we will eventually have to fight them at home,” he emphasized.