5 Facts About the Monkeypox Outbreak

As the United States deals with increasingly transmissible variants of COVID-19, another public health threat has emerged. Cases of monkeypox—also known as “mpox” or “MPX”—are rising around the world,* but the outbreak is disproportionately affecting the United States, with more than 21,500 U.S. cases reported to date. In response, the U.S. Department of Health and Human Services (HHS) declared monkeypox a public health emergency on August 4, 2022—a move that grants the agency more flexibility and additional authorities to combat the outbreak.

Policymakers must provide public health officials with the tools to effectively and appropriately respond to monkeypox and to create sustainable public health systems before the next inevitable threat. To help inform these efforts and combat growing misinformation, this article details five important facts about monkeypox.

1. Monkeypox is less contagious and less dangerous than COVID-19

The monkeypox virus is spread through prolonged contact with an infected individual—including direct skin-to-skin contact with open lesions or bodily fluids, close face-to-face contact, or, less commonly, contact with contaminated clothing or linens. Given that monkeypox’s mode of transmission requires intimate contact, it is much less contagious than COVID-19. Research shows that someone infected with the COVID-19 omicron variant will pass the disease to eight other people on average, as opposed to less than one person for someone infected with monkeypox. Additionally, the version of the disease responsible for the current outbreak is very rarely—less than 1 percent—fatal, albeit very painful and uncomfortable.

Yet the public is not well-informed about the facts. A July 2022 Annenberg Science Knowledge survey found that 48 percent of Americans were unsure if monkeypox is less contagious than COVID-19 and nearly two-thirds (66 percent) were unsure whether there is a vaccine for monkeypox. Ensuring educational materials are updated with the most recent and accurate information is key to empowering the public and combating swells of misinformation. The Centers for Disease Control and Prevention (CDC) is currently restructuring its communications office to improve the accessibility of public health guidance, increase employee retention, and speed up the production of actionable data. Additionally, the Office of Science and Technology Policy’s call for science publishers to make monkeypox-related research and data accessible to the public could help improve the availability of accurate information.

However, it is also vital that this information is shared with the public responsibly. The rise in health disinformation during the COVID-19 pandemic has shown the important role that social media companies can play in protecting—or endangering—public health. Product-level changes to social media platforms, alongside policy efforts that increase accountability, are key to preventing the spread of misinformation and disinformation.

2. While there is risk of infection for everyone, men who have sex with men and Black and Hispanic communities are most affected

The overwhelming majority of U.S. cases (94 percent) are among gay, bisexual, and other men who have sex with men, with the disease largely being spread through sexual or close, intimate contact. However, monkeypox is not a sexually transmitted infection. Although men who have sex with men are currently at higher risk, any person, regardless of sexual orientation or gender identity, can acquire and spread monkeypox. Indeed, some cases have been found in transgender and nonbinary people, cisgender women, and children.

Given the historical stigma toward the LGBTQ+ community, careful messaging on monkeypox is important. Public health officials have focused on transparency about the outbreak being concentrated among men who have sex with men, while also reinforcing that anyone can become infected as to balance downplaying risk against increasing stigmatization. Close partnership with trusted messengers, community organizations, and advocates—including additional support for LGBTQ+ events—should continue to be strengthened to reach those at greatest risk.

At the intersection of race, gender identity, and sexual orientation, data also show that Black and Hispanic men bear a larger burden of the disease. Indeed, Black people make up nearly 38 percent and Hispanic people make up 29 percent of monkeypox cases, despite only comprising roughly 12 percent and 19 percent of the population, respectively. In certain areas, disparities are even more pronounced: For example, in Georgia, 82 percent of monkeypox cases are among Black people, even though they only make up a third of the state’s population. Similar to with COVID-19, these disparities are driven by structural disadvantages and understated. Only 48 percent of the cases reported to the CDC have race and ethnicity data. And data collection efforts on sexual orientation and gender identity also need to be expanded. Giving CDC greater data authority would ensure the availability of consistent, standardized information to track public health threats nationally and issue actionable guidance promptly.

The lack of comprehensive disaggregated data early on in the monkeypox outbreak led to inequities that left people of color behind in the distribution of limited vaccine supplies, leading to lower rates of vaccination. Public health officials must develop solutions that prioritize communities of color, including by establishing strategic testing and vaccine locations, reserving a proportion of doses for people of color, offering walk-up appointments, and spreading information through avenues and messages that specifically cater to Black and Hispanic communities and their concerns. To build trust, state and local officials could, for instance, follow North Carolina’s move to be transparent about the lack of equity in its monkeypox response and plans to improve.

3. The Jynneos vaccine for monkeypox is safe and effective

The Jynneos vaccine, which has been approved for use since 2019, is the primary vaccine against monkeypox. Thankfully, the Jynneos vaccine already existed at the start of the outbreak because of U.S. investment in its development more than two decades ago. At 85 percent effectiveness, it is the best way to protect against infection for those most at risk. Other ways to mitigate risk include avoiding close contact with those who have symptoms, avoiding contact with objects and linens used by someone infected, limiting sexual partners, practicing good hand hygiene, and wearing protective gear such as gloves and masks when interacting with someone infected.

Although treatment options may be available for those at higher risk of severe disease, preventing infection through vaccination is the strongest method of protection. However, growing vaccine hesitancy in America catalyzed by the COVID-19 pandemic could affect uptake and threaten efforts to control the monkeypox outbreak, as it has with other infectious diseases. For example, despite a successful vaccination campaign leading to the eradication of polio in the late-1970s, wastewater surveillance shows the virus resurfacing in New York. Along with transparency on safety and effectiveness and building trust through partnerships, emphasizing the medical community’s experience with both the monkeypox disease and its vaccine could encourage vaccine participation.

4. The monkeypox outbreak reflects the continued underlying disinvestment in public health infrastructure revealed by COVID-19

Some of the early challenges in the U.S. response to the monkeypox outbreak mirror those seen at the beginning of the COVID-19 pandemic. The nation’s reliance on fragmented and underresourced data and laboratory systems to track and monitor disease makes it challenging to target resources effectively. Limited testing capacity led to backlogs that were amplified by the delay in expanding authorization beyond public health laboratories to include commercial laboratories. Narrow testing criteria also made access challenging and likely led to initial case underreporting.

Vaccine supply and access have also been a major challenge. Due to chronic underfunding, the Strategic National Stockpile (SNS) had only 2,400 viable doses of the Jynneos vaccine when the monkeypox outbreak first emerged in mid-May 2022—as compared with the 120 million doses officials said were needed in case of a smallpox resurgence. The country had roughly an additional 800,000 doses stored at the manufacturer in Denmark whose shipment awaited U.S. Food and Drug Administration (FDA) inspection. Vaccine access was also hampered by an untested, inefficient delivery system from the SNS to states put in place by the newly elevated Administration for Strategic Preparedness Response (ASPR). Shipments have been delayed or lost, not been stored properly, and left officials in large states scrambling to figure out how to disburse shipments from delivery sites. Moreover, targeted vaccination campaigns for those at highest risk in the United States began weeks after they did in other countries, delaying containment efforts.

Investment in the already fragile public health system is urgently needed. Congress must authorize the administration’s emergency supplemental funding request to combat monkeypox and other threats, allowing the United States to immediately purchase more tests, vaccines, and treatments. Beyond that, sustained funding is needed to keep the SNS fully stocked, expand public health lab capacity, and modernize public health data systems—three issues that proved costly in containing monkeypox. In addition, Congress should establish a new leadership position within HHS tasked with developing a federal public health system that coordinates preparedness and response efforts across CDC, ASPR, FDA, and other agencies.

5. Efforts to prevent the spread of monkeypox globally are key to controlling the U.S. outbreak

The threat of a global monkeypox outbreak has been building for more than a decade. In 2010, public health researchers noticed that rates of monkeypox in the Republic of Congo had increased significantly and warned of the importance of containment while the virus was still geographically limited. In 2017, Nigeria confirmed its first case in more than 40 years, and more followed—particularly among young men. During that outbreak, treating physicians in Nigeria noted sexual contact as a new method of transmission. However, these warning signs were largely ignored until 2022 when the disease spread to the West. The Nigerian cases are thought to be the origin of the outbreak spreading globally now.

Some critics believe that earlier attention and support from Europe, the United States, and others to cases in western and central Africa could have tapered the current outbreak. In contrast to the near-immediate availability of vaccines for at-risk groups in the United Kingdom and the United States once monkeypox was declared a public health emergency, Africa still has virtually no vaccines. Wealthy countries have been able to stockpile resources, while long-affected African countries continue to lack testing capacity, vaccines, and anti-viral treatments—highlighting massive inequities that threaten global health.

The United States has an important role in protecting global health by providing resources and research support internationally. Safeguarding the permanence of the Global Health Security and Biodefense unit of the National Security Council—which was disbanded under the Trump administration but later reinstated under President Joe Biden—would ensure a targeted focus on the threat of disease to national security and the development of global response efforts. The Biden administration has also expressed a commitment to combating monkeypox globally, which should include making tests and vaccinations available to those African countries hit hardest.

Conclusion

While the monkeypox outbreak has challenged an already underresourced system, there are some advantages to how the country has handled monkeypox versus COVID-19. To start, tests were available before the outbreak began, and officials ensured they were accurate before distribution. As part of the U.S. national monkeypox vaccine strategy, successful efforts to procure more vaccine doses began almost immediately after the first cases were identified, such that more than 1 million doses have now been made available. To further alleviate gaps, the FDA acted quickly to approve an innovative administration method between skin layers that would allow each vial to cover five times as many people. And in late August, $11 million was committed to supporting additional manufacturing capacity for the vaccine.

These efforts emphasize the need to continue investing in the research and development of vaccines, therapeutics, and the workforce and infrastructure needed to prevent and combat potential public health threats.

The author would like to thank CAP’s Health Policy team, Caroline Medina with the LGBTQI+ Research and Communications Project, Erin Simpson with the Technology Policy team, and Max Hoffman with the National Security and International Policy department for their thoughtful review of this column.

*Author’s note: Many critics have expressed concerns with the name of the monkeypox disease, as it evokes harmful racist stereotypes about Africa, Black people, and the LGBTQ community, ultimately stigmatizing the groups most affected by the disease. Efforts to rename the disease and its virus are ongoing through the World Health Organization. For the sake of clarity, the author has chosen to continue use of the current scientific name: “monkeypox.”