Monkeypox Outbreak Could Be Fueled by Similar Misinformation, Stigma and Inequities to COVID-19, HIV

Time continues to be of the essence to combat the spread of monkeypox, despite the many challenges presented by misinformation and inequities. According to the Centers for Disease Control and Prevention, monkeypox may incubate for one to two weeks before a person develops any symptoms. The delay may present an obstacle to tracking the numbers accurately as monkeypox spreads through a population, and it could hamper a powerful and speedy response. 

Misperceptions about the nature of monkeypox, who contracts it, and how it is spread may deter people from accessing vaccines and treatment, says Dr. Alissa Davis, an epidemiologist and Associate Professor at the Columbia School of Social Work. And longtime inequalities may determine who receives vaccines, testing, and care. Here are some insights and clarifications from an expert who has studied HIV and sexually transmitted infections, among other widespread health issues.

“Overall case numbers of monkeypox remain relatively low,”, says Davis, “but they are growing, and current numbers are likely an underestimation.” The US can learn from its failures to promptly address the COVID and HIV pandemics. “I think there is still the potential to contain the outbreak, but it’s also possible it could become an entrenched virus if we do not take sufficient action or dedicate enough resources in time.”

Davis also states that while tests for monkeypox have been developed, they are not widely available. Currently, tests are in limited supply and don’t detect early cases. “A direct swab of a monkeypox lesion is currently the only reliable way to test for the disease,” she explains, but these lesions develop later than symptoms such as aches, chills, and exhaustion. “However,” she cautions, “in the initial stages of infection, monkeypox may still be present in saliva or urine and can still be transmitted.”

Despite widespread misinformation to the contrary, monkeypox is not a sexually transmittable disease. Although sexual contact is one of the ways the virus can be spread, Davis says, it is not categorized as an STD. A person might also contract the virus through prolonged face-to-face contact, respiratory secretions, or contact with infectious scabs or a rash.

 “The danger of the media labeling this as an STD is that some people may think wearing a condom will prevent transmission,” Davis cautions, “but that isn’t the case. Monkeypox can still be transmitted even with condom use.”

“COVID fatigue” creates an additional concern, as it may create an opportunity for monkeypox to spread. Since the spring of 2020, protecting oneself from COVID has been an uppermost health concern for many. Davis explains that “many people are experiencing COVID fatigue and are resistant to take further protective measures against another virus, especially if they do not view themselves at high risk.” Vaccines exist that can protect people from monkeypox exposure, but after two years of rigorous precautions and vaccines bringing daily life back to a semblance of the way it was pre-pandemic, many may simply not be ready to seek another vaccine if they don’t have to.

Additionally, monkeypox may affect marginalized populations disproportionately. “The majority of cases in the US have been among men who have sex with men,” Dr. Davis notes, “and there is a lot of potential for increased stigma against this group.” This would not be the first time in history where LGBTQIA+ individuals experienced stigma surrounding an outbreak, as also seen during the HIV crisis in the 1980s.

Davis also observes that the systemic factors that caused people of color and lower-income individuals to be more severely affected by COVID-19 than others are still in play. “The barriers contributing to health disparities that we saw during the COVID-19 pandemic have not adequately been addressed, and I suspect we will see health disparities with monkeypox. It’s critical that we seek to ensure equitable access to care and avoid stigmatizing individuals who have become infected with monkeypox.”

Health inequity also occurs on a global scale. “We saw many countries in Africa and other low-income countries be left behind during the COVID-19 pandemic, and it is important that we try to avoid that with monkeypox,” Dr. Davis says. “Even with greater attention being paid to monkeypox, I worry that most of the resources dedicated to solving the problem will focus only on the US, Canada, Europe, and other relatively wealthy nations.” Monkeypox has been present in Africa for decades despite scientists’ early warnings of its severity. 

It is imperative that we act now to prevent monkeypox from becoming a health crisis in the United States on the level of HIV or COVID-19. Dr. Davis explains that RNA viruses (such as HIV and COVID-19) mutate differently from DNA viruses such as monkeypox. While HIV and COVID-19 became pandemics, monkeypox is still at the stage of an outbreak in this country. “But we should still take action quickly to contain it,” Davis cautions, “so that it does not become entrenched in the US. If that happens, then we are much more likely to see repeated outbreaks in the future.”