Even as COVID-19 has stubbornly continued to disrupt the lives of people around the world, the unexpected outbreak of another virus has signaled a new public health threat. Cases of monkeypox — long known to cause outbreaks of illness in Central and West Africa — are being reported in numerous other countries, including the United States, raising the specter of another global health emergency layered on top of the current one. And yet again, New York City is the early epicenter of the new outbreak.
One concerning feature of this new outbreak in non-endemic countries is that the majority of cases have been reported among men who have sex with men, quickly drawing comparisons with HIV, another virus that has been a longstanding threat to the same population in the U.S.
It is important to note, however, that the situation with monkeypox differs substantially from what we saw at the onset of both the AIDS and the COVID-19 epidemics. With AIDS, it took researchers years to identify the virus that caused the disease and to develop a diagnostic test and effective treatment. In contrast, with monkeypox, we are already familiar with the causative virus, and have effective tests and treatment in hand. In addition, more than four decades into the HIV epidemic, we have yet to discover an effective vaccine, but we already have two vaccines that offer protection from monkeypox infection.
With tools readily at hand, we seem to have many advantages for responding to monkeypox. Yet these advantages could be moot if we don’t carefully apply the lessons learned from the response to the HIV and COVID-19 epidemics.
First, we must fully acknowledge this emerging crisis and mobilize to act. We paid a dear price for the years of denial of HIV in the U.S. Precious time was lost, allowing the virus to spread unabated and to become entrenched among certain populations, resulting in much suffering and loss of lives. With the tools at our disposal, we have a chance to avoid the spread of monkeypox and to prevent its associated illness now, while it’s in its early stages; we must seize that opportunity.
Second, faced with a threat that is primarily affecting men who have sex with men (at least for the moment), we must engage those at risk in a meaningful way. As we learned from both the HIV and COVID-19 responses, public health officials and policymakers must reach out to gain the trust of those who stand to be affected. To do this, we need to shape messaging appropriately, focus on the immediate needs of this community, and respond to the threat together as partners.
Third, we must assertively combat stigma. While monkeypox virus is not yet considered a traditional sexually transmitted infection, the virus has been shown to be associated with intimate contact during sex. Because of this, those diagnosed with monkeypox infection may experience a dual stigma — the stigma faced by some men who have sex with men in certain settings as well as that associated with the diagnosis of a sexually transmitted infection. We must stand strong against this type of stigma and discrimination, disseminating accurate information and uncompromisingly respecting the rights of all people.
Fourth, supporting an equitable response is a must. During both HIV and COVID-19, we have seen that unequal access to services has left certain sectors of society behind. Whether in the context of HIV or COVID-19, vulnerable populations such as people of color and low-income communities have been more severely affected or have suffered from more limited access to services. Moreover, we have seen tragic disparities between the better-resourced countries of “The Global North” in comparison to low- and middle-income countries.
Inequities of this kind are not only morally unacceptable, but they also threaten the health and wellbeing of populations at risk as well as the entirety of our societies. When some are left behind during a health crisis, everyone pays the price.
HIV and COVID-19 have both severely affected people across the U.S. and around the world. But they have taught us valuable lessons about how we can best act to stop the spread of an infection and how to minimize the suffering and loss of life when a major viral outbreak strikes. Now, confronted by an early but growing new infectious disease threat — monkeypox — we must rapidly put those lessons into action and ensure that we mount a vigorous, rapid, effective, and equitable response. There is no time to lose.
El-Sadr is director of ICAP at Columbia University and Columbia World Projects, professor of epidemiology and medicine at Columbia Mailman School of Public Health, and lead of the New York City Pandemic Response Institute.
