California monkeypox response is bumpy, but builds on some lessons from COVID-19
Hundreds waiting hours for a monkeypox vaccine only to be turned away. Residents taking to social media to detail struggles getting diagnosed and treated. State and local leaders demanding federal action. Emergency orders declared.
At face value, these details paint the picture of a country and state in crisis, struggling to apply lessons learned from the past two and a half years of COVID-19 response. However, scientists, public health leaders, and physicians who spoke with CalMatters said infrastructure and resources augmented during the COVID-19 pandemic have, in fact, aided the monkeypox response.
Still, it has its faults.
“What we learned from COVID is that speed is everything. When we look at the response of monkeypox later on, we’ll see speed is the main thing we take issue with,” said Dr. Peter Chin-Hong, infectious disease specialist at UC San Francisco and member of the state’s scientific advisory committee for monkeypox.
California has the second-highest number of monkeypox cases in the country, with more than 1,300 infected residents, according to the latest state data. Gay and bisexual men have been disproportionately impacted, making up 96% of cases. Some experts say we’re already past the point of controlling monkeypox, which was first reported in California in late May.
The culprit? Too little testing and treatment and too few vaccinations — all of it layered with too much red tape at both the federal and state level. It’s a familiar refrain and one that has frustrated state and local leaders.
A cadre of California lawmakers asked the U.S. Department of Health and Human Services to allow the state to reallocate some of the $1.5 billion in COVID-19 response funds to monkeypox. Others submitted a $38.5 million emergency state budget request for monkeypox resources, and the California Department of Public Health sent a letter to the Centers for Disease Control and Prevention requesting 600,000 to 800,000 vaccines — that’s more than half of the total available doses for the entire country.
California is expected to receive 72,000 doses of the JYNNEOS vaccine used for monkeypox, with an additional 43,000 sent straight to Los Angeles County. Those doses represent “a drop in the bucket” of what’s needed, state epidemiologist Dr. Erica Pan told county health officers in a meeting last week.
During a Senate oversight hearing held Tuesday, Sen. Scott Wiener, a San Francisco Democrat, said “severe public health failures” at the federal level led to the current outbreak.
“We need to turn this around,” Wiener said. “We need to continue to push hard to make sure that our state, federal, state and local public health authorities are directing the resources where they’re needed most and rapidly expanding support for vaccination, testing and treatment to slow and hopefully stop this spread.”
Lessons learned
Despite continued resource challenges, public health systems are better prepared to respond to monkeypox than they were to COVID-19. In the early days of the pandemic, hospitals didn’t even have a way to quickly report how many COVID-19 patients were hospitalized or in intensive care.
“(Monkeypox) is a serious concern, but public health is far more prepared now than we have ever been,” said Sarah Bosse, Madera County public health director.
Madera County has not reported any monkeypox cases, but neighboring Fresno County has seven cases. Bosse said her department is already in talks with the state on how to redirect COVID-19 contact tracers to monkeypox response and how to scale up vaccination clinics.
“The state has been very proactive in identifying counties that need additional support,” Bosse said.
In comparison, in 2020, 11 counties declared local emergencies for COVID-19 before Gov. Gavin Newsom declared a statewide emergency, freeing up staff and fiscal resources. This time, only San Francisco beat the state to the punch, a signal that state officials are closely in tune with local needs.
“To someone like me who has been doing this for 30 years, this actually moved very fast,” said Dr. Timothy Brewer, an infectious disease specialist at UC Los Angeles, who recalled it was three years between when the first case of AIDS was described in Los Angeles and identification of the HIV virus. It took an additional three years before the first treatment was developed.
Comparing monkeypox to the HIV/AIDS epidemic and COVID-19 pandemic — both of which activists and state leaders have done — isn’t exactly apples-to-apples. What researchers knew about each disease at the onset of their respective outbreaks and available treatments varied widely.
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