Yglesias has a piece on the failures surrounding the response to monkey pox, but as is typical for him, it's really about a long running hobby horse of his. (Luckily, this bit isn't about urban planning.)
His critique is a reasonably solid one and he's applied it across other topics besides public health, even if that has been his main focus. Basically, we have some regulatory structures that are terribly outdated and do not account for different types of risk. He's written about this in regards to nuclear power in the past. If you never approve a new nuclear power plant then you will never have another nuclear accident. The problem is that hundreds of thousands of people are dying every year in extreme weather events caused by global warming.
Pandemics fall into the same risk blind spot. Monkey pox (and coronaviruses) circulate freely in parts of the world that we don't typically pay a great deal of attention to. We actually have the tools to fight both, but we tend not to use them. In his piece, Yglesias notes that any "pox" vaccine will protect against monkey pox, including a smallpox vaccine. The existing stockpiles of one vaccine are being replaced - slowly - with a new, better vaccine. Fine! But we should have been offering/requiring vaccinations with the existing vaccination for anyone traveling to west Africa.
As Covid should have proven, the best way to deal with a pandemic is to contain it early. Covid was so tricky because it spread easily and became symptomatic slowly. You were exposed, a couple of days later you're contagious, a week later you actually get sick. That made containing it really hard. The WHO and CDC work very hard to monitor new and emerging viruses, and they caught on to Covid reasonably quickly. The problem was...then what?
When you look at cases of Covid over the span of the pandemic, the early days don't show that many cases. Some of that is a lack of good testing. But some of it was that all the isolating that we did in spring of 2020 really did work. There are three "spikes" in reported cases of Covid: winter of 2020-21; late summer 2021 (Delta) and winter 2021-22 (Omicron). The daily death rate - which is not subject to a problem with testing - had five spikes: spring of 2020; late summer of 2020; winter of 2020-21; early fall of 2021 (Delta) and winter 2022 (Omicron).
Those first three spikes in deaths tended to coincide with people being forced inside and ignoring distancing and masking. By the time Omicron came along, there was such exhaustion with masking and distancing that it created a spike in deaths only surpassed by the previous winter - despite the widespread availability of vaccines.
The lessons should be clear.
- Certainly non-medical suppression methods work, but they are largely unsustainable over long periods of time.
- Vaccines need to be deployed as quickly as possible to contain outbreaks.
- There are going to be gaps, but the fewer the gaps, the fewer the outbreaks.
Monkey pox is not very lethal. It does seem to be centered on sexual contact among gay men at the moment. The response, however, does not inspire much confidence in our ability to handle another version of Covid, if it were to appear. What if we got a bird flu pandemic in 2024? Does anyone think we have demonstrated that we've learned anything from Covid-19?
Vaccines do not make drug companies the same sort of money that daily medications like statins or antidepressants do. This is clearly a place where governments need to act with vigor and clarity.
I'm not seeing that vigor and clarity.
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