Gottlieb predicts monkeypox will become a public health failure

Scott Gottlieb, the former commissioner of the Food and Drug Administration (FDA), wrote an op-ed in The New York Times published on Saturday arguing that the United States lacks a federal infrastructure capable of dealing with public health emergencies such as monkeypox and COVID-19.

“Our country’s response to monkeypox – has the same shortcomings that we had with Covid-19,” Gottlieb wrote in an editorial.

“Now if monkeypox were to gain a permanent foothold in the United States and become an endemic virus to join our circulating stock of pathogens, it would be one of the worst public health failures of the modern era, not only because of the pain and risk of disease but also because it could have been avoided.” “Our lapses extend beyond political decision-making to the agencies tasked with protecting us from these threats.”

Gottlieb said the country did not test enough people for monkeypox in the early days of the outbreak, noting that the Centers for Disease Control and Prevention (CDC) did not expand testing to large commercial labs until late June.

“Its cultural instinct is to take a deliberative approach, and to discuss every decision,” he said of the CDC. “With Covid, the virus emerged quickly. With ‌monkeypox, which spreads more slowly, usually through very close contact, the shortcomings of the Centers for Disease Control and Prevention’s cultural approach have not yet been severe. But the shortcomings are the same.”

The CDC has reported nearly 5,200 cases as of Sunday, and the outbreak has reached all but three states: Montana, Vermont and Wyoming.

Monkeypox is spread through close contact with an infected animal or person, generally through pests, body fluids, contaminated materials, and respiratory droplets. These droplets can travel up to a few feet and usually require a long contact to travel.

The virus has been detected largely in men who have sex with men, leading some jurisdictions to prioritize these groups to receive the currently limited number of doses of the monkeypox vaccine available.

Gottlieb called on the Centers for Disease Control and Prevention (CDC) to continue to lead the country’s epidemic response, but argued that some disease prevention work should be transferred to other agencies.

The Food and Drug Administration called for the Smoking Administration and the National Institutes of Health (NIH) to deal with cancer and heart disease.

“The CDC focused more on its primary mission of responding to the outbreak,” Gottlieb wrote. And imbue the agency with the national security mindset it had at its origins. If the CDC’s mission is more focused on the elements needed to deal with infection, Congress may be more willing to invest it with strong authority to do this well-targeted mission.”

But Gottlieb questioned the feasibility of reform to provide the CDC and other public health agencies with new tools and powers, citing conversations with lawmakers and their staff that showed what he called “little appetite” for such a move.

“After Covid, there is a view among some that public health agencies used flawed analysis and misjudged their advice,” Gottlieb wrote. “Ensuring political consensus that the CDC needs more empowerment to complete its mission — for example, invest power to compel states to submit reports — is politically unobtainable.”

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