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White House 'cautiously optimistic' on monkeypox


Here's a good news story about a disease that was spreading fast through the summer. Not COVID-19, monkeypox. A few months ago, the U.S. was reporting more than 400 cases a day on average. Infections have been dropping pretty steadily over the last few weeks and are now less than half where they were at the peak. Dr. Demetre Daskalakis is deputy coordinator for the White House National Monkeypox Response. Welcome to ALL THINGS CONSIDERED.

DEMETRE DASKALAKIS: Hi, Ari. Thank you so much for having me.

SHAPIRO: Let's take stock of where things stand at this moment. Over the last four months, the U.S. has reported more monkeypox cases than any other country - 25,000 according to the CDC. And the numbers have been dropping steadily, but we are still seeing an average of about 200 cases a day. So on a scale of worried to optimistic to running a victory lap, where are you right now?

DASKALAKIS: I am cautiously optimistic - nowhere near a victory lap. You know, infections tend to be really smart, as do outbreaks. So we're going to watch really carefully. But let's give it a 6 out of 10, right now.

SHAPIRO: Six out of 10. OK, that's good. It seems like there are at least three main factors here. There is the nature of the disease, there are individual behaviors and there's the policy response. So let's take them one at a time. First, the nature of the disease. When you compare the arc of this to COVID-19, how much of the difference is because of the way each disease is transmitted?

DASKALAKIS: I think the first thing to say is that this is definitely not COVID-19. The vast majority of transmission is occurring through close intimate contact, often related to sexual activity. Also, it started in a population of gay, bisexual, other men who have sex with men, and the majority of cases continue to be in that group. Its mechanism of transmission and also where it lives in a population is a lot different.

SHAPIRO: And how much of the decrease in cases do you attribute to behavior changes? A vaccine became available early in the summer. New data suggests it's been working pretty well. There were long lines to get access to it. Do you think high-risk populations, men who have sex with men, made choices in the last few months that changed the course of this disease?

DASKALAKIS: I not only think that they did, we have data to back it up. So looking at an MMWR that was released from the CDC in September...

SHAPIRO: Sorry, what's an MMWR?

DASKALAKIS: Sorry, it's a Morbidity and Mortality Weekly Report.


DASKALAKIS: MMWR. It's one of the ways that CDC disseminates some of their data and information. So in this report, a survey was done of about 800 men who have sex with men. And what they found was that there was a 50% reduction for several behaviors that could be associated with monkeypox. And it was in response to the monkeypox outbreak. So fewer one-time partners, less use of social networking sites or sex venues. Behavior - definitely a part of this. Biology - also a part of it.

SHAPIRO: As cases have dropped, they have not been dropping equally. A large proportion of new cases these days are detected in Black and Latino men. How do you plan to close this disparity?

DASKALAKIS: So I think it's really - our strategy has equity that has its cornerstone throughout it. I'll note that when you look at our treatment demographics, the disparity is significantly less. So individuals who've accessed TPOXX - the vast majority are Black and Latino. So really, we're focusing our equity efforts on vaccine and identifying strategies to actually improve vaccine uptake among Black and Latino individuals. Today, we also announced something that's really important, which is also expanding vaccine availability by increasing the folks who could qualify and by also getting rid of some of the risk assessments that have been hampering some people who aren't willing to say, hey, I have multiple sex partners, and I am a man who has sex with men.

SHAPIRO: So currently, in order to get the vaccine, people have to say, more or less, I have a lot of sex partners, which might not be something that everybody is comfortable saying, particularly when it comes to same-sex partners.

DASKALAKIS: Totally. And so this is, I think, an example of what sounds like a biological intervention, which is really a stigma intervention.

SHAPIRO: Some lawmakers have said that the Biden administration's response was flat-footed. This was Republican Senator Richard Burr of North Carolina at a Senate hearing earlier this month.


RICHARD BURR: For the next one, we've got to respond a hell of a lot faster than we did for COVID, and we've got to do much better than we did on monkeypox.

SHAPIRO: What do you say to that?

DASKALAKIS: I'll tell you that this has been a story of pivots. So, you know, when we first started and we looked at the monkeypox playbook, what you do is what they call ring vaccination. So you find someone with monkeypox, find out who their contacts were and then give them vaccine. Soon thereafter, it was clear that that's not going to work in this population and wasn't going to work with the way that this outbreak of monkeypox was transmitting, which is unprecedented. And so there was a pivot.

You know, really it's about responding to the epidemiology and changing the course of the response. I always say there's no such thing as an emergency response that's fast enough. But the lessons learned from COVID here actually mattered. And we were able to move things really quickly and were able to pivot fairly nimbly, given the changes that we saw with the outbreak as we move forward.

SHAPIRO: You know, so often with COVID, we saw cases beginning to drop, and then people would take off their masks and go party and cases would climb back up again. Do you worry that something similar might happen now as people get a sense of false complacency around monkeypox?

DASKALAKIS: Yeah, so I'm absolutely worried about that, which is one of the reasons that I gave us a 6 out of 10 in terms of where we are because I think we - as we are working to increase the immune force field that we're creating with vaccination, I think the messaging is still really important to make sure that people know we're not out of the woods and that if we want to see this outbreak end, we really need to sort of use all the tools in the toolkit - behavior, testing, vaccines, all of those until we get to a point where we have really good coverage of vaccine - two shots, not one - to make sure that people are protected as best as possible.

SHAPIRO: Dr. Demetre Daskalakis is the White House National Monkeypox Response Deputy Coordinator. Thanks so much.

DASKALAKIS: Thank you, Ari. Transcript provided by NPR, Copyright NPR.

Ari Shapiro has been one of the hosts of All Things Considered, NPR's award-winning afternoon newsmagazine, since 2015. During his first two years on the program, listenership to All Things Considered grew at an unprecedented rate, with more people tuning in during a typical quarter-hour than any other program on the radio.
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Ashley Brown is a senior editor for All Things Considered.