NPR’s Ari Shapiro talks with Dr. Demetre Daskalakis, the White House’s deputy national monkeypox response coordinator, about the administration’s response to the monkeypox outbreak.
ARI SHAPIRO, HOST:
Here’s some good news about a disease that spread rapidly over the summer. Not COVID-19, monkey pox. A few months ago, the US was reporting more than 400 cases per day on average. Infections have been declining fairly steadily over the past few weeks and are now less than half of where they were at peak. dr Demetre Daskalakis is deputy coordinator for the White House National Response to Monkeypox. Welcome to ALL THINGS CONSIDERED.
DEMETRE DASKALAKIS: Hello, Ari. Thank you very much for inviting me.
SHAPIRO: Let’s take stock of where things stand right now. In the last four months, the US has reported more cases of monkeypox than any other country: 25,000 according to the CDC. And the numbers have been steadily falling, but we’re still seeing an average of about 200 cases a day. So, on a scale from worried to optimistic to running a victory lap, where are you now?
DASKALAKIS: I’m cautiously optimistic, nowhere near a victory lap. You know, infections tend to be very clever, as are outbreaks. So let’s watch very carefully. But let’s give it a 6 out of 10, right now.
SHAPIRO: Six out of 10. Okay, that’s good. There seem to be at least three main factors here. There is the nature of the disease, there are individual behaviors and there is the political response. So let’s take them one at a time. First of all, the nature of the disease. When you compare the arc of this to COVID-19, how much of a difference is due to how each disease is transmitted?
DASKALAKIS: I think the first thing to say is this is definitely not COVID-19. The vast majority of transmission occurs through close intimate contact, often related to sexual activity. In addition, it began in a population of homosexuals, bisexuals, other men who have sex with men, and the majority of cases continue in that group. Its transmission mechanism and also where it lives in a population is very different.
SHAPIRO: And how much of the decrease in cases do you attribute to behavioral changes? A vaccine became available in early summer. The new data suggests that it has been doing quite well. There were long queues to access it. Do you think that high-risk populations, men who have sex with men, made decisions in the last few months that changed the course of this disease?
DASKALAKIS: Not only do I think they did, but we have data to back it up. So looking at an MMWR that was released by the CDC in September…
SHAPIRO: Sorry, what is MMWR?
DASKALAKIS: Sorry, it’s a Morbidity and Mortality Weekly Report.
DASKALAKIS: MMWR. It’s one of the ways CDC spreads some of its data and information. So in this report, about 800 men who have sex with men were surveyed. And what they found was that there was a 50% reduction in several behaviors that could be associated with monkeypox. And it was in response to the monkeypox outbreak. So less 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 decreased, they have not decreased 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 at all times. I will note that when you look at the demographics of our treatment, the disparity is significantly less. So the people who have accessed TPOXX, the vast majority are Black and Latino. So, really, we’re focusing our equity efforts on the vaccine and identifying strategies to really improve vaccine uptake among Black and Latino people. Today, we’re also announcing something that’s really important, which is also expanding the availability of vaccines by increasing the number of people who might qualify and also removing some of the risk assessments that have been getting in the way of some people who are unwilling to say Hey, I have multiple sexual partners and I’m a man who has sex with men.
SHAPIRO: So currently, to get the vaccine, people have to say, more or less, I have a lot of sexual partners, which might not be something that everyone feels comfortable saying, particularly when it comes to same-sex couples.
DASKALAKIS: Totally. And I think this is an example of what sounds like a biological intervention, which is actually a stigma intervention.
SHAPIRO: Some lawmakers have said the Biden administration’s response was nonchalant. This was Republican Senator Richard Burr of North Carolina at a Senate hearing earlier this month.
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RICHARD BURR: For the next one, we have to respond a lot faster than with COVID, and we have to do a lot better than with monkeypox.
SHAPIRO: What do you say to that?
DASKALAKIS: I’ll tell you this has been a pivot story. So, you know, when we start and look 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 you give them the vaccine. Shortly thereafter, it became clear that that wasn’t going to work in this population and it wasn’t going to work with the way this unprecedented outbreak of monkeypox was being transmitted. And then there was a pivot.
You know, it’s really about responding to epidemiology and changing the course of the response. I always say that there is no such thing as an emergency response that is almost enough. But the lessons learned from COVID here really mattered. And we were able to move things very quickly and we were able to pivot pretty nimbly, given the changes that we saw with the outbreak as we went along.
SHAPIRO: You know, very often with COVID, we saw the cases start to go down, and then people would take off their masks and party and the cases would go back up. Are you worried that something similar could happen now that people have a false sense of complacency about monkeypox?
DASKALAKIS: Yeah, I’m absolutely concerned about that, which is one of the reasons I gave us a 6 out of 10 in terms of where we are because I think we’re working to increase the immune force field that we’re creating with vaccination, I think. that the message is still very important to make sure people know that we’re not out of the woods and that if we want this outbreak to end, we really need to use all the tools in the toolkit: behavior, testing, vaccines, all of that until that we get to a point where we have very good coverage of vaccines, two shots, not one, to make sure people are protected as best as possible.
SHAPIRO: Dr. Demetre Daskalakis is the White House deputy national monkeypox response coordinator. Thank you
DASKALAKIS: Thank you, Ari.
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