U.S. Messaging on Monkeypox Is Deeply Flawed

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As monkeypox cases rise in the U.S., public officials are scrambling to balance concerns about stigmatization with the fact that the disease is largely affecting gay and bisexual men.

But first, here are three new stories from The Atlantic.

Risk Assessment

In the parts of the world where monkeypox is newly spreading, like the United States and Europe, the people currently most at risk of getting the disease are gay and bisexual men. A recent update from the World Health Organization noted that cases in newly afflicted countries have mainly been among “men who have had recent sexual contact with a new or multiple male partners.” In Europe, just 0.2 percent of the men who have gotten the disease identify as heterosexual. Reports from the center of the U.S. outbreak—New York City—show that “the number of monkeypox cases has nearly tripled in the last week, nearly all of them among men who have sex with men.” The infectious-disease and LGBTQ-health journalist Benjamin Ryan notes that though the U.S. is, frustratingly, not collecting demographic details on monkeypox patients, Britain is, and the numbers there are clear: “Half of men screened for monkeypox tested positive; women, by contrast, tested positive only 0.6 percent of the time.”

And yet, despite this barrage of data, an American following the public-health messaging on monkeypox might come away with the idea that all populations are similarly at risk of contracting the disease.

U.S. officials are taking action to specifically protect men who have sex with other men (MSM) from monkeypox—importantly, supplies of the vaccine have largely been reserved for that community. And yet, many public-health officials—and some media outlets—have scrambled to combat the idea that monkeypox is a “gay disease.” (Both the CDC and WHO websites bury mentions of MSM risk.) These authorities, Ryan has argued, have spread a message “so egregiously misleading it amounts to misinformation.”

That message? Anyone can get monkeypox.

This is not the first time American public-health officials have pushed a confusing communications strategy about the transmissibility of a dangerous virus. Smithsonian magazine has documented how some AIDS organizations criticized the federal government for its “everyone is at risk” message in the late 1980s and early ’90s. These organizations “saw the campaign as diverting money and attention away from the communities that needed it the most” and instead focusing resources on much lower-risk populations.

Yesterday, The New York Times reported on a battle within New York City’s health department. The story revealed a widespread discomfort within the agency with acknowledging and highlighting the primary route of monkeypox transmission: sex between men.

On its face, the “anyone can get monkeypox” messaging is true. But imagine for a moment that a hurricane is making landfall on your state. You turn on your TV and see the head of FEMA talking about how anyone could be struck by a hurricane—and stressing that hurricanes are not Floridians’ fault. Sure, you might say. But what about this hurricane, right now? Who is it most likely to strike? You’d probably be left feeling frustrated, confused, and underprepared.

Though hurricanes and infectious diseases are both acts of nature, Floridians are not stigmatized for their vulnerability to hurricanes in the way that gay men might be for their current vulnerability to monkeypox. Officials are wary of reinforcing stigmas. Case closed, right?

Well, no, not exactly. Government officials often talk about the disparate impacts of illnesses such as diabetes, sickle-cell disease, and COVID-19 on Black Americans. Might not Black Americans be stigmatized for being disproportionately impacted by these illnesses? Similarly, might not transgender youth be stigmatized for being disproportionately likely to end up homeless? Why is it that, at a time when governmental institutions are more willing than ever before to recognize and call out these disparate impacts, officials are so wary of calling out the disparate impact of monkeypox?

Public officials seem to have the logic exactly backwards. The most important time to be pointing out disparities is when the relevant population is both unaware of them and can take personal action to prevent harm. MSM urgently need access to vaccines and public-health information to keep themselves safe. As the writer and history professor Jim Downs recently argued in The Atlantic, “As a gay man who studies the history of infectious disease, I worry that public-health leaders are not doing enough to directly alert men who have sex with men about monkeypox.”

Conversely, the least important time to emphasize disparate impact is when it diminishes solidarity on key issues. For example, the idea that rich women won’t be impacted by the fall of Roe v. Wade is both untrue and divides the coalition of people needed to combat further restrictions on abortion. Similarly, a recent study indicates that white Americans who learned about COVID-19’s racial disparities actually became less afraid of the disease, lost empathy for those at risk, and reduced support for public-health measures.

It’s not clear what rule governs when disparities are discussed and when they are papered over, but one pattern I’ve noticed is that leaders tend to emphasize the message of disproportionate harm while ignoring times of disproportionate risk. Many politicians and policy makers have developed a fluency in discussing the past harms that have led to disparate outcomes today, including wealth gaps, housing inequality, and the overrepresentation of communities of color in jail and in homeless populations.

But when talking about risk, leaders flounder. Take the conversation around learning loss. COVID-19 led to the adoption of remote learning and the widespread closing of schools, leaving millions of kids at risk of long-term economic and educational deficits. But when it came to identifying students at risk, many officials, worried about “stigmatizing” an entire generation, balked.

Why is risk considered stigmatizing, and harm not? This heuristic is putting people at risk, and the leaders who are indulging it ought to at least attempt to justify it before allowing it to continue quietly impacting policy making.

Related:

Today’s News

Follow-up: Last week in the Daily, David A. Graham explored long-running concerns about the independence and competence of the Secret Service, which intensified after the events of January 6. Today, the agency announced that it has determined that text messages relevant to the January 6 investigation cannot be recovered.

Dispatches

Evening Read

How to Successfully Smash Your Face Against a Tree

By Ed Yong

In my third year of reporting on the coronavirus pandemic, I find woodpeckers, which can ram their heads against hard surfaces about 20 times a second, to be incredibly relatable. But the birds’ extraordinary behavior raises an obvious question: Why, as one team of scientists wrote in 1976, is the countryside “not littered with dazed and dying woodpeckers”?

Read the full article.

More From The Atlantic

Culture Break

Read. In Happy-Go-Lucky, David Sedaris is back with the wry, moving personal stories that his readers adore.

And check out the rest of our summer reading guide, which has books for every mood.

Watch. Ponyo (available on HBO Max), a 2009 film by the Japanese animator Hayao Miyazaki that’s bursting with youthful exuberance.

Listen. Special, Lizzo’s catchy new album, advances the pop star’s heartwarming world-domination plan.

Play our daily crossword.

P.S.

We published a really fascinating article (linked above) by Alec MacGillis today about one potential cause of the national crime wave: closed courts. Essentially, MacGillis argues, COVID-19 forced much of our criminal-justice system to pause operations, which he says led to fewer consequences for criminals. Even in normal times, our criminal-justice system doesn’t deliver on “swift, certain, and fair,” but during the past few years, that ideal slipped even further away. Of course, nothing is monocausal (and MacGillis doesn’t claim that), but this seems to be an important piece of the larger puzzle of why everything feels so disorderly now (for more on that feeling, read my fantastic colleague Olga Khazan).

— Jerusalem

Isabel Fattal contributed to this newsletter.