As if dealing with continued waves of Covid-19 isn’t enough, the U.S. is facing a new outbreak — monkeypox — that highlights just how close the U.S. public health system is to its breaking point.
While monkeypox has not technically been categorized as a sexually transmitted infection (STI), it looks and acts like common STIs and shares the same barriers to detection and treatment, including stigma and access to knowledgeable providers.
For people like me who are working inside the broad national response to monkeypox, there are loud echoes of the earliest days of Covid-19 and, longer ago, of AIDS. But understanding the country’s capacity to contain monkeypox requires an examination of the STI epidemic that the nation has ignored for years, which is why these diseases continue to be out of control.
Consider this: More than 2.5 million sexually transmitted infections were diagnosed in 2020, the last year with complete statistics. The ballooning rates touch people of every race, sexual orientation, and even age. Syphilis among newborns has increased 235% since 2016, and STIs like gonorrhea have reached historic highs among teens and adults.
The lack of accessible testing, combined with stigma, are major factors in the increases. Yet there is no dedicated federal funding to guarantee that communities can provide STI testing.
Most Americans are blissfully unaware of the fractured funding streams that make it possible for public health providers to offer services in their communities. One federal funding stream makes family planning available. Another funds HIV testing. Clinics providing these services also offer community education, treatment, and the capacity to successfully turn health issues around — just look at dropping rates of HIV and teen pregnancy. Without a similar funding stream for the rising outbreaks of syphilis, gonorrhea, chlamydia, and now monkeypox, there is no guaranteed service designed to keep them in check.
It will be difficult for the nation to address monkeypox if it can’t address diseases that have been on the rise for decades.
My colleagues and I in public health know what to do about monkeypox, just as we know what to do about sexually transmitted infections. By taking smart steps during this outbreak, we can stop monkeypox in its tracks, while also driving down STI rates and preparing for future outbreaks. But that can happen only with a serious federal response. Here are three key steps that response should include:
First, the U.S. needs to immediately develop a coordinated outbreak response. It should include investing in testing people with symptoms, which may turn out to be monkeypox but could also be due to something more common and more consequential, like syphilis. It’s essential to develop point-of-care testing technology and outreach to the public and to clinicians so they know what to look for. The response also needs to involve preparation for potential vaccination needs, taking into account bureaucratic hiccups and misinformation.
Second, permanent, dedicated funding must be established for STI and sexual health clinics to provide the same kinds of services for chlamydia, gonorrhea, syphilis, and other sexually transmitted infections that currently exist for HIV and family planning. This long-needed dedicated network would make it possible for every community to detect the spread of new infections, like monkeypox, and permanently address common sexually transmitted infections that are skyrocketing.
Third, the country must continue to invest in success. When Covid-19 emerged in early 2020, disease intervention specialists used their decades of contact tracing experience for sexually transmitted infections to provide an essential part of the national effort to combat the pandemic. This workforce is now being called upon to respond to monkeypox. Congress must make permanent the investment in disease intervention specialists.
If HIV and Covid-19 were wake-up calls for the government to prioritize public health, monkeypox shows the consequences of hitting the snooze button too many times. HIV showed the importance of creating an infrastructure of health care workers who can provide approachable, competent care for stigmatized infections. Covid-19 revealed the make-or-break nature of coordinated logistics and communications.
The U.S. is at a crossroads regarding sexually transmitted infections. It can mount an effective monkeypox response and provide communities across the country with the infrastructure needed to promote health care for everyone. Or it can continue to play catchup in crisis after crisis and let common infections continue to rage in between.
I choose the former. Anyone choosing the latter is clearly not interested in preserving and promoting the nation’s collective health.
David C. Harvey is the executive director of the National Coalition of STD Directors.
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