Monkeypox Outbreak Can Still Be Contained, Says Columbia Epidemiologist

Health officials worldwide can still take steps to contain the monkeypox outbreak, says Dr Alissa Davis, Associate Professor at the Columbia School of Social Work, but it will require addressing the challenges of stigma, misinformation, and health inequity.

“Overall case numbers of monkeypox are growing, although the number of new infections has recently been trending downward,” says Davis, an epidemiologist who has studied HIV and sexually transmitted infections (STIs), among other widespread health issues.¹ “I think there is still the potential to contain the outbreak and recent decreases in case rates are a promising sign. However, it’s important that we continue to take action and dedicate sufficient resources to address the outbreak so that it does not become an entrenched virus in the future.”

To quickly contain the spread of monkeypox, health officials will need to overcome several challenges in the near future, including determining appropriate messaging about monkeypox. Although sexual contact is one of the primary ways the monkeypox virus can be spread, it has not been officially categorized as an STI.²

“I think one concern is that labeling monkeypox as an STI can make it stigmatizing. There is also the potential for the misperception that condom use can completely prevent transmission of monkeypox, but that isn’t the case,” Davis cautions. “Although condom use can greatly decrease the risk of transmission, monkeypox can still be transmitted even with condom use.” A person may also contract the virus through prolonged face-to-face contact, respiratory secretions, or contact with infectious scabs or rashes.²

Additionally, it is important that people know they may carry the virus unknowingly. According to the Centers for Disease Control and Prevention, monkeypox may incubate for 1 to 2 weeks before a person develops any symptoms.² This delay could present an obstacle to tracking the number of cases accurately as monkeypox spreads through a population, which could hamper efforts to respond to the outbreak quickly and effectively.

Health officials worldwide must also work toward offering equitable health care without stigmatizing marginalized populations. Davis’s recommendations incorporate lessons learned from the inadequate response to the HIV and COVID-19 crises, as many of the systemic factors that contributed to past health inequity persist today.^3-6

“The barriers contributing to health disparities that we saw during the COVID-19 pandemic have not adequately been addressed,” Davis cautions, “and I suspect we will see health disparities with monkeypox. It’s critical that we seek to ensure equitable access to care and avoid stigmatizing individuals who have become infected with monkeypox.”

It is imperative that we act now to prevent monkeypox from becoming a health crisis in the United States on the level of HIV or COVID-19. “We should take action quickly to contain it,” Davis says, “so that it does not become entrenched in the US. If that happens, then we are much more likely to see repeated outbreaks in the future.”

Dr Alissa Davis is an Associate Professor at Columbia University School of Social Work and Faculty Affiliate of the Social Intervention Group. Her research focuses on the development of interventions to improve linkage to and retention in care for HIV/STI and substance use services for marginalized populations, including racial/ethnic and sexual minorities; individuals involved with the criminal justice system; and people who inject drugs. Her work has been supported by the National Institute of Drug Abuse, the National Institute of Mental Health, National Institute of Child Health and Human Development, the Fogarty International Center, and the Mellon Foundation.

Her current research focuses on developing and adapting a couples-based intervention to improve antiretroviral therapy adherence among people who inject drugs in Kazakhstan, using crowdsourcing to develop a digital intervention to reduce HIV stigma and increase HIV self-testing among adolescents and young adults in Kazakhstan, the use of physiological assessments and digital apps to promote mental health among adolescents in New York City, and examining factors associated with recurrent bacterial vaginosis infection among women in New York City.