Former Food and Drug Administration (FDA) Commissioner Scott Gottlieb wrote an opinion piece in the New York Times published on Saturday, arguing that the United States lacks a federal infrastructure capable of dealing with public health emergencies such as monkeypox and COVID-19.
“Our country’s response to monkeypox has been plagued by the same shortcomings that we had with Covid-19,” Gottlieb wrote in the op-ed.
“Now, if monkeypox gains a permanent foothold in the United States and becomes an endemic virus that joins our circulating repertoire of pathogens, it will be one of the worst public health failures in modern times, not just because of the pain and danger of the disease but also because it was so preventable,” he said. “Our lapses extend beyond political decision-making to the agencies tasked with protecting us from these threats.”
Gottlieb said the country did not test enough people for monkeypox in the early days of the outbreak, noting that the Centers for Disease Control and Prevention (CDC) did not expand testing to large commercial labs until late June. .
“Their cultural instinct is to take a deliberative approach, debating every decision,” he said of the CDC. “With Covid, the virus gained ground quickly. With monkeypox, which spreads more slowly, usually through very close contact, the shortcomings of the CDC’s cultural approach have not yet been as acute. But the shortcomings are the same.”
The CDC has reported nearly 5,200 cases as of Sunday, and the outbreak has reached all but three states: Montana, Vermont and Wyoming.
Monkeypox is spread through close contact with an infected animal or person, usually through injuries, bodily fluids, contaminated materials, and respiratory droplets. Those droplets can only travel up to a few feet and usually require prolonged contact for transmission.
The virus has been largely detected in men who have sex with men, leading some jurisdictions to prioritize those groups to receive the currently limited number of doses of monkeypox vaccine.
Gottlieb called on the CDC to continue leading the national response to the pandemic, but argued that they should transfer some of their disease prevention work to other agencies.
He called on the FDA to control smoking and the National Institutes of Health (NIH) to control cancer and heart disease.
“Focus CDC more on its core mission of outbreak response,” Gottlieb wrote. “And imbue the agency with the national security mindset that it had at its origins. If CDC’s mission were more focused on the elements needed to manage contagion, Congress might be more willing to vest it with the strong authority to do that specific mission well.”
But Gottlieb questioned the feasibility of reform to equip the CDC and other public health agencies with new tools and authority, citing his conversations with lawmakers and their staff that showed what he called a “little appetite” for such a move.
“Post-Covid, some are of the opinion that public health agencies used faulty tests and miscalculated their advice,” Gottlieb wrote. “Securing a political consensus that the CDC should be more empowered to complete its mission , for example, vested with the authority to compel states to report , is politically unattainable.”