Monkeypox has been in the news and on social media. Folks are really trying to make sense of what's happening. I don't think everybody's got it quite right. I mean, I don't know all the answers, but some of the things I'm seeing are wrong. What we're also seeing, though, is that a dog was likely infected with monkeypox recently, and so that was August eighteenth. There's just a lot to wrap my arms around. So I think we gotta look at this thing a little closer.
I'm TT and I'm Zachiah and from Spotify.
This is Dope Labs.
Welcome to Dope Labs, a weekly podcast that mixes hardcore science, pop culture, and a healthy dosa friendship. We're talking all about monkey pox, and it's only fitting because it's been everywhere in the news, not just in the news but on social media. We've seen y'all talking about.
It, and honestly, this episode has been in the making for weeks, but it's just that every time we go to press record, something new is happening.
So what do we know.
Monkey Pox has the word pos in it, so I know that means painful skin lesions. When I think about monkey pox, I think about smallpox and chicken pox, which I had when I was in kindergarten painful.
Yeah, and we know that monkey pos has been around for a while.
Monkey pox has been around for a while, but the cases we're seeing now in the United States are primarily concentrated among men having sex with men. This has led some folks that think monkeypox must be sexually transmitted, but that's.
Not the case. So what do we want to know? Well, I think we first got to start with what is monkey pox?
Right?
That is a very good question to start with, And my question right after that one is how did it get here?
I think the other thing I want to know is what does the science tell us about monkeypox? And how is that different from what we're seeing public health recommendations telling us about monkeypox, because those.
Are two different things.
We know that there's, yes, the science, but there's all the context around it, right, So we want to know the fact and the fiction and the context when it comes to monkeybox.
That's right, CT, let's jump into the dissection. So we really wanted to make sure that we were covering this issue from multiple angles because there's so much to discuss. So this week we have not just one, but two guest experts, doctor Angie Rasmussen, who's going to talk to us about the virus and the vaccine, and Kenyan Farroh, who provides the social and public health context.
I'm Angie Rasmussen. I am virologists. That's the Vaccine and Infectious Disease Organization at the University of Saskatchewan Here in Saskatoon, Canada. I studied the host response to emerging viruses, including monkey pox.
My name is Kenyon Farroll. I am the managing director of the advocacy in organizing with an organization called Prep for All, and I am also generally an activist and a writer.
So let's talk about the virus. What is it?
So? Monkeypox virus is an orthopox virus.
Orthopox Viruses are part of a family of viruses that cause disease, and back in the old days, used to be called generally pox. Pox is used to represent the marx and lesions left on the skin. Another orthopox virus that you may have heard of is smallpox, and that was declared eradicated in nineteen eighty. So monkey pox is not new, right.
Smallpox hasn't been around for a long time. But monkeypox was actually discovered in nineteen fifty eight in a group of Labne monkeys that had been imported into Denmark and they developed the smallpox like disease that turned out not to be smallpox. It was monkey pox, and so that's how it was named.
And there was a lot of stigma with this. How you name something carries.
A lot of weight.
Oh my gosh.
We saw this with COVID early on.
We saw it with our then President Trump calling COVID the Chinese virus, which was inaccurate. And similarly, we're calling monkey pox monkey pox because it was discovered in monkeys, but that's not where it came from, Like, that's not where the reservoir for the virus was. And the only reason it's called monkey pox is because that's where we got a scientific snapshot of it. And so there's been a push to rename the virus, but it just hasn't taken hold yet.
The symptoms of monkey pox can include fever, headache, muscle aches and backache, swollen lymph nodes, chills, respiratory issues, and a rash or lesions on the skin.
So there's a whole process with the rash that happens, and generally speaking, it starts off as a a rash with some flu like symptoms associated with it. That becomes a versicular rash, which eventually becomes like a pustule or a blister, and then that scabs over and then the scabs fall off. The new skin is underneath. When the scabs fall off, that's when people are thought to be no longer contagious.
Monkey pops can be extremely painful, but its fatality rate is much lower than smallpox, which has a fatality rate of about thirty percent.
What about how it's spread, I think there's a lot of confusion around this. Can it be spread on surfaces or is it airborne like stars coovy two or.
The pox viruses can be transmitted by both aerosols and faumites.
A fomite is an object, fabric or surface that can carry and spread disease, so like clothing, bedding, or towels. And while the virus can be transmitted by objects, the risk of TRANSMITSI and via this route is low.
So there are clearly examples of fomite transmission for orthopox viruses, and I think that probably is just a matter of the extent of the exposure. So if you are doing laundry in a hospital that's full of monkey POGs patients, they're going to be at a higher risk of fomite exposure than if you're just living in the same house as somebody and you sat on the same couch with them.
So there's no need to start disinfecting your groceries like we were doing for COVID.
This is so important because what we saw in COVID is initially people were concerned about getting COVID from touching things right surfaces.
I bought so much lyesol.
I have friends who were putting their mail and they had like a seven day rotation. They let that mail cure for a week basically, and then they would open it.
Yep.
But a lot of that comes from not having kind of the right information. So what we know is, yes, monkey pox is primarily spread from direct skin to skin contact, but also there can be transmission from aerosols. Aerosol transmission means a virus can be transmitted through the air, specifically through respiratory secretions. Scientists are still researching how often monkey pox is spread through these respiratory secretions. But again, doctor
Rasmussen says the risk here is low. Otherwise we wouldn't be seeing such a concentrated outbreak in one specific community.
If aerosol transmission we're driving this outbreak that's happening now. People in the queer community have families, they have co workers, they're around a lot of people. We would see many more cases occurring outside of that community. And the same is true with fo MIC. Certainly there is the possibility for transmission in schools, and there have been a few women and some children who have contracted monkey pox, and that's because sex is not the only activity that involves
close physical contact between people. If it were possible to be transmitting this by trying on clothing and other types of really incidental contact, we'd be seeing a lot more monkey pox cases, and we're just not. The vast, vast majority of these cases are occurring in men, in trans people and non binary folks who are part of these sexual networks within the queer community.
And that makes sense because the vast majority of infections are being driven by extensive, direct skin to skin contact between people.
Which, of course sex fits the bill for if you're doing it the way that I think you're doing it.
Yes, you're in very close physical contact with another person. And so I've been seeing some people confuse this and say, like, oh, monkeypox is an STI.
But we want to be really clear.
While there is some evidence that monkeypox virus could be in semen, meaning it could be sexually transmitted, the vast majority of people are contracting it via skin to skin contact.
We do that it is spread through contact with lesions or blisters and also bodily fluids of a person who has monkey pots, but that doesn't necessarily mean that it's sexually transmitted per se. We just know that in sects you're going to be having a lot of physical contact with someone, and so it is easy to facilitate transmission that way.
Monkey Pox wasn't reported outside of Africa until two thousand and three, so even though it had been occurring in the seventies, a lot of this was animal to human transmission, so encounters with wildlife right, and now what we're facing is a different mode of transmission, which is primarily driven by human to human. Before it was usually like import of exotic animals and things like that that people shouldn't
have been bringing in. Another thing to understand is that the median age range for monkeypox infection in Central and West Africa has increased, so in the nineteen seventies and eighties, the median age range for MONKEYPOXX infections was four to five years old. Then from the two thousand to twenty tens it moved to the median age range being ten to twenty one years old, and cases outside of Africa also occurred more frequently in males and primarily in adults.
A lot of this has to do with the way that we live. Your risk for monkeypox infection is directly related to where there is reservoir of virus. So when virus was primarily in animals and spread from animal to human, the riskiest behavior was sleeping in a forest, being near
those animals that are reservoirs for monkeypox virus. Now that we have monkey pops in humans and in a larger population, the risk behavior is living in the same house with someone, having a lot of direct skin to skin contact and sharing dishes and eating.
The same food as someone else. When we say things like sexual transmission, when we're talking about these viruses, I really worry about vilifying the queer community. I mean, we've seen throughout history people in the queer community be the scapegoats for a lot of different things for virus spread. They try and say that homosexuality is like you're a sexual deviant. They'd like to say that they're more likely
to be pedophiles, all of which is not true. So when I hear sexual transmission coming up and we're talking about monkey pots, it really makes me nervous because it's like we are doomed to repeat the same toxic cycles over and over again, and the folks in the queer community are always the ones that are taking the brunt of the toxicity, and it's really dangerous. People are losing their lives because of all of this false information.
That's right, and that's to me right now is the community that needs to be advised on how to decreach their risk.
Most significantly, monkey pox we have known about for fifty years, and yet because we're now seeing a new manifestation of monkey pots in the United States for.
The first time, and because it sort of entered the US kind of through gay men first, it is being framed as a gay disease. And there's no such thing as a gay disease or a gay virus.
Let me repeat that one more time for the people in the back. There is no such thing as a gay disease or a gay virus, you know.
The truth of it is, anybody can get monkeypos absolutely, and this is not the first time it's entered the United States. There are forty seven cases of monkeypox before, but that was associated with collecting exotic animals. So if you have skin and you're having skin to skin contact, the truth of it is, you can get monkeypos It's not about being gay or having sex. It's just that
our reservoir has changed now. The reservoir is human. So the more humanly behavior you're having a human in human contact, the higher risk.
And just like with COVID, some people may not know they have monkey pox or that they're contagiou.
And I think that that is one question is like when does somebody actually become contagious after they get monkey pox. Now, monkeybox has a relatively long incubation period, so people may not realize that they have it until a week or two after they've been exposed.
This sounds just like COVID, all the adding and subtracting the number of days you're contagious or potentially contagious. It just feels like we are all living in this constant state of anxiety, and you might think the experience with COVID that we're still kind of going through, that we would be better prepared for monkey pox, But it sounds like that's not the case. Both experts agree that we're not showing that we learned too much from COVID.
We haven't learned a damn thing in terms of our response in a lot of ways.
So how concerned should we be about monkey pocks?
What concerns me the most is really how this has exposed our massive failures to respond effectively, and how it really shows that we haven't actually internalized a lot of the lessons that we should have learned from the COVID nineteen pandemic.
I think one of the lessons that we didn't internalize is vaccine availability, what it takes to roll out a vaccine. I don't think that we learn anything from that because here we are another virus is spreading and there are no vaccines, just like when COVID was spreading and we
were like, uh oh, there are no vaccines. But folks have been working on a coronavirus vaccine for a long time, so it felt like we should have been a little bit more prepared, but it feels like the powers that be just don't take these things as seriously as they should.
I think we also see that we have big, clunky machines of governments and public health systems that don't really communicate with one another, right and because it takes them a long time to all get on the same page, folks are just typing and sharing whatever information have, whether it's accurate or not, and that can be really tricky, and I think we're starting to see that with monkeypox, just like we saw with COVID, and it's taken a
while to get recommendations, which feels very similar to what we saw with COVID. But I'm a little concerned because it's not new, so it feels like it didn't have to be that way.
Right early on, when we knew that monkey pox was beginning to spread outside of endemic countries, we had the opportunity then to make testing available, to really reach out to the community that's being affected, and to be very clear right now, that is the community of gay, bisexual men who have sex with men. We had the opportunity
to make testing accessible to that community. We had the opportunity to actually do contact tracing and provide vaccines for people who had been close contacts of people who ended up getting monkey pox. And we actually also have antiviral drugs that can make the symptoms of monkey pox a lot less difficult.
That does sound very, very familiar to the last you know, almost three years of our global experience, right.
So when we think about endemic countries, we're talking about places where there are reservoirs or virus and where there are consistent infections or consistent occurrences of viral infections. And when you look at the literature, monkey pox is endemic to two regions, Central and West Africa.
There's evidence that this particular clade or strain that we're seeing now in the United States was seen first in Nigeria in twenty seventeen.
And my colleagues, auditions scientists in Africa could have told you twenty years ago that monkey pox was going to be a problem, and that it's a problem they deal with regularly, and because it's not impacting people in wealthier countries, there just hasn't been that concern that it's something that needs to be a priority. The reason that we don't have any data on monkey pos or not that much
data on monkey pops. The reason why research hasn't been funded in the US or Canada, where I live now, or Europe is that it was happening primarily in endemic countries in Africa. So things that happen in Africa, you know, people have had a tendency to say, Oh, it's happening over there, or it's happening somewhere that doesn't affect me, because I don't know people who live there, and I'm not going there and it's not affecting my life, And
I think that that is a terrible mistake. The fact that we are a global world really shows the crucial importance of not just health equity, but also scientific equity.
The globalization of our world economy is a huge factor in how these outbreaks come to be. Because we're moving, we have planes, trains, and automobiles, which means those viruses are also on those planes, trains, and automobiles. We have to consider these things as we are moving about the globe. We're going to take a break and when we come back, we'll talk about how we can decrease the risk using vaccines.
Plus what the media is getting wrong about monkeybox. We're back, and before we get back into monkey pox, let's talk about our lab for next week.
In next week's lab, we're talking all about commercial spaceflight. It seems like everybody and anybody can get into space these days, so we're breaking down how commercial spaceflight evolved and where's headed with doctor Jordan Bim.
All right, so let's talk about monkey po's vaccine. Earlier, we talked about how smallpox and monkey pox are both orthopox viruses, and smallpox was eradicated in nineteen eighty thanks to the success with vaccination. So is there a vaccine for monkey pox.
It's a similar enough virus that smallpox vaccines do have some efficacy against monkey pox. And there's really two smallpox vaccines that we're talking about here.
So the vaccine that eradicated smallpox in the late seventies early eighties has effectiveness against monkey pox. And like doctor Rasmusen said, there are now two vaccines that are effective in preventing monkey pox. Let's break them down.
There's an older one which is called ACAM two thousand, and it's actually made from another orthopox virus called vaccinia virus. A fun fact is that's actually how the term vaccine got its name, so ACAM two thousand was targeted against vaccinia and is supposed to prevent smallpox, which is really awful. It's really transmissible, so super contagious, and it has a
high fatality rate. So you can consider something that has a high fatality rate and can get you really really sick, is easily transmitted, you're willing to take on a little bit more risk to make sure that you're not spreading that. So this is a really hard to take vaccine. AKM two thousand in some people can cause disease and sometimes cardiac complications because.
It's so tough on your immune system.
Historical data has indicated the smallpox vaccination with vaccinia virus was approximately eighty five percent protective against monkey pocks in the past. But when you don't put money behind these programs, then you see a decrease in smallpox vaccination in these other countries. And when there's a decrease in vaccination, that allows us to have more potential hosts.
So in the early two thousands, another company made a better vaccinia based vaccine called Genios, which is a lot safer. The problem is we don't have enough.
So we already had far fewer doses of genios available in our stock file for treating monkey pocks, and it requires two doses. So basically, if you have, you know, a million doses, that's actually only five hundred thousand people that can be vaccinated with it.
So now we're considering two things. We have doses of something that's really hard on the body, then we only have limited doses of something that's easier on the body, and it requires two doses. So cut that stockpile in half. Once we get more supply of the vaccine, we still got to conquer another issue.
Will people take it?
We ask Kenyon if he thinks people will have a similar hesitancy around the monkey pox vaccine that they did with the COVID vaccine.
So I don't think that we'll have the same vaccination of take issue with covid if for no other reason than people are vain, right, So if people are seeing images of people with these lesions, and I just think the physical manifestation changes, I think the way a lot of people see and creates a different kind of urgency for people to get vaccinated.
I think, yes, people are vain, but I think there's some differences between the COVID vaccine, which a lot of folks complained was that COVID was and they felt like the vaccine approval process happened really quickly and they weren't really sure about it. The smallpox vaccines have been around, right, so if there was hesitation around how quickly this got delivered, you shouldn't see that same concern if folks are candidates for a smallpox vaccine because it's been around. I think
there's more to it than people just being vain. There's a certain reality that you're confronted with when you can see the physical manifestation of a disease. And so while you may have trouble breathing with COVID, there wasn't much you could really see that it is alarming, and it's like, hey, this is being spread.
Human nature, I would guess, is you know one that we only sort of respond to things that we can sort of see, touch, taste and feel, you know, our kind of five sensus. And so when you're doing prevention work, it is very hard to argue to people that actually we need to prepare for things that are coming, or that we can anticipate comming that we don't currently have infrastructure for.
So if monkey pops has been around for so long and we have vaccines to prevent it, why is this happening now.
Part of the reason we're seeing this spread is just bad timing and our failure to act knowing the timing.
June was Pride month, and we knew that monkey pop was spreading in this community, and it was very difficult for people to be tested.
And so you're talking about, you know, just a time where people are doing parades and doing big circuit parties and gathering and of course people are having sex, and you know, all of those dynamics together as probably why I think we are seeing the outbreak kind of happen there first. But no one listening to this should believe that that is where any virus or infectious disease will stay in one community.
Additionally, there are a lot of cases that were either misdiagnosed or undiagnosed because of a coinfection where monkey pocks went undiagnosed, and that happened in one in three cases based on a study from the New England Journal of Medicine, or because the monkey pox was misdiagnosed as something else.
Kenyon says, all of this points to a disinvestment in public health systems broadly, and that's a problem that.
Includes everything from being able to track viruses and diseases you know, from your United States sort of like epidemiological surveillance systems, to then testing and contact tracing systems, to then the sort of research around you know, vaccines, treatments, etc. Or just research to sort of understand both the basic science of a virus or a bacteria, to other kinds of research to understand sort of spread and prevention, et cetera.
And we also need to prevent the spread of misinformation. I recently saw video on TikTok of this woman who was riding a train and she was wearing a mask so you couldn't really see her face, but she had some bumps on her skin, and somebody secretly recorded her and posted it and saying, oh my gosh, that she have monkey pox or whatever. And the woman on the train found the video because it was going viral and posted a response and said, no, I actually don't have
monkey pox. I have another disease that puts these bumps on my skin. But thank you so much for you know, making me a target of harassment and it's just so wild that we are repeating the same mistakes that we made before. Just like with COVID, the internet and social media are flooded with all kinds of misinformation about monkeybox, and so part of.
What we're seeing in the reporting is this kind of framing it within the context solely of gay men, and I think which leads people to think that that is
the only place that the virus will end up. The second piece is a kind of question about whether it's a sexally transmitted infection or not, and I I think the media also has not done a good job of explaining that it also assumes that gay and bisexual men's only relationship to one another is sex, so that it is the only possible way that we may be.
Contracting it, you know.
And this can be confusing because you have to kind of reconcile these different bits of information. Earlier in this lab we said, hey, this is primarily in the community of men having sex with men.
But I think because.
People are also conflating sex as a vehicle for direct skin to skin contact, and assuming that monkey pox is transmitted sexually, they're thinking, oh, you have to be having sex with men to get monkey pox that's not necessarily the case, and I think a lot of this is related to the hyper sexualization of gay.
And bisexual men.
Right.
People think, Oh, all they're doing is having sex, and so that's how this is spreading. But as Kenya notes, they are full of humans. They are having close relationships with other people in their lives, children, their parents, their siblings, right, and so there's an opportunity for direct skin to skin contact. So even though we're seeing this concentrated in this one community right now, it doesn't mean it will always be that way.
I do think that it's really important that when we are talking about this, we're talking about it in the context of the people who are being affected, the people who are at the highest risk, and their behavior is irrelevant. It's not about moral judgment. It's about the risk of exposure, and that's what we need to be focusing on, not sex with multiple partners, not people who are having sex with people of the same sex or people who are
on the gender spectrum. We need to be talking about this as people who are at risk, a community that is specifically at risk, without stigmatizing or passing moral judgment on that community. Because ultimately, having sex is a human need. We need to focus on the fact that we can't just tell people not to have sex. We can tell people in a judgmental, stigmatizing way that their behavior needs to change. And that's the one thing that's keeping us
from controlling monkey coocks. That's completely unacceptable. What we need to do is reach out to the community that's at risk and do everything in our power to prioritize them for education, for access to testing, to vaccines, to treatments.
We're also failing because of an inability to plan ahead, and that's a real problem because if we don't plan ahead, it's the marginalized communities that are affected the most.
One of the things that we have as an issue too, is that you know, infections diseases often track along the
lines of structural oppression in our societies. Right, So racism, xenophobia, homophobia, transphobia, sexism, classism. Right, So, it's no surprise when we see infectionous diseases begin to impact poor people, communities of color, the LGBT community, right, places in the South, places that are resource for first, because those are folks who are often in structural positions that put them more at risk.
Right, Doctor Rasmussen was saying, if you get monkey pops, you may need to stay home and isolate for up to four to five weeks.
That is a long time.
Can you imagine they don't even want you to isolate with COVID then that's breathable, And.
With our sickly policies with our healthcare in the US, that's just simply not a realistic proposition. So again, a lot of our failures to control this come back to failures and health equity and making sure that people have the resources they need to protect themselves and to protect others around them from potentially becoming infected.
People for various reasons, blame those communities for the outbreaks that happen, as opposed to understanding our social conditions are structured in such a way that those individuals, if the virus doesn't enter that community first, it'll spread there faster.
So recently, the World Health Organization or WHO declared monkey pops a global health emergency. We asked Kenyon, what's the significance of these declarations?
So countries that are members of the Oral Health Organization
part of their sort of responsibility. Once they become a member of the who IS, then they have to actually sort of mobilize a response in their countries, right, but it also gives a wahhow the possibility of kind of mobilizing and coordinating internationally, right, so that there's data being collected everywhere, that there are cases that there's a kind of streamlining of funding, and it can accelerate the advancement of In the case of things like COVID, where we
didn't have vaccines with therapeutics or diagnostics, right, the resources come together to be able to kind of create those things.
The United States declared monkey pops a National Health emergency. This means that all states are legally required to report cases to the CDC. States are also required to track and report or demographic information associated with infection like age, gender, and race.
So we can then begin to understand sort of how transmission is happening and part of what it also sort of hopefully will trigger once that happens is Congress then can take that to then allocate emergency resources to better find a response.
That response means better testing, and better testing means more tests available, It means better education for providers, and that leads to less misdiagnosis, So people being diagnosed for something else when it actually is monkeypox or undiagnosed, where people aren't diagnosed with anything, they just say, we don't know what it is. And so we need better testing, more resources to help and expand the services that are available.
We need to create more vaccine access, and we need to produce more anti viral treatment to alleviate the awful symptoms of monkeypox.
Too often we mobilize, we turn up show up in instances where either people die at the end of a police revolver or because of a kind of white vigilante right in many cases. But we don't do as much when actually more of our folks die prematurely from systems of neglect, of which public health and our kind of
healthcare infrastructure certainly fits the build. And so we have got to also, as people of contience and communities, really begin to take seriously our healthcare and public health infrastructure as much as we do policing and voting and education and schools and the things that we typically will show up in mass mobilizations that we'll tweet about, etc.
Etc.
And not just assume that somehow somebody else has the healthcare piece down, or just assume that the system that we have is the one that we need that is intractable and unfixable. I think that we can really begin to ask ourselves, what is the future of public health, What is the future of healthcare so that it serves people, so that we don't keep rolling from one pandemic to one crisis after another and reinvent the wheel every time.
Doctor Rasmussen is spot on.
Okay.
When I was going back to the literature to look at kind of what's going on, I was looking at this overview of all these other studies of monkeypos I saw that there was a paper submitted in June twenty twenty one, but it wasn't published until February twenty twenty two, and it was asking if monkeypox could potentially become a threat.
And part of this is like science takes a long time to do and some of our processes are really slow and clunky, and so by the time this article came out, the answer was yes.
Girl. But it's really.
Interesting because we're just starting to consider this a threat in the United States. But folks have been kind of telling us, The literature has been saying, hey, this is a thing that's happening. We know we live in a very global society. And what that study was showing was that decade, over decades, there were increases in monkeypox cases.
Wow.
And so folks signed scientist physicians in Central and West Africa have been ringing the alarm that something was going on with monkey pops and that it was spreading. But like she said, you gotta put the dollars where.
Something is happening. That's it for this lab.
Call us at two zero two five six seven seven zero two eight and tell us what you thought, or give us an idea for a different lab you think we should do this semester. We like hearing from you. That's two zero two five six seven seven zero two eight.
And don't forget that there is so much more to dig into on our website. There'll be a cheat sheet for today's lab, additional links and resources in the show notes. Plus you can sign up for our newsletter check it out at Dope labspodcast dot com. Special thanks to today's guest experts, doctor Angie Rasmussen and Kenyan Pharaoh.
You can find doctor Rasmussen on Twitter at Angie Underscore Rasmussen and Kenyon Pharaoh is at Kenyon Pharaoh.
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