Monkeypox hit our shores in May of this year. How did our public health agencies and infrastructure perform? What went right, what went wrong, and what needs to improve? We talked with three experts in public health and biodefense about the threats on their radar screens and how the U.S. can better prepare for the next inevitable outbreak or pandemic.
Monkeypox hit our shores in May of this year. How did our public health agencies and infrastructure perform? What went right, what went wrong, and what needs to improve? We talked with three experts in public health and biodefense about the threats on their radar screens and how the U.S. can better prepare for the next inevitable outbreak or pandemic.
Guests:
Dr. Asha George, Bipartisan Commission on Biodefense
Dr. Lynn Goldman, Milken Institute School of Public Health at the George Washington University
Dr. John Redd, Medical Countermeasures Coalition
Senator Patty Murray: According to the Senators for Disease Control and Prevention, the US now has over 21,000 confirmed cases of Monkeypox, more than anyone else in the world. COVID was never going to be the last public health crisis we face, and neither is Monkeypox. The question is not whether there will be a new threat, it is [00:00:30] when it will strike and whether we will be ready. The truth is the Monkeypox response so far has not been encouraging.
Senator Richard Burr: Monkeypox is now a public health emergency. It didn't have to become one. After almost three years of the COVID pandemic, you would think that the public health agencies responsible for our preparedness and response would be prepared for anything, particularly a threat like Monkeypox, which we've known about for decades and for which we have vaccines and treatments.
Dr. Michelle McMurry-Heath: [00:01:00] The Monkeypox outbreak has hit the US hard with more cases than any other country. What you just heard is a snippet of audio from two senators during a congressional hearing about the outbreak, and although things are always clearer in hindsight, the senators make an excellent point. Why weren't we able to stop the Monkeypox outbreak? The US National [00:01:30] Stockpile already had a vaccine proven effective against the virus. Our experience with Monkeypox begs the question, are we doing enough to prepare for infectious disease outbreaks? Today we talk with a public health expert about our response to Monkeypox. We also speak with two experts on how we can better respond to the next infectious disease outbreak. I'm Dr. Michelle McMurry-Heath and you are listening to [00:02:00] I Am BIO.
Dr. Lynn Goldman: Our federal government, but also state and local governments, have under invested in public health over a very long period of time, and this is something that [00:02:30] we have been talking about, those of us in public health policy, and this is not a new problem. And that has resulted in a number of shortcomings that if you may, the chickens are coming to roost for the American public. And what I mean by under invested, the public health system doesn't have the technology that it needs to have that's up to date, it doesn't have the data systems, it doesn't have the personnel, it doesn't have the support for [00:03:00] the research that it needs.
Dr. Michelle McMurry-Heath: This is Dr. Lynn Goldman, an epidemiologist and the Dean of the Milken Institute School of Public Health at the George Washington University.
Dr. Lynn Goldman: Monkeypox is not constantly evolving. It is probably an older virus in the human population. Population genetics would say that over time, viruses quit shifting quite so rapidly. I could be wrong, but it seems that we're safe to say [00:03:30] that the vaccines that we have available now are going to be effective for a very long time. It's also true that the vaccines provide much longer term immunity for the ortho pox viruses.
Dr. Michelle McMurry-Heath: So, if we already have an effective vaccine in the National Stockpile that fights Monkeypox, why didn't we just use it to stop the outbreak?
Dr. Lynn Goldman: The situation with our availability of vaccines with the Monkeypox has been [00:04:00] terrible. We have known that we need to have stockpiles of these vaccines. The people in charge of the stockpile were not the CDC, they were not our public health agency. They were looking at this as a stockpile that was there in case of a bioterror attack and deploying it in a certain way that's very different than how you deploy a vaccine with an epidemic that is happening [00:04:30] within specific communities. This is not an attack. This is not a situation where you're sending cases of this around and that's the way that you deal with it. This is a situation where we need to have a very targeted campaign that's aimed at people who are at highest risk.
Dr. Michelle McMurry-Heath: In fact, the world knew about a potential monkeypox outbreak in 2017 when the virus was detected in Africa. However, it was ignored until [00:05:00] it reached the UK on May 6th 2022. When it hit the United States on May 18th, the US Stockpile contained just 2,400 doses of vaccine, a far cry from the more than 20 million it once held.
Dr. Lynn Goldman: The people who are running the stockpile, they allowed the supplies to expire and, unfortunately, neglected to order more even when the Monkeypox first made its appearance [00:05:30] in countries in Europe, we should have said, "It's circulating in the UK and Spain and other European countries, human to human. It's just a matter of several flights across the Atlantic for it to be circulating that same way in the United States," which is absolutely what happened. But unfortunately, we don't have that early warning system that triggers that when we see an epidemic like that overseas, that [00:06:00] we are immediately preparing here. I mean I would say that that's something that's been in common between the Monkeypox and COVID, that early information coming out of China was not heeded as quickly enough as it should have been in the United States.
Dr. Michelle McMurry-Heath: With an expired supply of vaccine, Monkeypox took off. As of September 14th, the Centers for Disease Control and Prevention reported more than 23,000 cases of [00:06:30] Monkeypox across the country.
Dr. Asha George: Manufacturing capacity for smallpox vaccine is not keeping up with demand, not with demand from the United States or demand from anywhere else in the world. This means that we're sitting around waiting for more smallpox vaccine to come back into the stockpile.
Dr. Michelle McMurry-Heath: This is Dr. Asha George, the Executive Director of the Bipartisan Commission on Biodefense, which was developed to examine biological threats to our country.
Dr. Asha George: [00:07:00] Look, Monkeypox was an issue in Africa before it ever got here to the United States. We could have rotated some of our contents out of our own stockpile and given it to Africa, and given it to other countries for that matter well in advance of what we have going on right now. I just think we need to take a different approach and it cannot just be that, "Well, the United States government is the only customer," and so the government just endlessly has to pay. I think that that's a pretty naive and limited [00:07:30] view of the business of biodefense. Lots of people right now are looking for that vaccine for Monkeypox or for ortho pox. Lots of people are, and it's not just the government or governments, it's also the private sector, it's also individuals by themselves. We need a new model and we need to support that model.
Dr. Michelle McMurry-Heath: Dr. George argues that we have to take another approach to deal with outbreaks, one that is based on partnerships between biotech companies [00:08:00] and the government.
Dr. Asha George: I think partnerships between biotech companies and the government is incredibly important. It is vital, but partnership between companies and the government, for whatever purpose and of whatever type, do not solely come down to somebody has a service and somebody's got money to pay for that service, or somebody's got pharmaceutical or some technology, biotechnology [00:08:30] or otherwise, and the government is going to pay for it. That is not a partnership, that is a business model, but that is not a partnership.
Partnership is when two or more entities decide that they're going to work on something together and solve that problem together and recognize that all of those entities have different resources that they can bring to the table. Everybody needs to bring something to the table, then together they work on solving problems, on saving lives. I think that [00:09:00] the biotech community has done probably better at this than many, many other organizations and individuals for that matter. But that's what it's going to take and we have seen that demonstrated with COVID and with other infectious disease threats.
Dr. Michelle McMurry-Heath: But how do we build a national vaccine stockpile in case of biological warfare, while also having enough doses ready for the next global health pandemic?
Dr. Asha George: I think that in order to build [00:09:30] support for biodefense and for pandemic preparedness and for just biological event preparedness, people have to be aware of what's going on, people have to understand what the threat is. And whether they're in the government or they're in the private sector, or whether they're just citizens in a country, they have to be aware of what's happening. They can't be constantly surprised when something occurs, especially when so many of these things are predictable, [00:10:00] forecastable, and expected by bunches of people in the government and many people in the private sector.
There's no reason that people wouldn't be supportive, in my opinion, if they knew about it, if they really understood it. I think there's an educational component to this. I think we have to get some more information out there, we have to explain what's going on, and we have to stop pretending like the current [00:10:30] event that we're going through is the last event we're going to go through, and then we can all just move on to other things. I think the public is quite aware now, however disappointed they might be, that infectious disease threats seem to be with us and coming back over and over again and affecting the nation and affecting them much more frequently than what used to happen in the past.
Dr. Michelle McMurry-Heath: If pandemics are here to stay, our current approach can't meet the moment. [00:11:00] When we come back from our break, we'll hear from our next guest about a potential new model.
Are you interested in hearing more [00:11:30] fascinating stories like this one? Check out bio.news. Bio.news is a daily news website exploring the intersection of biotech innovation and US and international policy. With new content daily, bio.news has you covered on the latest biotech. Visit now by typing in bio.news into your web browser.
Narrator: [00:12:00] Senator Patty Murray from Washington State and the highest ranking female Democrat in the Senate.
Senator Patty Murray: We have to end the cycle of crisis and complacency by making sustained investments that allow us to build and maintain robust public health infrastructure at all levels.
Dr. Michelle McMurry-Heath: [00:12:30] Our next guest agrees with Senator Murray's statement.
Dr. John Redd:I'm Dr. Dr. John Redd. I'm the Chief Medical Officer of the Medical Countermeasures Coalition, or MC2.
Dr. Michelle McMurry-Heath: Dr. Redd's organization was recently formed to create better coordination among government, academia, and the biotech industry in developing medical countermeasures for the next outbreak.
Dr. John Redd: The new model, looking ahead toward medical counter measures in the future, is going to require a lot of aspects [00:13:00] that were not present during the COVID response or the Monkeypox response. Those are measures that prevent, detect, and treat pandemic pathogens. The great success of big scale efforts like Operation Warp Speed, which was part of the COVID response, shows that life-saving interventions can really happen quickly if there's coordination between government, the biotech industry, and academia.
If you look at both the recent pandemic of SARS‐CoV‐2, which [00:13:30] of course causes COVID-19, and also the recent outbreak of Monkeypox, it's very clear that there needs to be a central body that brings together people from industry, academia, and works with people from the government in order to develop sound policy and to advocate for forward-looking solutions for the United States and the world.
Dr. Michelle McMurry-Heath: And that includes decisions about procurement, storage, and maintenance of medical countermeasures globally.
Dr. John Redd: We've got to have [00:14:00] a system that is going to be capable of, as much as possible, keeping up with the pathogens themselves. What that means is we've got to respond quickly, we've got to be flexible, and we have to have a robust system. We want a system that's going to be capable of responding with testing for multiple potential pathogens in multiple places at once. We need to make sure that we maintain that capacity for the future, including for pathogens that we've not seen yet.
In terms of response, [00:14:30] we need to make sure that the public health system in the United States is widely distributed. We need to have laboratory testing and epidemiology capacity all over the country, and that includes through state departments of health, tribal departments of health, territorial locations. The entire country needs to have a system that's integrated, communicates well, and is capable of a very rapid response, which includes testing for a new pathogen.
The system looking forward is going to have to be [00:15:00] rapid, rapid, rapid, just as quick as we can imagine. We've gotten better over time, when we look at our COVID-19 responses, but we need to continue to improve for the future, and that's what we hope to contribute to with the Medical Countermeasures Coalition.
Dr. Michelle McMurry-Heath: Dr. Redd imagines a system in which the government looks ahead towards emerging threats with an up to date response while collaborating with industry to anticipate needs before crises occur.
Dr. John Redd: This system that we imagine also has to be flexible enough to be responsive [00:15:30] to different types of pathogens, to respond to outbreaks in multiple locations at once, and to respond very quickly. So the whole point is that we've got to have a nationwide effort that continues to be both well funded, but also well supported in terms of government effort, it needs to remain a priority for the government of the United States, even when we all feel the urge, the natural reflex to relax a bit about pathogens after COVID, there's natural human temptation to become complacent during those intervening episodes [00:16:00] and the crisis portion occurs when a pandemic causes a life-threatening or, unfortunately, life-taking crisis. And that's the cycle.
Dr. Michelle McMurry-Heath: It is tempting to move on once a crisis is behind us, but as we've learned today, we can't afford to stop preparing for the next pandemic, and it could be even worse, especially if no one is paying attention. It's up to all of us to continually sound the alarm and invest in the research, development, and [00:16:30] biomedical infrastructure that will help us respond when the time comes.
I'd like to thank our guests, Doctors Goldman, George, and Redd, for helping us understand how critically important it is to keep our foot on the gas even when a crisis wanes.
This episode was developed by Executive Producer Theresa Brady and producers Connor McKoy, Lynne Finnerty, and Rob Gutnikoff. [00:17:00] It was engineered and mixed by Jay Goodman, theme music created by Luke Smith and Sam Brady. Make sure to subscribe, rate, and/or review this podcast and follow us on Twitter, Facebook, and LinkedIn at iambiotech, and subscribe to Good Day BIO at bio.org/goodday.