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Speaker 1: Monkeypox has been in the news and on social media.

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Speaker 1: Folks are really trying to make sense of what's happening.

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Speaker 1: I don't think everybody's got it quite right. I mean,

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Speaker 1: I don't know all the answers, but some of the

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Speaker 1: things I'm seeing are wrong. What we're also seeing, though,

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Speaker 1: is that a dog was likely infected with monkeypox recently,

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Speaker 1: and so that was August eighteenth. There's just a lot

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Speaker 1: to wrap my arms around. So I think we gotta

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Speaker 1: look at this thing a little closer.

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Speaker 2: I'm TT and I'm Zachiah and from Spotify.

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Speaker 3: This is Dope Labs.

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Speaker 2: Welcome to Dope Labs, a weekly podcast that mixes hardcore science,

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Speaker 2: pop culture, and a healthy dosa friendship. We're talking all

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Speaker 2: about monkey pox, and it's only fitting because it's been

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Speaker 2: everywhere in the news, not just in the news but

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Speaker 2: on social media. We've seen y'all talking about.

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Speaker 1: It, and honestly, this episode has been in the making

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Speaker 1: for weeks, but it's just that every time we go

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Speaker 1: to press record, something new is happening.

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Speaker 2: So what do we know.

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Speaker 1: Monkey Pox has the word pos in it, so I

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Speaker 1: know that means painful skin lesions. When I think about

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Speaker 1: monkey pox, I think about smallpox and chicken pox, which

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Speaker 1: I had when I was in kindergarten painful.

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Speaker 2: Yeah, and we know that monkey pos has been around

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Speaker 2: for a while.

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Speaker 1: Monkey pox has been around for a while, but the

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Speaker 1: cases we're seeing now in the United States are primarily

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Speaker 1: concentrated among men having sex with men. This has led

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Speaker 1: some folks that think monkeypox must be sexually transmitted, but that's.

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Speaker 2: Not the case. So what do we want to know? Well,

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Speaker 2: I think we first got to start with what is

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Speaker 2: monkey pox?

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Speaker 3: Right?

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Speaker 2: That is a very good question to start with, And

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Speaker 2: my question right after that one is how did it

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Speaker 2: get here?

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Speaker 1: I think the other thing I want to know is

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Speaker 1: what does the science tell us about monkeypox? And how

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Speaker 1: is that different from what we're seeing public health recommendations

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Speaker 1: telling us about monkeypox, because those.

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Speaker 2: Are two different things.

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Speaker 1: We know that there's, yes, the science, but there's all

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Speaker 1: the context around it, right, So we want to know

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Speaker 1: the fact and the fiction and the context when it

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Speaker 1: comes to monkeybox.

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Speaker 2: That's right, CT, let's jump into the dissection. So we

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Speaker 2: really wanted to make sure that we were covering this

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Speaker 2: issue from multiple angles because there's so much to discuss.

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Speaker 2: So this week we have not just one, but two

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Speaker 2: guest experts, doctor Angie Rasmussen, who's going to talk to

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Speaker 2: us about the virus and the vaccine, and Kenyan Farroh,

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Speaker 2: who provides the social and public health context.

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Speaker 4: I'm Angie Rasmussen. I am virologists. That's the Vaccine and

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Speaker 4: Infectious Disease Organization at the University of Saskatchewan Here in Saskatoon, Canada.

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Speaker 4: I studied the host response to emerging viruses, including monkey pox.

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Speaker 5: My name is Kenyon Farroll. I am the managing director

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Speaker 5: of the advocacy in organizing with an organization called Prep

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Speaker 5: for All, and I am also generally an activist and

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Speaker 5: a writer.

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Speaker 2: So let's talk about the virus. What is it?

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Speaker 4: So? Monkeypox virus is an orthopox virus.

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Speaker 1: Orthopox Viruses are part of a family of viruses that

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Speaker 1: cause disease, and back in the old days, used to

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Speaker 1: be called generally pox. Pox is used to represent the

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Speaker 1: marx and lesions left on the skin. Another orthopox virus

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Speaker 1: that you may have heard of is smallpox, and that

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Speaker 1: was declared eradicated in nineteen eighty. So monkey pox is

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Speaker 1: not new, right.

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Speaker 4: Smallpox hasn't been around for a long time. But monkeypox

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Speaker 4: was actually discovered in nineteen fifty eight in a group

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Speaker 4: of Labne monkeys that had been imported into Denmark and

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Speaker 4: they developed the smallpox like disease that turned out not

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Speaker 4: to be smallpox. It was monkey pox, and so that's

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Speaker 4: how it was named.

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Speaker 1: And there was a lot of stigma with this. How

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Speaker 1: you name something carries.

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Speaker 2: A lot of weight.

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Speaker 3: Oh my gosh.

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Speaker 2: We saw this with COVID early on.

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Speaker 1: We saw it with our then President Trump calling COVID

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Speaker 1: the Chinese virus, which was inaccurate. And similarly, we're calling

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Speaker 1: monkey pox monkey pox because it was discovered in monkeys,

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Speaker 1: but that's not where it came from, Like, that's not

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Speaker 1: where the reservoir for the virus was. And the only

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Speaker 1: reason it's called monkey pox is because that's where we

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Speaker 1: got a scientific snapshot of it. And so there's been

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Speaker 1: a push to rename the virus, but it just hasn't

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Speaker 1: taken hold yet.

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Speaker 2: The symptoms of monkey pox can include fever, headache, muscle

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Speaker 2: aches and backache, swollen lymph nodes, chills, respiratory issues, and

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Speaker 2: a rash or lesions on the skin.

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Speaker 4: So there's a whole process with the rash that happens,

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Speaker 4: and generally speaking, it starts off as a a rash

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Speaker 4: with some flu like symptoms associated with it. That becomes

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Speaker 4: a versicular rash, which eventually becomes like a pustule or

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Speaker 4: a blister, and then that scabs over and then the

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Speaker 4: scabs fall off. The new skin is underneath. When the

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Speaker 4: scabs fall off, that's when people are thought to be

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Speaker 4: no longer contagious.

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Speaker 1: Monkey pops can be extremely painful, but its fatality rate

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Speaker 1: is much lower than smallpox, which has a fatality rate

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Speaker 1: of about thirty percent.

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Speaker 2: What about how it's spread, I think there's a lot

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Speaker 2: of confusion around this. Can it be spread on surfaces

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Speaker 2: or is it airborne like stars coovy two or.

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Speaker 4: The pox viruses can be transmitted by both aerosols and faumites.

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Speaker 1: A fomite is an object, fabric or surface that can

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Speaker 1: carry and spread disease, so like clothing, bedding, or towels.

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Speaker 1: And while the virus can be transmitted by objects, the

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Speaker 1: risk of TRANSMITSI and via this route is low.

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Speaker 4: So there are clearly examples of fomite transmission for orthopox viruses,

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Speaker 4: and I think that probably is just a matter of

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Speaker 4: the extent of the exposure. So if you are doing

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Speaker 4: laundry in a hospital that's full of monkey POGs patients,

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Speaker 4: they're going to be at a higher risk of fomite

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Speaker 4: exposure than if you're just living in the same house

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Speaker 4: as somebody and you sat on the same couch with them.

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Speaker 2: So there's no need to start disinfecting your groceries like

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Speaker 2: we were doing for COVID.

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Speaker 1: This is so important because what we saw in COVID

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Speaker 1: is initially people were concerned about getting COVID from touching

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Speaker 1: things right surfaces.

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Speaker 2: I bought so much lyesol.

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Speaker 1: I have friends who were putting their mail and they

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Speaker 1: had like a seven day rotation. They let that mail

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Speaker 1: cure for a week basically, and then they would open it.

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Speaker 2: Yep.

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Speaker 1: But a lot of that comes from not having kind

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Speaker 1: of the right information. So what we know is, yes,

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Speaker 1: monkey pox is primarily spread from direct skin to skin contact,

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Speaker 1: but also there can be transmission from aerosols. Aerosol transmission

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Speaker 1: means a virus can be transmitted through the air, specifically

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Speaker 1: through respiratory secretions. Scientists are still researching how often monkey

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Speaker 1: pox is spread through these respiratory secretions. But again, doctor

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Speaker 1: Rasmussen says the risk here is low. Otherwise we wouldn't

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Speaker 1: be seeing such a concentrated outbreak in one specific community.

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Speaker 4: If aerosol transmission we're driving this outbreak that's happening now.

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Speaker 4: People in the queer community have families, they have co workers,

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Speaker 4: they're around a lot of people. We would see many

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Speaker 4: more cases occurring outside of that community. And the same

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Speaker 4: is true with fo MIC. Certainly there is the possibility

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Speaker 4: for transmission in schools, and there have been a few

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Speaker 4: women and some children who have contracted monkey pox, and

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Speaker 4: that's because sex is not the only activity that involves

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Speaker 4: close physical contact between people. If it were possible to

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Speaker 4: be transmitting this by trying on clothing and other types

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Speaker 4: of really incidental contact, we'd be seeing a lot more

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Speaker 4: monkey pox cases, and we're just not. The vast, vast

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Speaker 4: majority of these cases are occurring in men, in trans

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Speaker 4: people and non binary folks who are part of these

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Speaker 4: sexual networks within the queer community.

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Speaker 1: And that makes sense because the vast majority of infections

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Speaker 1: are being driven by extensive, direct skin to skin contact

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Speaker 1: between people.

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Speaker 2: Which, of course sex fits the bill for if you're

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Speaker 2: doing it the way that I think you're doing it.

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Speaker 1: Yes, you're in very close physical contact with another person.

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Speaker 1: And so I've been seeing some people confuse this and say, like, oh,

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Speaker 1: monkeypox is an STI.

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Speaker 2: But we want to be really clear.

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Speaker 1: While there is some evidence that monkeypox virus could be

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Speaker 1: in semen, meaning it could be sexually transmitted, the vast

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Speaker 1: majority of people are contracting it via skin to skin contact.

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Speaker 5: We do that it is spread through contact with lesions

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Speaker 5: or blisters and also bodily fluids of a person who

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Speaker 5: has monkey pots, but that doesn't necessarily mean that it's

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Speaker 5: sexually transmitted per se. We just know that in sects

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Speaker 5: you're going to be having a lot of physical contact

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Speaker 5: with someone, and so it is easy to facilitate transmission

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Speaker 5: that way.

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Speaker 1: Monkey Pox wasn't reported outside of Africa until two thousand

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Speaker 1: and three, so even though it had been occurring in

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Speaker 1: the seventies, a lot of this was animal to human transmission,

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Speaker 1: so encounters with wildlife right, and now what we're facing

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Speaker 1: is a different mode of transmission, which is primarily driven

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Speaker 1: by human to human. Before it was usually like import

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Speaker 1: of exotic animals and things like that that people shouldn't

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Speaker 1: have been bringing in. Another thing to understand is that

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Speaker 1: the median age range for monkeypox infection in Central and

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Speaker 1: West Africa has increased, so in the nineteen seventies and eighties,

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Speaker 1: the median age range for MONKEYPOXX infections was four to

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Speaker 1: five years old. Then from the two thousand to twenty

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Speaker 1: tens it moved to the median age range being ten

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Speaker 1: to twenty one years old, and cases outside of Africa

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Speaker 1: also occurred more frequently in males and primarily in adults.

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Speaker 1: A lot of this has to do with the way

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Speaker 1: that we live. Your risk for monkeypox infection is directly

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Speaker 1: related to where there is reservoir of virus. So when

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Speaker 1: virus was primarily in animals and spread from animal to human,

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Speaker 1: the riskiest behavior was sleeping in a forest, being near

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Speaker 1: those animals that are reservoirs for monkeypox virus. Now that

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Speaker 1: we have monkey pops in humans and in a larger population,

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Speaker 1: the risk behavior is living in the same house with someone,

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Speaker 1: having a lot of direct skin to skin contact and

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Speaker 1: sharing dishes and eating.

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Speaker 2: The same food as someone else. When we say things

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Speaker 2: like sexual transmission, when we're talking about these viruses, I

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Speaker 2: really worry about vilifying the queer community. I mean, we've

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Speaker 2: seen throughout history people in the queer community be the

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Speaker 2: scapegoats for a lot of different things for virus spread.

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Speaker 2: They try and say that homosexuality is like you're a

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Speaker 2: sexual deviant. They'd like to say that they're more likely

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Speaker 2: to be pedophiles, all of which is not true. So

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Speaker 2: when I hear sexual transmission coming up and we're talking

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Speaker 2: about monkey pots, it really makes me nervous because it's

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Speaker 2: like we are doomed to repeat the same toxic cycles

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Speaker 2: over and over again, and the folks in the queer

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Speaker 2: community are always the ones that are taking the brunt

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Speaker 2: of the toxicity, and it's really dangerous. People are losing

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Speaker 2: their lives because of all of this false information.

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Speaker 4: That's right, and that's to me right now is the

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Speaker 4: community that needs to be advised on how to decreach

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Speaker 4: their risk.

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Speaker 6: Most significantly, monkey pox we have known about for fifty years,

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Speaker 6: and yet because we're now seeing a new manifestation of

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Speaker 6: monkey pots in the United States for.

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Speaker 5: The first time, and because it sort of entered the

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Speaker 5: US kind of through gay men first, it is being

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Speaker 5: framed as a gay disease. And there's no such thing

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Speaker 5: as a gay disease or a gay virus.

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Speaker 2: Let me repeat that one more time for the people

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Speaker 2: in the back. There is no such thing as a

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Speaker 2: gay disease or a gay virus, you know.

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Speaker 1: The truth of it is, anybody can get monkeypos absolutely,

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Speaker 1: and this is not the first time it's entered the

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Speaker 1: United States. There are forty seven cases of monkeypox before,

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Speaker 1: but that was associated with collecting exotic animals. So if

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Speaker 1: you have skin and you're having skin to skin contact,

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Speaker 1: the truth of it is, you can get monkeypos It's

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Speaker 1: not about being gay or having sex. It's just that

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Speaker 1: our reservoir has changed now. The reservoir is human. So

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Speaker 1: the more humanly behavior you're having a human in human contact,

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Speaker 1: the higher risk.

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Speaker 2: And just like with COVID, some people may not know

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Speaker 2: they have monkey pox or that they're contagiou.

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Speaker 4: And I think that that is one question is like

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Speaker 4: when does somebody actually become contagious after they get monkey pox. Now,

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Speaker 4: monkeybox has a relatively long incubation period, so people may

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Speaker 4: not realize that they have it until a week or

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Speaker 4: two after they've been exposed.

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Speaker 2: This sounds just like COVID, all the adding and subtracting

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Speaker 2: the number of days you're contagious or potentially contagious. It

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Speaker 2: just feels like we are all living in this constant

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Speaker 2: state of anxiety, and you might think the experience with

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Speaker 2: COVID that we're still kind of going through, that we

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Speaker 2: would be better prepared for monkey pox, But it sounds

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Speaker 2: like that's not the case. Both experts agree that we're

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Speaker 2: not showing that we learned too much from COVID.

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Speaker 5: We haven't learned a damn thing in terms of our

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Speaker 5: response in a lot of ways.

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Speaker 2: So how concerned should we be about monkey pocks?

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Speaker 4: What concerns me the most is really how this has

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Speaker 4: exposed our massive failures to respond effectively, and how it

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Speaker 4: really shows that we haven't actually internalized a lot of

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Speaker 4: the lessons that we should have learned from the COVID

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Speaker 4: nineteen pandemic.

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Speaker 2: I think one of the lessons that we didn't internalize

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Speaker 2: is vaccine availability, what it takes to roll out a vaccine.

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Speaker 2: I don't think that we learn anything from that because

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Speaker 2: here we are another virus is spreading and there are

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Speaker 2: no vaccines, just like when COVID was spreading and we

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Speaker 2: were like, uh oh, there are no vaccines. But folks

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Speaker 2: have been working on a coronavirus vaccine for a long time,

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Speaker 2: so it felt like we should have been a little

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Speaker 2: bit more prepared, but it feels like the powers that

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Speaker 2: be just don't take these things as seriously as they should.

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Speaker 1: I think we also see that we have big, clunky

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Speaker 1: machines of governments and public health systems that don't really

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Speaker 1: communicate with one another, right and because it takes them

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Speaker 1: a long time to all get on the same page,

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Speaker 1: folks are just typing and sharing whatever information have, whether

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Speaker 1: it's accurate or not, and that can be really tricky,

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Speaker 1: and I think we're starting to see that with monkeypox,

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Speaker 1: just like we saw with COVID, and it's taken a

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Speaker 1: while to get recommendations, which feels very similar to what

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Speaker 1: we saw with COVID. But I'm a little concerned because

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Speaker 1: it's not new, so it feels like it didn't have

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Speaker 1: to be that way.

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Speaker 4: Right early on, when we knew that monkey pox was

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Speaker 4: beginning to spread outside of endemic countries, we had the

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Speaker 4: opportunity then to make testing available, to really reach out

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Speaker 4: to the community that's being affected, and to be very

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Speaker 4: clear right now, that is the community of gay, bisexual

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Speaker 4: men who have sex with men. We had the opportunity

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Speaker 4: to make testing accessible to that community. We had the

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Speaker 4: opportunity to actually do contact tracing and provide vaccines for

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Speaker 4: people who had been close contacts of people who ended

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Speaker 4: up getting monkey pox. And we actually also have antiviral

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Speaker 4: drugs that can make the symptoms of monkey pox a

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Speaker 4: lot less difficult.

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Speaker 2: That does sound very, very familiar to the last you know,

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Speaker 2: almost three years of our global experience, right.

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Speaker 1: So when we think about endemic countries, we're talking about

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Speaker 1: places where there are reservoirs or virus and where there

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Speaker 1: are consistent infections or consistent occurrences of viral infections. And

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Speaker 1: when you look at the literature, monkey pox is endemic

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Speaker 1: to two regions, Central and West Africa.

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Speaker 2: There's evidence that this particular clade or strain that we're

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Speaker 2: seeing now in the United States was seen first in

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Speaker 2: Nigeria in twenty seventeen.

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Speaker 4: And my colleagues, auditions scientists in Africa could have told

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Speaker 4: you twenty years ago that monkey pox was going to

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Speaker 4: be a problem, and that it's a problem they deal

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Speaker 4: with regularly, and because it's not impacting people in wealthier countries,

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Speaker 4: there just hasn't been that concern that it's something that

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Speaker 4: needs to be a priority. The reason that we don't

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Speaker 4: have any data on monkey pos or not that much

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Speaker 4: data on monkey pops. The reason why research hasn't been

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Speaker 4: funded in the US or Canada, where I live now,

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Speaker 4: or Europe is that it was happening primarily in endemic

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Speaker 4: countries in Africa. So things that happen in Africa, you know,

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Speaker 4: people have had a tendency to say, Oh, it's happening

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Speaker 4: over there, or it's happening somewhere that doesn't affect me,

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Speaker 4: because I don't know people who live there, and I'm

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Speaker 4: not going there and it's not affecting my life, And

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Speaker 4: I think that that is a terrible mistake. The fact

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Speaker 4: that we are a global world really shows the crucial

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Speaker 4: importance of not just health equity, but also scientific equity.

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Speaker 2: The globalization of our world economy is a huge factor

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Speaker 2: in how these outbreaks come to be. Because we're moving,

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Speaker 2: we have planes, trains, and automobiles, which means those viruses

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Speaker 2: are also on those planes, trains, and automobiles. We have

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Speaker 2: to consider these things as we are moving about the globe.

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Speaker 2: We're going to take a break and when we come back,

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Speaker 2: we'll talk about how we can decrease the risk using vaccines.

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Speaker 2: Plus what the media is getting wrong about monkeybox. We're back,

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Speaker 2: and before we get back into monkey pox, let's talk

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Speaker 2: about our lab for next week.

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Speaker 1: In next week's lab, we're talking all about commercial spaceflight.

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Speaker 1: It seems like everybody and anybody can get into space

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Speaker 1: these days, so we're breaking down how commercial spaceflight evolved

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Speaker 1: and where's headed with doctor Jordan Bim.

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Speaker 2: All right, so let's talk about monkey po's vaccine. Earlier,

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Speaker 2: we talked about how smallpox and monkey pox are both

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Speaker 2: orthopox viruses, and smallpox was eradicated in nineteen eighty thanks

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Speaker 2: to the success with vaccination. So is there a vaccine

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Speaker 2: for monkey pox.

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Speaker 4: It's a similar enough virus that smallpox vaccines do have

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Speaker 4: some efficacy against monkey pox. And there's really two smallpox

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Speaker 4: vaccines that we're talking about here.

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Speaker 2: So the vaccine that eradicated smallpox in the late seventies

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Speaker 2: early eighties has effectiveness against monkey pox. And like doctor

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Speaker 2: Rasmusen said, there are now two vaccines that are effective

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Speaker 2: in preventing monkey pox. Let's break them down.

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Speaker 1: There's an older one which is called ACAM two thousand,

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Speaker 1: and it's actually made from another orthopox virus called vaccinia virus.

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Speaker 1: A fun fact is that's actually how the term vaccine

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Speaker 1: got its name, so ACAM two thousand was targeted against

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Speaker 1: vaccinia and is supposed to prevent smallpox, which is really awful.

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Speaker 1: It's really transmissible, so super contagious, and it has a

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Speaker 1: high fatality rate. So you can consider something that has

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Speaker 1: a high fatality rate and can get you really really sick,

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Speaker 1: is easily transmitted, you're willing to take on a little

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Speaker 1: bit more risk to make sure that you're not spreading that.

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Speaker 1: So this is a really hard to take vaccine. AKM

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Speaker 1: two thousand in some people can cause disease and sometimes

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Speaker 1: cardiac complications because.

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Speaker 2: It's so tough on your immune system.

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Speaker 1: Historical data has indicated the smallpox vaccination with vaccinia virus

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Speaker 1: was approximately eighty five percent protective against monkey pocks in

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Speaker 1: the past. But when you don't put money behind these programs,

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Speaker 1: then you see a decrease in smallpox vaccination in these

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Speaker 1: other countries. And when there's a decrease in vaccination, that

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Speaker 1: allows us to have more potential hosts.

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Speaker 2: So in the early two thousands, another company made a

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Speaker 2: better vaccinia based vaccine called Genios, which is a lot safer.

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Speaker 2: The problem is we don't have enough.

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Speaker 4: So we already had far fewer doses of genios available

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Speaker 4: in our stock file for treating monkey pocks, and it

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Speaker 4: requires two doses. So basically, if you have, you know,

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Speaker 4: a million doses, that's actually only five hundred thousand people

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Speaker 4: that can be vaccinated with it.

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Speaker 1: So now we're considering two things. We have doses of

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Speaker 1: something that's really hard on the body, then we only

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Speaker 1: have limited doses of something that's easier on the body,

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Speaker 1: and it requires two doses. So cut that stockpile in half.

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Speaker 1: Once we get more supply of the vaccine, we still

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Speaker 1: got to conquer another issue.

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Speaker 2: Will people take it?

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Speaker 1: We ask Kenyon if he thinks people will have a

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Speaker 1: similar hesitancy around the monkey pox vaccine that they did

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Speaker 1: with the COVID vaccine.

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Speaker 5: So I don't think that we'll have the same vaccination

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Speaker 5: of take issue with covid if for no other reason

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Speaker 5: than people are vain, right, So if people are seeing

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Speaker 5: images of people with these lesions, and I just think

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Speaker 5: the physical manifestation changes, I think the way a lot

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Speaker 5: of people see and creates a different kind of urgency

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Speaker 5: for people to get vaccinated.

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Speaker 1: I think, yes, people are vain, but I think there's

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Speaker 1: some differences between the COVID vaccine, which a lot of

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Speaker 1: folks complained was that COVID was and they felt like

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Speaker 1: the vaccine approval process happened really quickly and they weren't

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Speaker 1: really sure about it. The smallpox vaccines have been around, right,

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Speaker 1: so if there was hesitation around how quickly this got delivered,

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Speaker 1: you shouldn't see that same concern if folks are candidates

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Speaker 1: for a smallpox vaccine because it's been around. I think

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Speaker 1: there's more to it than people just being vain. There's

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Speaker 1: a certain reality that you're confronted with when you can

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Speaker 1: see the physical manifestation of a disease. And so while

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Speaker 1: you may have trouble breathing with COVID, there wasn't much

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Speaker 1: you could really see that it is alarming, and it's like, hey,

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Speaker 1: this is being spread.

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Speaker 5: Human nature, I would guess, is you know one that

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Speaker 5: we only sort of respond to things that we can

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Speaker 5: sort of see, touch, taste and feel, you know, our

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Speaker 5: kind of five sensus. And so when you're doing prevention work,

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Speaker 5: it is very hard to argue to people that actually

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Speaker 5: we need to prepare for things that are coming, or

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Speaker 5: that we can anticipate comming that we don't currently have

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Speaker 5: infrastructure for.

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Speaker 2: So if monkey pops has been around for so long

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Speaker 2: and we have vaccines to prevent it, why is this

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Speaker 2: happening now.

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Speaker 1: Part of the reason we're seeing this spread is just

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Speaker 1: bad timing and our failure to act knowing the timing.

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Speaker 4: June was Pride month, and we knew that monkey pop

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Speaker 4: was spreading in this community, and it was very difficult

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Speaker 4: for people to be tested.

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Speaker 5: And so you're talking about, you know, just a time

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Speaker 5: where people are doing parades and doing big circuit parties

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Speaker 5: and gathering and of course people are having sex, and

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Speaker 5: you know, all of those dynamics together as probably why

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Speaker 5: I think we are seeing the outbreak kind of happen

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Speaker 5: there first. But no one listening to this should believe

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Speaker 5: that that is where any virus or infectious disease will

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Speaker 5: stay in one community.

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Speaker 2: Additionally, there are a lot of cases that were either

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Speaker 2: misdiagnosed or undiagnosed because of a coinfection where monkey pocks

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Speaker 2: went undiagnosed, and that happened in one in three cases

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Speaker 2: based on a study from the New England Journal of Medicine,

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Speaker 2: or because the monkey pox was misdiagnosed as something else.

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Speaker 1: Kenyon says, all of this points to a disinvestment in

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Speaker 1: public health systems broadly, and that's a problem that.

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Speaker 5: Includes everything from being able to track viruses and diseases

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Speaker 5: you know, from your United States sort of like epidemiological

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Speaker 5: surveillance systems, to then testing and contact tracing systems, to

439
00:24:34,040 --> 00:24:38,680
Speaker 5: then the sort of research around you know, vaccines, treatments, etc.

440
00:24:39,119 --> 00:24:42,320
Speaker 5: Or just research to sort of understand both the basic

441
00:24:42,400 --> 00:24:45,800
Speaker 5: science of a virus or a bacteria, to other kinds

442
00:24:45,800 --> 00:24:48,560
Speaker 5: of research to understand sort of spread and prevention, et cetera.

443
00:24:49,040 --> 00:24:51,440
Speaker 2: And we also need to prevent the spread of misinformation.

444
00:24:52,000 --> 00:24:54,680
Speaker 2: I recently saw video on TikTok of this woman who

445
00:24:54,760 --> 00:24:57,280
Speaker 2: was riding a train and she was wearing a mask

446
00:24:57,280 --> 00:25:00,720
Speaker 2: so you couldn't really see her face, but she had

447
00:25:00,960 --> 00:25:05,360
Speaker 2: some bumps on her skin, and somebody secretly recorded her

448
00:25:05,359 --> 00:25:07,960
Speaker 2: and posted it and saying, oh my gosh, that she

449
00:25:08,040 --> 00:25:11,800
Speaker 2: have monkey pox or whatever. And the woman on the

450
00:25:11,840 --> 00:25:15,879
Speaker 2: train found the video because it was going viral and

451
00:25:16,320 --> 00:25:18,719
Speaker 2: posted a response and said, no, I actually don't have

452
00:25:18,800 --> 00:25:21,639
Speaker 2: monkey pox. I have another disease that puts these bumps

453
00:25:21,680 --> 00:25:24,600
Speaker 2: on my skin. But thank you so much for you know,

454
00:25:24,640 --> 00:25:28,919
Speaker 2: making me a target of harassment and it's just so

455
00:25:29,080 --> 00:25:31,600
Speaker 2: wild that we are repeating the same mistakes that we

456
00:25:31,680 --> 00:25:34,800
Speaker 2: made before. Just like with COVID, the internet and social

457
00:25:34,840 --> 00:25:39,120
Speaker 2: media are flooded with all kinds of misinformation about monkeybox,

458
00:25:39,320 --> 00:25:40,200
Speaker 2: and so part of.

459
00:25:40,119 --> 00:25:42,720
Speaker 5: What we're seeing in the reporting is this kind of

460
00:25:43,280 --> 00:25:47,199
Speaker 5: framing it within the context solely of gay men, and

461
00:25:47,240 --> 00:25:49,119
Speaker 5: I think which leads people to think that that is

462
00:25:49,119 --> 00:25:52,199
Speaker 5: the only place that the virus will end up. The

463
00:25:52,280 --> 00:25:55,760
Speaker 5: second piece is a kind of question about whether it's

464
00:25:55,800 --> 00:26:00,439
Speaker 5: a sexally transmitted infection or not, and I I think

465
00:26:00,720 --> 00:26:02,600
Speaker 5: the media also has not done a good job of

466
00:26:02,680 --> 00:26:06,000
Speaker 5: explaining that it also assumes that gay and bisexual men's

467
00:26:06,080 --> 00:26:08,760
Speaker 5: only relationship to one another is sex, so that it

468
00:26:08,840 --> 00:26:10,639
Speaker 5: is the only possible way that we may be.

469
00:26:10,720 --> 00:26:11,959
Speaker 2: Contracting it, you know.

470
00:26:12,000 --> 00:26:13,800
Speaker 1: And this can be confusing because you have to kind

471
00:26:13,840 --> 00:26:17,040
Speaker 1: of reconcile these different bits of information. Earlier in this

472
00:26:17,119 --> 00:26:19,360
Speaker 1: lab we said, hey, this is primarily in the community

473
00:26:19,359 --> 00:26:20,800
Speaker 1: of men having sex with men.

474
00:26:21,200 --> 00:26:22,560
Speaker 2: But I think because.

475
00:26:22,240 --> 00:26:27,080
Speaker 1: People are also conflating sex as a vehicle for direct

476
00:26:27,080 --> 00:26:31,479
Speaker 1: skin to skin contact, and assuming that monkey pox is

477
00:26:31,480 --> 00:26:35,399
Speaker 1: transmitted sexually, they're thinking, oh, you have to be having

478
00:26:35,440 --> 00:26:39,399
Speaker 1: sex with men to get monkey pox that's not necessarily

479
00:26:39,440 --> 00:26:41,199
Speaker 1: the case, and I think a lot of this is

480
00:26:41,240 --> 00:26:44,880
Speaker 1: related to the hyper sexualization of gay.

481
00:26:44,720 --> 00:26:45,640
Speaker 2: And bisexual men.

482
00:26:45,720 --> 00:26:45,800
Speaker 4: Right.

483
00:26:45,880 --> 00:26:47,359
Speaker 1: People think, Oh, all they're doing is having sex, and

484
00:26:47,440 --> 00:26:50,679
Speaker 1: so that's how this is spreading. But as Kenya notes,

485
00:26:51,000 --> 00:26:54,280
Speaker 1: they are full of humans. They are having close relationships

486
00:26:54,440 --> 00:26:59,160
Speaker 1: with other people in their lives, children, their parents, their siblings, right,

487
00:26:59,560 --> 00:27:02,880
Speaker 1: and so there's an opportunity for direct skin to skin contact.

488
00:27:03,240 --> 00:27:05,880
Speaker 1: So even though we're seeing this concentrated in this one

489
00:27:05,880 --> 00:27:08,480
Speaker 1: community right now, it doesn't mean it will always be

490
00:27:08,600 --> 00:27:09,040
Speaker 1: that way.

491
00:27:09,600 --> 00:27:12,439
Speaker 4: I do think that it's really important that when we

492
00:27:12,520 --> 00:27:15,080
Speaker 4: are talking about this, we're talking about it in the

493
00:27:15,119 --> 00:27:18,399
Speaker 4: context of the people who are being affected, the people

494
00:27:18,400 --> 00:27:23,160
Speaker 4: who are at the highest risk, and their behavior is irrelevant.

495
00:27:23,320 --> 00:27:28,160
Speaker 4: It's not about moral judgment. It's about the risk of exposure,

496
00:27:28,680 --> 00:27:30,800
Speaker 4: and that's what we need to be focusing on, not

497
00:27:31,080 --> 00:27:34,520
Speaker 4: sex with multiple partners, not people who are having sex

498
00:27:34,560 --> 00:27:37,200
Speaker 4: with people of the same sex or people who are

499
00:27:37,240 --> 00:27:40,159
Speaker 4: on the gender spectrum. We need to be talking about

500
00:27:40,200 --> 00:27:43,280
Speaker 4: this as people who are at risk, a community that

501
00:27:43,400 --> 00:27:47,960
Speaker 4: is specifically at risk, without stigmatizing or passing moral judgment

502
00:27:48,000 --> 00:27:51,840
Speaker 4: on that community. Because ultimately, having sex is a human need.

503
00:27:52,160 --> 00:27:54,600
Speaker 4: We need to focus on the fact that we can't

504
00:27:54,760 --> 00:27:58,160
Speaker 4: just tell people not to have sex. We can tell

505
00:27:58,200 --> 00:28:02,720
Speaker 4: people in a judgmental, stigmatizing way that their behavior needs

506
00:28:02,760 --> 00:28:05,199
Speaker 4: to change. And that's the one thing that's keeping us

507
00:28:05,240 --> 00:28:09,360
Speaker 4: from controlling monkey coocks. That's completely unacceptable. What we need

508
00:28:09,400 --> 00:28:12,359
Speaker 4: to do is reach out to the community that's at

509
00:28:12,480 --> 00:28:16,280
Speaker 4: risk and do everything in our power to prioritize them

510
00:28:16,760 --> 00:28:21,440
Speaker 4: for education, for access to testing, to vaccines, to treatments.

511
00:28:21,800 --> 00:28:25,360
Speaker 1: We're also failing because of an inability to plan ahead,

512
00:28:25,720 --> 00:28:28,320
Speaker 1: and that's a real problem because if we don't plan ahead,

513
00:28:28,560 --> 00:28:31,639
Speaker 1: it's the marginalized communities that are affected the most.

514
00:28:32,119 --> 00:28:34,160
Speaker 5: One of the things that we have as an issue too,

515
00:28:34,359 --> 00:28:37,960
Speaker 5: is that you know, infections diseases often track along the

516
00:28:38,040 --> 00:28:48,959
Speaker 5: lines of structural oppression in our societies. Right, So racism, xenophobia, homophobia, transphobia, sexism, classism. Right, So,

517
00:28:49,000 --> 00:28:51,920
Speaker 5: it's no surprise when we see infectionous diseases begin to

518
00:28:52,040 --> 00:28:56,400
Speaker 5: impact poor people, communities of color, the LGBT community, right,

519
00:28:56,640 --> 00:29:00,880
Speaker 5: places in the South, places that are resource for first,

520
00:29:01,240 --> 00:29:04,560
Speaker 5: because those are folks who are often in structural positions

521
00:29:04,560 --> 00:29:06,520
Speaker 5: that put them more at risk.

522
00:29:06,960 --> 00:29:09,600
Speaker 1: Right, Doctor Rasmussen was saying, if you get monkey pops,

523
00:29:09,680 --> 00:29:11,600
Speaker 1: you may need to stay home and isolate for up

524
00:29:11,600 --> 00:29:13,240
Speaker 1: to four to five weeks.

525
00:29:13,480 --> 00:29:14,320
Speaker 2: That is a long time.

526
00:29:14,400 --> 00:29:17,120
Speaker 1: Can you imagine they don't even want you to isolate

527
00:29:17,120 --> 00:29:19,680
Speaker 1: with COVID then that's breathable, And.

528
00:29:19,880 --> 00:29:23,520
Speaker 4: With our sickly policies with our healthcare in the US,

529
00:29:23,800 --> 00:29:27,440
Speaker 4: that's just simply not a realistic proposition. So again, a

530
00:29:27,480 --> 00:29:30,360
Speaker 4: lot of our failures to control this come back to

531
00:29:30,440 --> 00:29:34,000
Speaker 4: failures and health equity and making sure that people have

532
00:29:34,080 --> 00:29:37,760
Speaker 4: the resources they need to protect themselves and to protect

533
00:29:37,800 --> 00:29:40,800
Speaker 4: others around them from potentially becoming infected.

534
00:29:41,280 --> 00:29:45,520
Speaker 5: People for various reasons, blame those communities for the outbreaks

535
00:29:45,520 --> 00:29:49,520
Speaker 5: that happen, as opposed to understanding our social conditions are

536
00:29:49,520 --> 00:29:52,600
Speaker 5: structured in such a way that those individuals, if the

537
00:29:52,720 --> 00:29:56,000
Speaker 5: virus doesn't enter that community first, it'll spread there faster.

538
00:29:58,600 --> 00:30:02,880
Speaker 2: So recently, the World Health Organization or WHO declared monkey

539
00:30:02,880 --> 00:30:06,960
Speaker 2: pops a global health emergency. We asked Kenyon, what's the

540
00:30:07,000 --> 00:30:09,040
Speaker 2: significance of these declarations?

541
00:30:09,480 --> 00:30:12,480
Speaker 5: So countries that are members of the Oral Health Organization

542
00:30:13,240 --> 00:30:15,800
Speaker 5: part of their sort of responsibility. Once they become a

543
00:30:15,840 --> 00:30:19,040
Speaker 5: member of the who IS, then they have to actually

544
00:30:19,200 --> 00:30:22,360
Speaker 5: sort of mobilize a response in their countries, right, but

545
00:30:22,440 --> 00:30:25,720
Speaker 5: it also gives a wahhow the possibility of kind of

546
00:30:25,760 --> 00:30:30,200
Speaker 5: mobilizing and coordinating internationally, right, so that there's data being

547
00:30:30,240 --> 00:30:34,480
Speaker 5: collected everywhere, that there are cases that there's a kind

548
00:30:34,480 --> 00:30:38,200
Speaker 5: of streamlining of funding, and it can accelerate the advancement

549
00:30:38,400 --> 00:30:40,680
Speaker 5: of In the case of things like COVID, where we

550
00:30:40,720 --> 00:30:45,360
Speaker 5: didn't have vaccines with therapeutics or diagnostics, right, the resources

551
00:30:45,400 --> 00:30:48,280
Speaker 5: come together to be able to kind of create those things.

552
00:30:48,720 --> 00:30:52,160
Speaker 1: The United States declared monkey pops a National Health emergency.

553
00:30:52,720 --> 00:30:56,160
Speaker 1: This means that all states are legally required to report

554
00:30:56,200 --> 00:30:59,600
Speaker 1: cases to the CDC. States are also required to track

555
00:30:59,640 --> 00:31:04,479
Speaker 1: and report or demographic information associated with infection like age, gender,

556
00:31:04,600 --> 00:31:05,200
Speaker 1: and race.

557
00:31:05,760 --> 00:31:08,040
Speaker 5: So we can then begin to understand sort of how

558
00:31:08,040 --> 00:31:11,400
Speaker 5: transmission is happening and part of what it also sort

559
00:31:11,440 --> 00:31:16,080
Speaker 5: of hopefully will trigger once that happens is Congress then

560
00:31:16,240 --> 00:31:20,880
Speaker 5: can take that to then allocate emergency resources to better

561
00:31:21,040 --> 00:31:22,480
Speaker 5: find a response.

562
00:31:22,680 --> 00:31:26,240
Speaker 1: That response means better testing, and better testing means more

563
00:31:26,360 --> 00:31:30,960
Speaker 1: tests available, It means better education for providers, and that

564
00:31:31,080 --> 00:31:35,760
Speaker 1: leads to less misdiagnosis, So people being diagnosed for something

565
00:31:35,800 --> 00:31:39,080
Speaker 1: else when it actually is monkeypox or undiagnosed, where people

566
00:31:39,080 --> 00:31:41,240
Speaker 1: aren't diagnosed with anything, they just say, we don't know

567
00:31:41,280 --> 00:31:44,560
Speaker 1: what it is. And so we need better testing, more

568
00:31:44,640 --> 00:31:48,120
Speaker 1: resources to help and expand the services that are available.

569
00:31:48,520 --> 00:31:51,440
Speaker 1: We need to create more vaccine access, and we need

570
00:31:51,480 --> 00:31:55,280
Speaker 1: to produce more anti viral treatment to alleviate the awful

571
00:31:55,400 --> 00:31:57,000
Speaker 1: symptoms of monkeypox.

572
00:31:57,400 --> 00:32:01,560
Speaker 5: Too often we mobilize, we turn up show up in

573
00:32:01,560 --> 00:32:05,000
Speaker 5: instances where either people die at the end of a

574
00:32:05,040 --> 00:32:09,200
Speaker 5: police revolver or because of a kind of white vigilante

575
00:32:09,320 --> 00:32:13,320
Speaker 5: right in many cases. But we don't do as much

576
00:32:13,480 --> 00:32:19,680
Speaker 5: when actually more of our folks die prematurely from systems

577
00:32:19,680 --> 00:32:22,320
Speaker 5: of neglect, of which public health and our kind of

578
00:32:22,360 --> 00:32:26,600
Speaker 5: healthcare infrastructure certainly fits the build. And so we have

579
00:32:26,760 --> 00:32:30,400
Speaker 5: got to also, as people of contience and communities, really

580
00:32:30,440 --> 00:32:35,040
Speaker 5: begin to take seriously our healthcare and public health infrastructure

581
00:32:35,520 --> 00:32:39,280
Speaker 5: as much as we do policing and voting and education

582
00:32:39,440 --> 00:32:41,960
Speaker 5: and schools and the things that we typically will show

583
00:32:42,080 --> 00:32:44,920
Speaker 5: up in mass mobilizations that we'll tweet about, etc.

584
00:32:45,200 --> 00:32:45,400
Speaker 4: Etc.

585
00:32:46,120 --> 00:32:49,480
Speaker 5: And not just assume that somehow somebody else has the

586
00:32:49,520 --> 00:32:53,400
Speaker 5: healthcare piece down, or just assume that the system that

587
00:32:53,440 --> 00:32:55,560
Speaker 5: we have is the one that we need that is

588
00:32:55,720 --> 00:32:59,280
Speaker 5: intractable and unfixable. I think that we can really begin

589
00:32:59,320 --> 00:33:01,960
Speaker 5: to ask ourselves, what is the future of public health,

590
00:33:02,040 --> 00:33:04,640
Speaker 5: What is the future of healthcare so that it serves people,

591
00:33:05,080 --> 00:33:07,880
Speaker 5: so that we don't keep rolling from one pandemic to

592
00:33:08,000 --> 00:33:11,840
Speaker 5: one crisis after another and reinvent the wheel every time.

593
00:33:12,240 --> 00:33:14,520
Speaker 1: Doctor Rasmussen is spot on.

594
00:33:14,880 --> 00:33:15,240
Speaker 2: Okay.

595
00:33:15,720 --> 00:33:17,720
Speaker 1: When I was going back to the literature to look

596
00:33:17,760 --> 00:33:20,000
Speaker 1: at kind of what's going on, I was looking at

597
00:33:20,000 --> 00:33:23,440
Speaker 1: this overview of all these other studies of monkeypos I

598
00:33:23,480 --> 00:33:25,440
Speaker 1: saw that there was a paper submitted in June twenty

599
00:33:25,480 --> 00:33:28,160
Speaker 1: twenty one, but it wasn't published until February twenty twenty two,

600
00:33:28,200 --> 00:33:31,520
Speaker 1: and it was asking if monkeypox could potentially become a threat.

601
00:33:32,000 --> 00:33:34,160
Speaker 1: And part of this is like science takes a long

602
00:33:34,160 --> 00:33:36,440
Speaker 1: time to do and some of our processes are really

603
00:33:36,480 --> 00:33:38,600
Speaker 1: slow and clunky, and so by the time this article

604
00:33:38,640 --> 00:33:40,160
Speaker 1: came out, the answer was yes.

605
00:33:40,200 --> 00:33:42,320
Speaker 2: Girl. But it's really.

606
00:33:42,120 --> 00:33:44,680
Speaker 1: Interesting because we're just starting to consider this a threat

607
00:33:44,720 --> 00:33:47,440
Speaker 1: in the United States. But folks have been kind of

608
00:33:47,520 --> 00:33:49,880
Speaker 1: telling us, The literature has been saying, hey, this is

609
00:33:49,880 --> 00:33:51,680
Speaker 1: a thing that's happening. We know we live in a

610
00:33:51,800 --> 00:33:54,760
Speaker 1: very global society. And what that study was showing was

611
00:33:54,800 --> 00:33:58,040
Speaker 1: that decade, over decades, there were increases in monkeypox cases.

612
00:33:58,240 --> 00:33:58,640
Speaker 3: Wow.

613
00:33:58,760 --> 00:34:02,240
Speaker 1: And so folks signed scientist physicians in Central and West

614
00:34:02,280 --> 00:34:05,360
Speaker 1: Africa have been ringing the alarm that something was going

615
00:34:05,400 --> 00:34:07,840
Speaker 1: on with monkey pops and that it was spreading. But

616
00:34:08,080 --> 00:34:10,719
Speaker 1: like she said, you gotta put the dollars where.

617
00:34:10,480 --> 00:34:20,240
Speaker 2: Something is happening. That's it for this lab.

618
00:34:20,440 --> 00:34:22,839
Speaker 1: Call us at two zero two five six seven seven

619
00:34:23,000 --> 00:34:24,840
Speaker 1: zero two eight and tell us what you thought, or

620
00:34:24,880 --> 00:34:26,520
Speaker 1: give us an idea for a different lab you think

621
00:34:26,520 --> 00:34:28,719
Speaker 1: we should do this semester. We like hearing from you.

622
00:34:28,960 --> 00:34:31,759
Speaker 1: That's two zero two five six seven seven zero two eight.

623
00:34:32,000 --> 00:34:34,400
Speaker 2: And don't forget that there is so much more to

624
00:34:34,440 --> 00:34:37,120
Speaker 2: dig into on our website. There'll be a cheat sheet

625
00:34:37,120 --> 00:34:40,560
Speaker 2: for today's lab, additional links and resources in the show notes.

626
00:34:40,800 --> 00:34:43,040
Speaker 2: Plus you can sign up for our newsletter check it

627
00:34:43,080 --> 00:34:46,920
Speaker 2: out at Dope labspodcast dot com. Special thanks to today's

628
00:34:46,960 --> 00:34:50,680
Speaker 2: guest experts, doctor Angie Rasmussen and Kenyan Pharaoh.

629
00:34:51,000 --> 00:34:54,360
Speaker 1: You can find doctor Rasmussen on Twitter at Angie Underscore

630
00:34:54,520 --> 00:34:58,719
Speaker 1: Rasmussen and Kenyon Pharaoh is at Kenyon Pharaoh.

631
00:34:58,000 --> 00:35:00,200
Speaker 2: And you can find us on Twitter and Instagram at

632
00:35:00,200 --> 00:35:01,160
Speaker 2: Dope Blabs.

633
00:35:00,800 --> 00:35:04,320
Speaker 1: Podcast, TT's on Twitter and Instagram at d R Underscore

634
00:35:04,440 --> 00:35:05,800
Speaker 1: t Sho.

635
00:35:05,640 --> 00:35:09,040
Speaker 2: And you can find Zakia at z said So. Dope

636
00:35:09,120 --> 00:35:12,560
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637
00:35:12,680 --> 00:35:15,560
Speaker 1: Our producers are Jenny Ratleick Mask and Lydia Smith of

638
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639
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640
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641
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642
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643
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644
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