Title: Mpox Response Highlights the Risks of Repeating Past Mistakes

Description: After the COVID-19 pandemic, there was a new worldwide
health emergency--a global outbreak of Mpox, which may be better known as
monkeypox. That outbreak once again highlighted the need for a strong
federal response to public health emergencies. But even after all we've
observed from COVID, the federal government's response efforts to public
health emergencies like these still face a number of challenges. GAO's
Mary Denigan-Macauley tells us more. 

Related work: GAO-24-106276, Public Health Preparedness: Mpox Response
Highlights Need for HHS to Address Recurring Challenges

Released: April 2024

{Music}

[Mary Denigan-Macauley:] What happens if a bad guy were to introduce
something for which we have no medical countermeasures? It will be
overwhelming.

[Holly Hobbs:] Hi, and welcome to GAO's Watchdog Report. Your source for
fact-based, nonpartisan news and information from the U.S. Government
Accountability Office. I'm your host, Holly Hobbs. At the tail-end of
the COVID-19 pandemic, there was another new worldwide health
emergency--a global outbreak of Mpox, which may be better known as
monkeypox. That outbreak once again highlighted the need for a strong
federal response to public health emergencies. But even after all we've
observed from COVID, the federal government's response to Mpox faces
some of the same challenges seen during the pandemic response. Here to
tell us more is GAO's Mary Denigan-Macauley, who led work for our new
report about the federal response to Mpox. Thanks for joining us.

[Mary Denigan-Macauley:] Thanks for having me, Holly.

[Holly Hobbs:] So, Mary, what is Mpox? 

[Mary Denigan-Macauley:] So Mpox, which used to be known as
monkeypox--they changed the name--is a serious infectious disease and it's
in the same family as smallpox.

Fortunately, it's not as infectious and as lethal as smallpox. It's
spread by contact. And it starts out with kind of looks like a pimple,
and it can be on your hands, it can be on your feet, it can be in your
private parts. It can be on your face. And so it starts out as a small
pimple that spreads as a rash. And then it becomes a blister and it
bubbles up. In addition to that, you can also get body aches. You can
feel like you have the flu. You get aches and pains. You can get a
fever. You can get swollen lymph nodes. And it's normally found in
Africa. It is endemic there. And when Europe started seeing a spread
back in 2022, in May, the World Health Organization became concerned.
And it also spread here to the United States. And that's why they
declared an emergency of concern.

[Holly Hobbs:] And what's been the federal response to Mpox so far? 

[Mary Denigan-Macauley:] So as we would have expected, the Department of
Health and Human Services, HHS, took the lead because that's what they
do. And the first thing they wanted to do was to look at what
countermeasures do we have to fight this. They looked at their supply of
vaccines. They looked at their supply of therapeutics--for example
anti-virals--and also diagnostic test kits. They wanted to make sure they
could test to see who has the virus and to track the spread. They are
also responsible for communicating who's infected, who's at risk. And so
they took the lead. But by August, cases continued to rise. And the
White House became concerned because, remember, this is at the tail end
of COVID. There's a lot of anxiety about infectious disease. And so, the
White House stood up their own Mpox response team, and they really
assumed leadership hoping to accelerate efforts and to be able to
coordinate and manage the response. 

[Holly Hobbs:] So one of the things we saw during COVID is that a lot of
this response actually falls to the states and localities. Right? And
then they have to work with the federal government in various ways. Can
you tell us what we have seen so far in the state and local response to
Mpox? And maybe also, what have they've told us about how the federal
government is helping them?

[Mary Denigan-Macauley:] So you're absolutely right. The state and local
response are at the forefront of the response. And so what was really
important is to be able to get those medical countermeasures, to get the
vaccines, to get the therapeutics in the hands of those who need it. So
communication is key. Who's being infected by this? Initially, the state
and local representatives that we spoke with said that there was a lot
of confusion about who actually needed to have shot in arms, for
example. And it turned out to be a very small population that it was
affecting the most. It's still a highly infectious disease that can
spread to anyone. But it seemed to be infecting those most of men having
sex with other men. And so the communication needed to be appropriate to
get those folks to come forward, to get the vaccines and treatments that
they needed without stigmatizing that community. They also needed to
make sure that they knew exactly how much of the vaccine was coming,
because we don't have an unlimited supply. 

[Holly Hobbs:] So some of the mechanics of this sounds similar to what
we saw during COVID. Is it?

[Mary Denigan-Macauley:] It is. And that's really what our concern is.
And what this report was about--is we are hearing it's echoing many of
the same problems that we saw with COVID and not just COVID, but past
infectious disease outbreaks, for example, having good communication,
ensuring that you have the right supply to the right people. Ensuring
that we have the data to be able to track where this disease is
spreading. We're still struggling with things like that. We don't have
good data. According to the state and local folks that we spoke with,
that communication was still a concern. Leadership was a concern. Data
is a concern. And it really wasn't until the White House stepped in and
took control that the state and local representatives that we spoke with
said that it became a better response from the federal government.

[Holly Hobbs:] Public health preparedness is an area that we (GAO)
designated as High Risk because of its impacts on the public and the
urgent need to take action. Why hasn't HHS done more?

[Mary Denigan-Macauley:] And it's a good question, and it's one that we
get asked a lot. So in 2022, we added HHS's leadership in coordination
of public health emergencies to our High Risk List. And if you think
about that, that was in the height of the pandemic, because what we were
seeing were the same problems being repeated from past outbreaks. We did
have another pandemic. People forget H1N1, also known as swine flu, back
in 2009--we were seeing some of those same mistakes being repeated. We
also have HHS responding to disasters that happen all the time that
would cause a public health emergency such as the hurricanes down in
Virgin Islands and Puerto Rico. So it's absolutely critical that HHS pay
attention to this and that we get sustained leadership and that action
is taken.

And that's why we put it on the High Risk list in 2022. This isn't just
about public health. You saw schools shut down. We saw the economy just
tank. They really needs to take action to address what we are calling
systemic issues. 

{MUSIC}

[Holly Hobs:] Mary just told us that while the federal government is
working to prevent the spread of Mpox, its response so far echoes many
of the same issues we saw during the response to COVID-19. So, Mary,
what more do we think HHS should be doing to respond not only to Mpox,
but also to any infectious disease threat?

[Mary Denigan-Macauley:] So for this specific report, which is about
Mpox, we did go a little broader with the recommendation. And in order
to not repeat the same mistakes again, they really need to have a
rigorous department-wide program that looks at where are we not making
progress? Where do we make mistakes? How do we close those gaps? How do
we ensure that we're better prepared going forward? It's not that HHS
doesn't do this, but there's many, many agencies that are involved and
not just within HHS, but other government agencies. For example, during
COVID, we heard a lot about FEMA coming to help and the Department of
Defense can help. And so instead of working in those stovepipes, we
really need a departmental analysis looking over time--what have been the
problems, how are we going to close that as a department to make sure
that we have a holistic approach going forward? 

[Holly Hobbs:] And Mary, how do those steps that we're recommending fit
into what we've asked HHS to do as part of our High Risk designation? 

[Mary Denigan-Macauley:] We need to make sure that we have sustained
attention. We need to make sure that we have leadership that is
committed. That when they've identified problems, they've come up with a
course of action and they relay that to these very vital partners, not
only at the local, state, Tribal and territorial level, but also to
Congress. It takes money. It takes resources. We were short of workforce
to be able to control Mpox. If you remember correctly, this came at
right during COVID--at the heels of COVID--and the workforce was
absolutely exhausted. So to then have to not only battle COVID, but then
battle Mpox--you're not talking an easy problem to resolve.

[Holly Hobbs:] And last question, what's the bottom line of this report?

[Mary Denigan-Macauley:] So the bottom line of the report demonstrates
really that they are repeating past mistakes and we're not really ready
for the next big event. Because if you look at Mpox--Mpox was a known
disease among a small subset of the population. It did not spread widely
amongst all of the people. We already had countermeasures in place. You
take all of that combined and we still had problems. So if you were to
ask me what keeps me awake at night--what happens if a bad guy were to
introduce something for which we have no medical countermeasures and
they introduce it in simultaneous and multiple places around the United
States, it will be overwhelming. So we are looking for HHS needs to step
up its game because it is a matter of saving lives.

[Holly Hobbs:] That was Mary Denigan-Macaulay talking about our new
report on Mpox. Thanks for your time, Mary. 

[Mary Denigan-Macauley:] Thanks for having me, Holly.

[Holly Hobbs:] And thank you for listening to the Watchdog Report. To
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