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The Morning Dispatch: How Monkeypox Containment is Failing
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The Morning Dispatch: How Monkeypox Containment is Failing

'If we have allowed monkeypox to become an endemic virus in the U.S. ... it will be among the most unfortunate public health failures in recent times.'

Happy Thursday! Spotify said yesterday that streams of Kate Bush’s 1985 “Running Up That Hill” spiked 9,000 percent after the song was featured prominently in Stranger Things’ fourth season.

We have decided to send Netflix our entire advertising budget for 2023 to get Vecna in a Dispatch hat for Season 5.

Quick Hits: Today’s Top Stories

  • A key part of President Joe Biden’s legislative agenda is back in play after Democratic Sen. Joe Manchin announced Wednesday he will support a significantly pared back version of Build Back Better, which he is now calling the Inflation Reduction Act. According to a framework circulated last night, the package would devote $369 billion to energy security and climate change measures—and $64 billion toward shoring up the Affordable Care Act—while generating revenue by implementing a 15 percent corporate minimum tax, allowing Medicare to negotiate drug prices, beefing up IRS enforcement, and eliminating the carried interest loophole. According to the Congressional Budget Office and Joint Committee on Taxation, the framework—which would pass through the reconciliation process with only Democratic support, if it passes at all—would reduce the deficit by $300 billion over the next decade.

  • The Senate voted 64-33 on Wednesday to advance a $79 billion package intended to jumpstart domestic computer chip manufacturing and boost the United States’ competitiveness with China. The legislation includes both $52.7 billion in subsidies and a 25 percent tax credit aimed at incentivizing manufacturers to develop and research semiconductors and chips in the U.S., and it authorizes—but does not fund—about $200 billion for scientific research, including $81 billion for the National Science Foundation. The legislation will now return to the House, where it is expected to pass.

  • The Federal Reserve announced Wednesday it will raise interest rates by a hefty 75 basis points for the second consecutive month, bringing the target range for the federal funds rate to between 2.25 and 2.5 percent. Although Powell said he believes it’s “necessary” for economic growth to slow in order to tame inflation, he told reporters he does not believe the United States is currently in a recession. 

  • CNN reported Wednesday the Biden administration offered in June to release imprisoned Russian arms dealer Viktor Bout—nicknamed the “Merchant of Death”—as part of a deal to secure the release of WNBA star Brittney Griner and former Marine Paul Whelan, both imprisoned in Russia. Secretary of State Antony Blinken declined to confirm details of the proposal yesterday but said he plans to speak with Russian Foreign Minister Sergey Lavrov—their first conversation since Russia invaded Ukraine—and urge him to accept a U.S.-proposed deal.

  • Axios reported Wednesday that White House Middle East coordinator Brett McGurk told a group of think tank experts last week it’s “highly unlikely” the 2015 Joint Comprehensive Plan of Action—or Iran nuclear deal—will be revived at any point in the near future, despite months of negotiations.

  • Thousands of anti-Iran protesters stormed Iraq’s government center and parliament building in Baghdad on Wednesday, tearing down walls and occupying the parliament floor to express their opposition to Mohammed Sudani, a nominee to be Iraq’s next prime minister who is seen as close to Tehran. The protesters support Moqtada al-Sadr, a Shiite cleric who emerged victorious in last year’s elections but resigned—alongside his supporters in Parliament—after failing for months to form a government.

  • A new FBI search warrant claims the man who allegedly attempted to assassinate Justice Brett Kavanaugh last month was also planning to kill ​​two other Supreme Court justices. The FBI alleges the man searched “assassin skills,” “most effective place to stab someone,” and “quietest semi auto rifle” online before he was arrested, and that he messaged unnamed users on Discord that he was going to “stop Roe v. Wade from being overturned” and that he would “remove some people from the Supreme Court.” 

  • Amid rising threats, the House sergeant-at-arms’ office will cover up to $10,000 in security equipment and services at the homes of all House members, according to a memo sent to lawmakers and staff this week. 

  • The Federal Trade Commission sued Meta (formerly Facebook) on Wednesday to block it from acquiring virtual reality company Within Unlimited, alleging the purchase would decrease consumer choice, innovation, and competition for labor. Meta announced its quarterly earnings on Wednesday, revealing the social media company’s revenue fell year-over-year for the first time in its history.

  • Former Vice President Mike Pence on Wednesday endorsed Rebecca Kleefisch—Wisconsin’s former lieutenant governor—in Wisconsin’s Republican gubernatorial primary, breaking yet again with former President Donald Trump, who is backing construction executive Tim Michels. 

  • A handful of former Democratic and Republican officials announced Wednesday they are forming a new national political party—Forward—that they believe will appeal to voters frustrated with the United States’ current two-party system. The centrist party will be chaired by former Democratic presidential candidate Andrew Yang and former Republican New Jersey Gov. Christine Todd Whitman, and plans to gain ballot access in all 50 states in time for the 2024 presidential and congressional elections.

Public Health Fails Redux

A line of people waiting to receive the monkeypox vaccine. (Photo by Hollie Adams/Getty Images.)

A strange disease hopscotching around the world. The World Health Organization declaring a global emergency. A shortage of tests, and fumbling—or non-existent—contact tracing. Lines down the block for a dose of the vaccine. 

Monkeypox is giving epidemiologists COVID-19 déjà vu.

As we’ve explained before, there are some critical differences: Monkeypox is less contagious than COVID-19, has been around for decades, and already has effective vaccines. It is also, for the time being, primarily affecting men who have sex with men—which should make it easier to identify high-risk populations and provide them with effective care to curb the spread.

And yet. A disease that produces lesions and flu-like symptoms, previously endemic to parts of West Africa, monkeypox has now infected a confirmed 20,838 people worldwide and killed five, according to the Centers for Disease Control and Prevention and the WHO, with just 327 of those cases in countries that typically see outbreaks. And the United States is leading the world with 4,639 cases—likely an undercount thanks to limited testing.

Health officials are certainly taking the outbreak seriously. The Food and Drug Administration announced Wednesday it’s approved a Danish vaccine manufacturing facility, clearing the way for U.S. distribution of nearly 800,000 more monkeypox vaccine doses this summer in addition to the nearly 200,000 doses the Department of Health and Human Services says it has already shipped around the country. HHS says the U.S. plans to have purchased more than 6.9 million doses by mid-2023. The U.S. can now test about 80,000 people per week for monkeypox, and the White House has set aside $140 million to study the virus and its transmission and develop countermeasures.

But health authorities initially struggled to respond to the virus when it began popping up in May—despite all the practice they’ve had with COVID-19. Early on, doctors could only test for monkeypox under a narrow set of circumstances—evidence of exposure, high risk, and so on—because labs could only handle about 6,000 tests per week. HHS didn’t announce until late June that testing would expand beyond the CDC’s lab network to commercial labs, increasing capacity. 

And by June 10, the government had distributed only a few thousand vaccine doses. New York City’s vaccine signup website glitched and slots were booked up within minutes as people competed for limited doses. San Francisco, Colorado, NYC, and Washington, D.C., all limited people to one dose of the two-shot vaccine to stretch their supply. 

Plus, in a bid to avoid stigmatizing the disease—which is primarily, though not solely, sexually transmitted—public health officials have at times muddled the message that men who have sex with men are at substantially higher risk than the general population, potentially creating confusion over who should take precautions or prioritize getting vaccinated. While monkeypox can spread through non-sexual contact—holding a child, for instance, or touching dirty linens—98 percent of global cases discovered thus far have been among that population of men. WHO head Tedros Adhanom Ghebreyesus said Wednesday that men at risk should consider limiting sexual partners for now, discussing risk, and exchanging contact information for possible contact tracing.

Epidemiologists and advocates say the authorities’ sluggish responses have cost valuable time to contain the outbreak and prevent suffering—about 10 percent of cases have been admitted to the hospital to manage painful lesions. “Speed is so important and the slower the response, the longer it’s going to take to put the genie back in the bottle,” Dr. Isaac Bogoch—clinical epidemiologist and infectious disease expert at the University of Toronto—told The Dispatch. “A more rapid vaccine program … would have been really helpful in curbing this faster. Now it’s going to rumble along for a long, long time.” 

Dr. Monica Gandhi—an infectious disease specialist at the University of California San Francisco—agreed. “I’m underwhelmed and disappointed by the U.S. response so far,” she told The Dispatch. “I was hoping we would have higher rates of vaccination and vaccine supply by this point in the outbreak.” Instead, Gandhi said, men are still lining up for doses and being turned away. 

Both argued the U.S. still has time to prevent monkeypox from becoming endemic by pursuing aggressive vaccination, strong outreach to and collaboration with affected groups, and practical support for people isolating while contagious—a period of about four weeks. But the clock is ticking. 

“If we have allowed monkeypox to become an endemic virus in the U.S.—which is becoming an increasingly possible outcome,” former FDA head Dr. Scott Gottlieb wrote Sunday, “it will be among the most unfortunate public health failures in recent times.”

Worth Your Time

  • We wrote to you on Tuesday about the extreme energy crunch Europe finds itself in heading into the winter, but as Atlantic Council fellow James Kirchick points out, it didn’t have to be this way. “The European energy dilemma is the result of three interrelated illusions: that dependence on Russian gas was worth whatever (minor) risks it entailed, that the supplier of that gas was a partner rather than an adversary, and that conventional war on the continent was a thing of the past,” he writes in the Washington Post. “For years, German politicians routinely deflected criticism of Nord Stream by stating that their hands were tied. The pipeline was a ‘commercial project,’ they insisted, over which the German government exercised no control. But increasing European dependence on Russian gas at the expense of other sources has always entailed a political dimension, especially in Germany. No one forced Berlin to shutter its nuclear energy sector in a fit of characteristically German panic in the aftermath of the 2011 Fukushima disaster. Unlike the island nation of Japan, Germany sits in the middle of a continent, safe from the earthquake-induced tsunamis of the sort that destroyed the Fukushima plant. Thanks to then-Chancellor Angela Merkel’s hasty decision to phase out nuclear energy by the end of 2022 by the time Putin decided to wage energy war against Europe, Germany was even more addicted to Russian gas.”

  • Tess Mata, a 10-year-old girl murdered in the Uvalde shooting in May, loved the Houston Astros, and had a dream of making her little league softball all-star team. But she hated practicing her pitching in the backyard, against a sugar maple tree on which her father Jerry had spray-painted a white strike zone. “Tess watched countless hours of YouTube on her iPad to learn the pitching mechanics. She refined them at that tree. She kept going because few things felt better than hitting the target,” Roberto José Andrade Franco writes for ESPN. “She threw for hours, and after she was done, Jerry rubbed Biofreeze on her shoulder to comfort her. Talking about Tess while standing at the kitchen table, Jerry says he has video of the first time she pitched in a game for her team, the Bandits. He pulls out his phone from his front pocket and scrolls through videos looking for the right one. He stands there, with salt-and-pepper stubble on his chin and puffiness under his eyes, wearing a gray T-shirt with the Bandits logo on it. ‘Here it is,’ Jerry says. He holds the phone so I can see Tess pitching. His back is to the chimney wall, now full of flowers, balloons and drawings. Further behind Jerry’s back is the sugar maple tree. ‘She struck out the first batter she faced,’ he says.”

Presented Without Comment

Also Presented Without Comment 

Toeing the Company Line

  • On the site today, Audrey discusses how Democratic leaders are divided on the strategy of propping up far-right Republican candidates ahead of the midterms, Ivana Stradner and Iulia Sabina-Joja write about how the refugee crisis sparked by Russia’s invasion of Ukraine is destabilizing the EU, and intern Ben Woodard breaks down five recent Congressional hearings on abortion in the wake of Dobb v. Jackson Women’s Health.

  • Is that Washington Post scoop about the federal prosecutors asking witnesses in their January 6 probe about Donald Trump really that big a deal? “Prosecutors looking into a potential conspiracy or scheme or effort (choose whatever word you want to use) to flip the election results in Trump’s favor have to ask questions about Trump’s actions,” Jonah writes in Wednesday’s G-File (🔒). “What kind of investigation into such an alleged effort wouldn’t ask questions about the primary alleged beneficiary of the effort?”

  • Arkansas federal district judge Lee Rudofsky joins Sarah and David on today’s episode of Advisory Opinions for a discussion of corpus linguistics, a new tool in jurists’ toolbelt. How do they help define constitutional concepts and definitions? Plus: Do we know anything else about the Dobbs leaker?

  • Between the inflation news and the recession news, Jonah knew it was time to have David Bahnsen back on The Remnant. The two have an ultra-wonky conversation on how conservatives should approach economic policy before turning to common errors media outlets make in their economic coverage and the relationship between moral and economic well-being.

Let Us Know

Do you have any interest at all in the new centrist third party Andrew Yang and Christine Todd Whitman announced yesterday? Describe a third party you believe would have the most electoral success.

Declan Garvey is the executive editor at the Dispatch and is based in Washington, D.C. Prior to joining the company in 2019, he worked in public affairs at Hamilton Place Strategies and market research at Echelon Insights. When Declan is not assigning and editing pieces, he is probably watching a Cubs game, listening to podcasts on 3x speed, or trying a new recipe with his wife.

Esther Eaton is a former deputy editor of The Morning Dispatch.