Who’s Most at Risk of Monkeypox as It Spreads | Lemonada Media

As the monkeypox virus gained momentum in mid-2022, public health experts sounded the alarm. On this In the Bubble episode, guest host Stephanie Wittels Wachs interviews Dr. Jay Varma, Director of the Cornell Center for Pandemic Prevention and Response, and Dr. Joseph Osmundson, microbiologist and LGBTQ+ activist, to unpack who’s most at risk and why the U.S. public health response has lagged.

Dr. Varma explains how the outbreak has spread through dense social and sexual networks, particularly among men who have sex with men (MSM), while emphasizing that anyone can contract the virus through skin-to-skin contact. Together, the experts address failures in testing, treatment distribution, and vaccine rollout—and what needs to happen to curb further spread.

 

What Is Monkeypox, and Why Is It Spreading Now?

Monkeypox, traditionally confined to central and western Africa, gained global attention in 2022 when cases began appearing in European and North American cities. Initially, the virus was thought to be zoonotic—jumping from animals to humans—but as Dr. Varma points out, human-to-human transmission through close contact is now the primary concern.

Once monkeypox entered tight-knit social networks—particularly in LGBTQ+ communities—it spread rapidly. But the early U.S. response was flawed.

“As soon as it got into those networks, and we saw unlinked cases across cities, we knew we were missing infections,” said Dr. Varma. “That’s a red flag in epidemiology.”

Missteps in Testing, Treatment, and Vaccination

1. Testing Came Too Late

By May 2022, experts like Dr. Varma and Dr. Osmundson were already warning that the U.S. was failing to diagnose cases. Labs were overwhelmed, and testing was limited to people with visible lesions—leaving asymptomatic or early-stage patients undetected.

“We had PCR tests ready,” Osmundson noted, “but testing was still a bottleneck. It’s public health malpractice.”

2. Treatment Is Available—But Inaccessible

A promising treatment, tecovirimat (TPOXX), was sitting in federal stockpiles but wasn’t made available for wide use due to regulatory hurdles.

Dr. Varma explains that the FDA had approved the drug for smallpox under emergency use protocols, not monkeypox, which required new paperwork and clinical trial structures. In the meantime, patients were suffering unnecessarily.

“It’s unconscionable,” Osmundson added. “People are isolated, in pain, for four weeks—while drugs sit on shelves.”

3. Vaccine Stockpiles Went Unused

The U.S. had access to hundreds of thousands of JYNNEOS vaccine doses, but they sat in freezers in Denmark instead of being delivered to cities like New York during Pride Month—when risk was high and demand was skyrocketing.

The government’s rationale? Preserving doses for a theoretical smallpox bioterror attack, ignoring an actual outbreak.

“We didn’t use them in Nigeria. We didn’t use them in June. And now, people are paying the price,” said Osmundson.

Who Is at Risk—and How to Stay Safe

While the virus has largely affected men who have sex with men, Dr. Varma emphasizes that anyone can be infected through close contact, including athletes, massage therapists, or people handling contaminated clothing.

That said, both experts strongly oppose framing monkeypox as a “gay disease.”

“Diseases don’t respect identity. They follow human behavior and contact patterns,” said Varma.

Instead of stigmatizing sex, Dr. Osmundson and Dr. Varma advocate for risk reduction and community empowerment:

• Encourage condom use and reduce partner count temporarily.
• Improve access to testing, vaccines, and treatments through community clinics and LGBTQ+ centers.
• Avoid shaming or isolation—offer mental health support and financial aid for those required to quarantine.

 

Public Health Messaging: Targeted, Not Stigmatizing

Messaging matters. Dr. Varma and Dr. Osmundson agree: public health leaders must walk a fine line between acknowledging at-risk groups and avoiding harmful stereotypes.

Dr. Varma says we should be realistic and compassionate:

“We need to treat sex like what it is: a healthy, joyful human behavior. Our job is to help people do it safely.”

Rather than telling people to abstain, harm-reduction strategies like temporary partner reduction, promoting vaccination, and normalizing care are more effective.

Final Takeaways: What Needs to Happen Now

According to Dr. Varma and Dr. Osmundson, this is what needs to happen to stop monkeypox from becoming endemic in the U.S.:

1. Massively expand access to testing, including at events, clinics, and through home kits.
2. Accelerate vaccine delivery—especially to the communities already affected.
3. Remove red tape around tecovirimat (TPOXX) and begin widespread clinical trials.
4. Fund and empower local health departments and LGBTQ+ community organizations to lead outreach.
5. Shift the public health narrative—from fear and stigma to empowerment and care.

“Monkeypox is not the next COVID,” Dr. Varma concludes, “but every delay increases suffering and makes this harder to contain.”

 

🎧 Podcast: Who’s Most at Risk of Monkeypox as It Spreads