Gottlieb: Window for Containing Monkeypox ‘Probably Has Closed’

MARGARET: Give us a sense of the scale of this because the CDC numbers are out. They say they’re only eight women within that. No children. You’re saying this is a pandemic? That’s not a word the administration is using yet, what level of emergency are we at?

GOTTLIEB: Yeah look, and I think they’re going to be reluctant to use the word pandemic, because it implies that they’ve failed to contain this. And I think at this point, we’ve failed to contain this. We’re now at the cusp of this becoming an endemic virus where this now becomes something that’s persistent that we need to continue to deal with. I think the window for getting control of this and containing it probably has closed, and if it hasn’t closed, it’s certainly starting to close. 11,000 cases across the world right now. 1,800 cases, as you said, in the US. We’re probably detecting just a fraction of the actual cases because we have a very, we had for a long time a very narrow case definition on who got tested. And by and large, we’re looking in the community of men who have sex with men and STD clinics. So we’re looking there, we’re finding cases there. But it’s a fact that there’s cases outside that community right now. We’re not picking them up, because we’re not looking there. This has spread more broadly in the community. I wouldn’t be surprised there’s thousands of cases right now.

BRENNAN: It’s a little chilling to hear you say containment has failed. I’ve heard you say that before with COVID.

GOTTLIEB: Well look, this isn’t going to explode like COVID. This is a slower moving virus, which is why we could have gotten control of this if we had been more aggressive up front, and we made a lot of the same mistakes that we made with COVID with this – having a very narrow case definition not having enough testing early enough, not deploying vaccine in an aggressive fact- fashion to ring vaccinate. But now this is firmly embedded in the community. And while it’s not going to explode, because it’s harder for this virus to spread, it’s probably going to be persistent, you’ll-you’ll have this as a sort of a fact of life, maybe spreading as a sexually transmitted disease, but also breaking out of those settings.

BRENNAN: So the CDC said monkey pox can show up up to three weeks post exposure. What are the basic symptoms? If you have a rash you call your dermatologist? Who do you call?

GOTTLIEB: Well, it’s a vesicular rash. It’s associated with fever and achiness. You know, the historically used to get a disseminated rash. What we’re seeing right now is people aren’t presenting with a widely diffused rash, but sometimes just a small number of vesicles. So I think it’s being confused with other vesicular rashes, Herpes, Coxsackie could cause a vesicular rash, certainly chickenpox. Right now, anyone who presents with a particular rash that can’t be explained by another etiology. So a rash that causes vesicles, should be tested for monkey pox, whether they come from a high risk community or not. That’s the way we’re going to snuff this out. We didn’t have enough testing to do that. Now CDC has gotten in place more testing this probably adequate testing to broaden it to-to accomplish that. So we should be doing that physicians should be sending off these tests.

BRENNAN: The problem with testing also, it seems that distribution or access to a vaccine is an issue, the mayor of New York, the governor of New York, asking the Biden administration to do more to get them access. Why is this a problem?

GOTTLIEB: Well, we didn’t have adequate stockpiles of the vaccine, the one vaccine that’s proven monkeypox, we only had 2,000 doses in a national strategic stockpile. It was there as a hedge against smallpox, we took our eye off that ball, so we didn’t replenish that supply. They ordered about 300,000 doses that have been delivered. 150,000 have been distributed, another 130,000 will go out this week.

BRENNAN: Some of that overseas.

GOTTLIEB: Some of it- well, there’s 800,000 doses that were overseas, that the manufacturer, Bavarian Nordic, had overseas. Those are being brought into the US right now. FDA has to do what’s called “lot release”, they have to inspect those doses to make sure they were appropriately manufactured. They’re doing that inspection at the same time that they’re forward deploying those 800,000 doses. So those are going to cities right now. And as soon as FDA finishes that, which should be this week, those doses will be turned on, they’ll be able to be distributed or be used on patients. So I think the vaccine situation is going to improve dramatically this week, you’re going to see literally hundreds of thousands of doses become available. The White House has intervened to take more control of the response away from CDC. This can’t be our response every time that when CDC drops the ball, the White House and the political leadership need to step in. That’s what’s happened here. It happened in COVID. We need to fundamentally reform how we respond to these-these crises.

BRENNAN: You wrote a book on that. I want to ask you about COVID. The CDC says now about 54% of Americans live in an area of high COVID Community spread. That’s up from 31%, the prior week, that seems fast moving. What is different about these variants now?

GOTTLIEB: Well, look, it’s the B-5 variant that’s growing. It has the capacity to evade the immunity that we’ve acquired from vaccination and also from prior infection. It does seem to be that B-2 infection confers more robust immunity against this B-5 variants, so places that had big outbreaks of B-2, like the Northeast, are probably going to be more protected. There’s 100,000, over 100,000 cases on average being reported on a daily basis. We’re probably detecting one in 10 infections right now. So it’s probably more like a million. I think most Americans have started to accept this as part of the fabric of daily living. In part that’s, that’s based on a wholesale recalibration of risk, in part is based on the fact that there’s very few people who are immune. I.e so people feel rightly, more impervious to a bad outcome. So we have to recognize that this spread is happening against the backdrop basically, of normal living.

BRENNAN: But the White House is saying put a mask on if you go into indoor gatherings, the city of Los Angeles says they might institute this at the end of the month.

GOTTLIEB: I don’t think we’re going to see mandates. I don’t think there’s a lot of tolerance for mandates, maybe in select cities, like Los Angeles.

BRENNAN: But is it advisable?

GOTTLIEB:  I think if you’re going into a congregate setting with a lot of people you don’t know, wearing a mask is prudent if you’re in a high prevalence area, especially if you’re someone who-who’s at risk. You know, I still wear a mask in certain settings, I wear when I go through the airport. If I catch COVID I want it to be from a family member or friend not some stranger I’m sitting next to on a plane. So I try to be prudent when I’m in mixed company. I think right now, if you live in a high prevalence region, it’s advisable, especially if you’re someone who’s vulnerable if it’s easy enough.

BRENNAN: And a booster shot. Will we have a rebooted bivalent vaccine in the fall?

GOTTLIEB: Yeah,well, look, there’s going to be a vaccine based on B-4 that the manufacturers are developing right now. There is a bivalent vaccine based on B-1 on the shelf right now that we could be deploying, we’re not. That probably would be more protected against this B-4 variant and B-5 variant. We- they’ve made a decision so far not to deploy that but to wait for the B-4 variant vaccine that’s going to be available this fall. Right now, if you’re above the age of 50 and you haven’t had a dose of vaccine this year, you probably should get one, and as sequencing is good, get a dose now if you’re someone who’s at high risk and come back and get one later.