Fractured Trust: Learning Lessons From COVID-19 to Prevent Monkeypox

How much information should the public have about infectious diseases? Can the public handle the truth? If the correct information is not given out, will the public believe the medical leaders when another serious disease threatens the public’s health? Ambassador Deborah Birx, MD, continues her discussion with ICT.

Medical leaders during the COVID-19 pandemic grappled with what—and what not—to tell the public about the threat the world faced. Two and a half years later, the world now is faced with another serious infectious disease—monkeypox. But what lessons has the world learned?

Ambassador Deborah Birx, MD, who will be giving a presentation titled, “COVID-19 USA - Lessons and new tools to improve workplace safety" at the "Frontline Worker Safety in the Age of COVID-19: A Global Perspective” a Health Watch USA Webinar on September 14, 2022, addressed this and other topics when she sat down with Infection Control Today® (ICT®) to discuss her presentation, monkeypox, polio, Langya virus, her book, and several other topics.

In this, the third of 4 installments of the interview, Birx discusses monkeypox—and unless we learn from the mistakes made with COVID-19, the future she is concerned about could happen.

Birx is a world-renowned medical expert and leader whose long career has focused on clinical and basic immunology, infectious disease, pandemic preparedness, vaccine research, and global health. Birx served the United States as an Army Colonel and later, running some of the most high-profile and influential programs at the US Centers for Disease Control and Prevention and US Department of State.

The first installment of the interview is here.

The second installment of the interview is here.

Ambassador Deborah Birx, MD: I think monkeypox will continue to spread, and primarily the gay and bisexual community until we do what's right by them, and for them and with them, and that is to get them the vaccines in treatment that they need. Monkeypox, like smallpox, though, can spread within a family. Because contaminated sheets and towels and surfaces can spread the virus within close contact within the family. So I'm not saying it's going to be a pandemic, but we shouldn't have the nearly 10,000 cases we have right now--we're headed to 20. [At the time of this recording.] We shouldn't have that. We knew what was going to happen 3 months ago. We didn't get vaccines out there. If they didn't have enough vaccines, they should have studied immediately in May [2022], how to use low dose vaccines.

Here we are in August, and all of a sudden that occurs to them. So again, we're slow to react. Because of that, yes, people are not dying here. But I can tell you, if monkeypox gets into nursing homes because of a health care provider unknowingly got exposed in a family and brought it into a nursing home, we will see deaths. Because you know, this is our debilitated population. Like in the daycare center, [monkeypox] could get there.

You [the interviewer] are so right; you're a mom, I find moms want to do the right thing for their families. If you give them the tools, they will do the right thing. And they will test.

We [Birx’s family] use testing. We have a significant number of family members over 40 [years of age], and at higher risk. No one over 40 in our households across the country have gotten COVID-19. That's not by accident. We're not some genetically unusual group. We're all intermarried; we don't share genes. We all have spouses who are totally different genetically. This is not some bizarre thing of nature. This is using testing. Yes, the grandchildren got infected outside from their swim instructor who was very good about testing and let us know. Because he let us know, we were able to stop [COVID-19] in the tracks. We were able to test those grandchildren, find out immediately within 12 hours that they were positive and isolate them with their mom who ended up being a casualty of COVID-19 because she had to take care of the children. But we were able to protect the 60-somethings, the 70-somethings, and the 90-somethings. [Protection] is possible if you use today's technology, but, for some reason, we're stuck in the 20th century, both in the data and data use and in our tools when we could be in the 21st century.

If you tell people and give them the information, they will adapt it to their lives and make it work. I find people are incredibly creative. If you give them the information, if you empower them, they will make the best decisions for themselves and their family. This is not about rules and mandates. This is about knowledge and empowerment. It's how we changed the course of HIV across the world. And it's possible to change the course of COVID-19, but not the way we're approaching it.

Infection Control Today® (ICT®): The thing is we must give them truth, and not conspiracy theories. If we need to get it down to teaching them the basics of how a bacterium works, then let's do that. But too many people listen to the wrong people. They take that advice to heart, and then they say, “Oh, we don't need that. We don't need to test. It's all a lie.” Do you know how many people here, where I live, don't even believe that COVID-19 is a thing.

DB: But I think that is on us. And I take responsibility. I think every public health person should take responsibility for the situation that we're in. For one thing. I've heard a lot of public health officials say to me, “We can't trust people with all the information.” When you start out that way, you fracture trust. From the very beginning, when these vaccines were developed, I felt very strongly—and I've been very consistent in my view on these vaccines—that these vaccines were only studied to prevent severe disease and hospitalization; they were never studied to prevent transmission. We should never imply to the American public that these vaccines were going to protect them from getting infected. Yet we did, and when I called people on it, they said, “We don't want to do anything to discourage people, so we don't want to really tell them the whole truth.” That's what fractures trust.

What I'm worried about right now is fracturing trust about other vaccines because there are vaccines today that do create what we call sterilizing immunity. Natural infection results in long-term protection like measles, mumps, rubella, diphtheria, tetanus, pertussis. [With] natural infection, [you] usually get it once. When you're vaccines are made to mimic natural infection, you can achieve herd immunity; you can prevent spread of that.

But that's not what the COVID-19 vaccines were. And because we're not explaining the difference in vaccines, people may say, “They've been misleading us about childhood vaccines.” It's not true. They weren't misleading us about childhood vaccines. No, we [leaders] misled people about the efficacy of the COVID-19 vaccines, and we implied to people, if they were vaccinated and boosted, they wouldn't get infected. Because of that, people let down their guards who were in extraordinarily high-risk groups, we're probably going to lose almost 300,000 Americans in 2022, with Paxlovid, monoclonal antibodies and vaccines. To me, that's inexcusable. But it's because we imply to people [that] they were invincible, and they weren't invincible.

Just tell people the truth: These are great vaccines. They work to protect against severe disease, hospitalizations, and death. They do not protect against infection. If you're worried about long COVID19, you're going to have to do more during a surge to keep from getting it. Because we're only talking about acute disease, not long COVID-19 and the disabilities. If you talk about mental health issues, there is nothing that leads to more depression and mental health issues than chronic fatigue. If we have 15 to 20 Americans with chronic fatigue-type syndromes because we didn't warn them, that these vaccines didn't protect against infection and reinfection, and it put them at risk for long COVID-19, I feel, as public health [workers], if we don't tell people the whole truth and tell them both the good and the bad, we're creating a whole population that is not going to believe science and data because we purposely withheld some of the science and data thinking people couldn't understand it, and they can.

ICT®: Thank you.

[This interview has been edited for length and clarity.]