• The dwindling monkeypox outbreak shows public health strategies can still work
• Hard numbers on how election choices affect U.S. death rates
• How should we regulate pandemic virus experiments?

FROM THE HEALTH DESK

In an era of public health crises, monkeypox offers a glimmer of good news. 

Of course, the U.S. outbreak had a rough start. Despite signs the virus was spreading, public health authorities failed to adequately expand testing and bungled the early rollout of pre-existing vaccines. That allowed monkeypox to run rampant among men who have sex with men (MSM). By early August, more than 400 people were testing positive each day in the U.S., and many feared the virus would establish itself in the MSM community and potentially spread beyond. But then, new cases started falling before stabilizing at about 50 a day. 

What happened? There was no silver bullet, but a combination of a salvaged public health response — especially a robust effort within MSM communities to slow the spread — helped control a virus that turned out to be less transmissible than initially feared. 

Behavior change. Monkeypox spreads via close physical contact, especially sex, and there’s evidence that MSM networks changed their behavior to tamp down spread. Improved testing and awareness enabled more people with monkeypox to isolate and prevent further spread. People with multiple sexual partners were at highest risk, and by mid-August, many MSM reduced the number of sexual partners, sexual encounters and use of dating apps because of monkeypox, a CDC report found.  

Vaccines have helped. Despite worries over how effective a smallpox vaccine would be against monkeypox, there’s emerging evidence the vaccines do some good. People with at least one dose of Jynneos were 14 times less likely to get monkeypox than unvaccinated people, according to a preliminary study from CDC. More real-world evidence will be needed to understand exactly how protective the shots are. 

Natural immunity. Monkeypox has been spreading through very dense MSM sexual networks, and some studies suggest that naturally acquired immunity at key nodes of these networks — people with many sexual partners — took some steam out of the virus’ spread. 

It’s not super transmissible. Monkeypox does not spread like SARS-CoV-2, which has helped limit the former to circulating in MSM sexual networks. Likely by chance, the virus happened to enter these especially dense communities but has had a harder time establishing itself outside of them.  

The U.S. is still a long way from eliminating the virus, but for now, at least, the country is in a good position. Truly beating monkeypox would require vaccination campaigns in African countries, where the virus is endemic. But vaccines are not available to the public there, as wealthier nations bought up the limited supply for themselves. 

ELECTION 2022: How choices made at the polls affect health outcomes 🇺🇸

As voters prepare to head to the polls, a new nationwide analysis looks back at how two decades of policy choices at the state level — everything from raising minimum wages to open carry laws — have affected death rates over time.  

The results, published recently in the journal PLOS One, suggest that instituting liberal state policies nationwide, along with more conservative ones on marijuana, would have saved more than 170,000 lives in 2019. Putting in place more conservative policies across all 50 states, such as easing gun purchases and lowering cigarette taxes, would have cost 217,635 lives. 

Grid’s science reporter, Dan Vergano, spoke to two authors of the study, Syracuse University sociologists Jennifer Karas Montez and Shannon Monnat, about the findings. Their answers have been edited for length and clarity. 

DV: Why look at the mortality effects of state policies? 

JKM: We wanted to focus on state policies because they've been shifting, and very dramatically. They've been pulling apart for decades, and there's good reasons to suspect that is contributing to higher mortality rates.  

SM: What state policies do is shape the downstream conditions and behaviors that condition, how our behaviors that then go on to hormones or kill us. So, you can think of things, for example like economic and labor policy, that can affect whether people living in a state have enough money to eat healthy. Those same policies can affect whether people can afford safe housing or access medical care. … Policies related to things like tobacco taxes can influence the likelihood that young people will take up smoking. Permissive gun laws can lead to suicide. 

DV: If you could throw a switch, which of the policies would you change first to save the most lives? 

SM: One of the really important messages of this paper is that it isn't just one policy, that all these things act in concert and have interactive effects. I want to make sure that that is clear, but I would say the most upstream of these are taxes and labor policies. They have the largest umbrella effect over the largest share of different causes of death. With something like firearms, you can see how it's really important. It affects things like homicide and suicide, but with labor and taxes, they're going to affect like every cause of death you can think of because of their influence on people's material circumstances.  

DV: Are you concerned that these findings will simply turn off the voters who need to hear them simply because of the conservative and liberal labels the study gives them? 

JKM: This is something that our team has debated for years, and we tried to come up with a different label and, at the end of the day, we just decided to call it what it is. It may turn off some people.  

However, longevity, or not dying, surely is a value that people hold. I hope that they wouldn't get stuck by this label of conservative or liberal, right? If your primary value is, “Hey, I don't want to die early,” then I hope that people would be receptive to this message that these conservative policies are going to cut your life short. 

DV: What do your findings tell voters? 

JKM: Our analysis shows you that decisions that are being made in state houses that have life and death consequences for working-age Americans. And we've given state policymakers a free pass. They are actually playing a pretty important role in this terrible trend. 

SM: When we're thinking about the politicians we're going to elect, [the question is] what is their outlook on life? And how does that outlook influence the types of policies we think that they might put into place? We don't know what the landscape of policies five years from now is going to be. And so, we have to choose people who are going make the best choice for us all rather than help only a few richer people get to live long happy and healthy lives, but at the expense of the rest of us. 

MORE FROM GRID

WHAT WE’RE READING

• The U.S. Army is struggling to find the recruits it needs to win the fight over the future (CNBC)
• Overturning Roe Has Meant At Least 10,000 Fewer Legal Abortions (FiveThirtyEight)
• Why Does the U.S. Always Seem to Get Coronavirus Variants After Europe? (Slate) 

👋 Thanks for reading. Until next week, take care. –Jon 

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