Analysis: Why monkeypox cases suddenly began to decline

Much of this explanation may sound familiar after more than two years of Covid: A virus can be tamed by vaccines and behavioral changes.

Unclear communication

Another factor worth emphasizing: public health communication. During Covid, officials have sometimes given unclear or misleading guidance because they did not trust the public with the truth.

A similar phenomenon played out with monkeypox. Some officials were cautious about explicitly labeling monkeypox as a greater risk to gay and bisexual men and asking them to reduce risky sexual activities, out of fear of stigmatizing a population that already faces discrimination over AIDS.

New York City’s health department initially opposed recommending that gay and bisexual men reduce their number of sexual partners, arguing that L.G.B.T.Q. people have had “their sex lives dissected, prescribed and proscribed in myriad ways.” (Internally, the agency debated whether that was the right response.) Those concerns stopped officials from clearly communicating the dangers to the population most at risk.

Eventually, public health officials began tailoring their warnings toward gay and bisexual men. In late July, the World Health Organization’s director general said that men who have sex with men should consider limiting their number of sexual partners. The C.D.C. and New York City’s health department echoed the guidance.

And it appeared to work: Monkeypox cases began to decline. That shift in public messaging enabled two of the four factors I explained earlier, as officials targeted gay and bisexual men for vaccine drives, and men who have sex with men limited riskier activities.

But the clearer guidance came after weeks of criticism, exposing a habit of unclear messaging that keeps the country vulnerable to health crises.

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