It was a bad month for public health.
On August 14, the World Health Organization declared bird flu an international health emergency due to the “unprecedented” spread of a new, more deadly variant. In the United States, bird flu, officially known as H5N1, has spread to 10 farm workers in Colorado, an alarming development given that only three other cases have been reported this year.
Mpox and bird flu are different infectious diseases. However, they are united by the assumption that containment is easy to achieve, and thus a lax public health response. In fact, nearly 100,000 people became infected with Mpox after the 2022 outbreak, and while the disease disappeared from public view, Mpox continued to spread and evolve into deadlier variants. Even though bird flu first jumped to mammals around the same time in 2022, the response in the U.S. was weak, with little consistent messaging or concrete action.
This is part of a larger inertia around infectious diseases that we believe is due to two main factors.
First, public health leaders have become overcautious in the wake of the COVID-19 pandemic, as they saw bold efforts to contain the pandemic respond to anti-science aggression, populist outrage, relentless litigation, and the curtailment of public health powers in at least 30 states. The upcoming U.S. election has only increased polarization and disinformation. So instead of proactive action, we are seeing concern.
Second, there is a sense that another pandemic cannot happen so soon after COVID-19—that these infectious diseases will inevitably die out as they did before. This is a “gambler’s fallacy,” and because of this, the U.S. may be underestimating the risks posed by smallpox and bird flu, allowing two potential pandemics to brew on the world stage.
This has translated into several outages for both diseases. For example, there were 1800 cases of MPOX in the US between October 2023 and April 2024, while in Africa the more dangerous Clade 1b variant, which combines efficient sexual transmission with high mortality, began to spread. However, the US Centers for Disease Control and Prevention (CDC) stopped updating its MPOX outbreak case numbers in January, downplaying this additional threat as case numbers were not yet increasing. The CDC resumed public reporting in May, suggesting that its attitude may have been too expedient and optimistic.
Our global health response to Mpox reflects such underestimation and delay. On August 7, the US announced it would donate 50,000 vaccines to the Democratic Republic of Congo, nearly a year after Clade 1b was first reported there. By comparison, the Africa CDC estimates it will need 10 million doses to bring the current outbreak under control on the continent. In 2022, the US failed to combat Mpox while it remained confined to Africa, and hesitated until the disease spread unchecked at home; we are witnessing history repeat itself in 2024.
Read more: Health experts observe a more dangerous version of Mpox
According to WHO case data, the mortality rate for bird flu can be as high as 52%. New York Times noted, “Only recently has the CDC begun mobilizing real resources for a testing initiative, after months of various federal groups wrangling over responsibility and ultimate authority.” In the United States, ignorance is bliss, and our public health leaders are doing everything they can to make this happen, too.
So perhaps we should not be surprised that the U.S. Department of Agriculture (USDA) did not detect avian influenza until four months after it emerged in cattle, or that the agency did not require routine testing of cattle (unless they cross state lines) or vaccinations of farmworkers. While the decision to keep these programs voluntary is multifactorial, it is likely influenced by political reluctance in the wake of COVID-19 and recent Supreme Court rulings that have struck down vaccination requirements.
To be clear, the pandemic risk from Mpox or bird flu is currently low. The transmission dynamics of Mpox, which require very close contact, make it more difficult to spread than SARS-CoV-2. Cases of bird flu have also been mild and limited in number so far. However, these are not absolute truths, but day-to-day assessments that require real preparation – measured by testing, continuous monitoring and forward planning.
We don’t have easy answers to overcome public health paralysis. But at a minimum, the U.S. needs better public health communications that not only emphasizes transparency but also holds our politicians accountable. Applying this COVID-19-era lesson to the Mpox and bird flu is one way to give Americans a new, positive public health reminder and encourage early, decisive action and realistic risk assessments.
In the face of two rapidly evolving disease outbreaks, we cannot afford fear or false optimism. And as we work to make the United States safer, we must not forget our global commitments to share vaccines, medicines, and resources. Global crises require global solidarity and collective action.
