Monkeypox testing remains low despite growing number of cases

Right on the heels of COVID-19, monkeypox has emerged as a global health emergency, spreading around the world. Tens of thousands have already been diagnosed with the virus, and many more could lie undetected due to a lack of testing accessibility and information explaining disease risk. This is because a testing strategy still has yet to have been solidified, with diagnostics conducted largely at STI clinics, despite the virus not being a sexually transmitted illness¹. Tests are not being made readily available, and public health officials are still in the process of explaining to individuals that anyone can catch the disease, instead of just the men who have sex with men (MSM) community. However, lessons from the past could point to solutions that can still be implemented to help improve the lives of those that could be impacted.

Perhaps similar to monkeypox, the Zika virus had a swirl of confusion and misinformation in its early days as well as a lack of available testing², and the Ebola virus often did not have proper communications or tests available during several of its outbreaks³. This led to both diseases spreading further, making later containment more difficult. At the beginning of the COVID-19 pandemic, widespread testing wasn’t available and numbers were underreported, allowing infected individuals to expose others to the virus because they didn’t know their status. This could have potentially lulled those in charge of public health responses and the public into a mindset that the virus had spread less than it had, ultimately leading to the current pandemic.

It is easy to see the parallels with monkeypox, where again, we have public confusion about viral characteristics and limited testing availability. Both of these factors could potentially lead to cases ballooning beyond what public health officials are aware of, and in turn, causing a lag in effective responses. The United States, for instance, allowed very few labs to process⁴ monkeypox tests when the virus was first suspected of spreading, leading to under testing and under reporting, which caused a backlog of tests needing to be processed in some instances⁵. Some companies have already jumped into the fray to support testing capabilities, which has already started to help get a further grip on the virus. For instance, Mako Medical Laboratories has partnered with Thermo Fisher Scientific to provide MAKO with the reagents to create a PCR test for monkeypox⁶, but still more can be done by those in the industry to make tests more accessible and regulatory bodies allowing for more labs to be authorized to run tests.

Perhaps most critically, public health organizations and agencies need to be engaged at every level, but especially in local communities around the globe. They are the first lines of defense against any emergency, providing care and information to those that need it, and tracking the spread of viruses as they emerge. However, they are often underfunded and understaffed⁷, meaning commercial labs and other organizations, such as hospitals, need to come alongside to ensure public health emergencies like these are properly handled.

Going in tandem with that support, in order to ensure we’re giving communities the best chance possible to counteract the ongoing surge of monkeypox, we need to destigmatize the disease to encourage testing and make tests widely accessible. This means not just being available in STI clinics, but also to anybody that needs them at sites in their communities, in as pervasive of a way that COVID-19 tests became available during the peak of the pandemic. The labs should be able to provide answers clearly and quickly, so individuals can isolate⁸ or receive treatment as needed.

Progress in the testing arena also requires additional education about how monkeypox infects and spreads, so people know when they or their loved ones need to get tested. Once general populations better digest available health information and understand that they are all at risk of contracting the virus with prolonged contact with an infected individual, not just through intimate contact, the demand for testing is expected to increase proportionally.

While the first effort at slowing down monkeypox hasn’t been a success, there is still an opportunity, as well as an obligation, to further curb the spread. Public health officials, clinicians, laboratorians, and test manufacturers have an obligation to use all of the tools at their disposal to help protect individuals from the virus as well as write the blueprint for how to successfully manage health crises in the future.

¹https://www.cdc.gov/poxvirus/monkeypox/transmission.html
²https://journals.asm.org/doi/10.1128/JCM.01972-17
³https://media.nature.com/original/magazine-assets/d41586-019-00212-y/d41586-019-00212-y.pdf
⁴https://www.healio.com/news/infectious-disease/20220718/five-commercial-labs-now-performing-monkeypox-testing-in-us
⁵https://time.com/6198670/monkeypox-testing-difficult-slow/
⁶https://www.globenewswire.com/news-release/2022/07/11/2477156/0/en/MAKO-Medical-Validates-Monkeypox-Test-from-Thermo-Fisher-Scientific.html
⁷https://www.npr.org/2020/04/28/845484900/public-health-labs-suffered-budget-cuts-prior-to-the-coronavirus-pandemic
⁸https://www.cdc.gov/poxvirus/monkeypox/clinicians/isolation-procedures.html

Manoj Gandhi, MD, PhD, is the senior medical director for the genetic testing solutions business at Thermo Fisher Scientific, and is part of the team that provides medical strategy, medical and scientific oversight for product development, on-market product support, and customer engagement.