Aug 4, 2022 - Podcasts

Can we still fix our response to monkeypox?

California is the latest state to declare a state of emergency over the monkeypox outbreak. The CDC says more than 6,600 U.S. cases of monkeypox have been reported since May, and as that number grows so does pressure for more government action.

  • Plus, back to school could mean disease outbreaks beyond COVID.
  • And, credit card balances are soaring.

Guests: Axios' Tina Reed, Arielle Dreher, and Courtenay Brown.

Credits: Axios Today is produced by Niala Boodhoo, Sara Kehaulani Goo, Alexandra Botti, Nuria Marquez Martinez, LydiaMcMullen-Laird, Alex Sugiura, and Ben O'Brien. Music is composed by Evan Viola. You can reach us at [email protected]. You can text questions, comments and story ideas to Niala as a text or voice memo to 202-918-4893.

Go deeper:


NIALA: Good morning! Welcome to Axios Today! 

It’s Thursday, August 4th. 

But first, is it too late to fix our response to monkeypox? That’s today’s One Big Thing.

NIALA: California is the latest state to declare a state of emergency over the monkeypox outbreak. Earlier this week, the Biden administration named a White House coordinator to manage the federal response. The CDC says more than 6,600 US cases of monkeypox have been reported since May. And as that number grows, so does pressure for more government action. Tina Reed is a healthcare editor for Axios. Hey Tina.

TINA REED: Hi Niala.

NIALA: Tina monkeypox is rarely fatal in the US, but we know it can cause terrible pain for patients who contract this. Why are some people saying that government response still has been inadequate so far.

TINA: In many ways it felt like deja vu from the beginning of COVID. But what we saw was really a slow response and a lack of clear communication. It was very difficult to find testing and treatment data has been piecemeal. And then there's been this very poor coordination between local state and federal governments on this.

NIALA: And what's the situation with vaccines?

TINA: The story has been very different geographically. In some cities there's been very high demand for vaccines. For instance, in San Francisco, the San Francisco Aids Foundation Clinic, has a 10,000 person waiting list for vaccines as of Tuesday this week. However, our Axios locals team has also found that, in some states they really haven't asked for their entire allocation of vaccines and demand has been much lower. So it's been very different depending on where you are in the US.

NIALA: Tina, your team's also reporting that people are having trouble finding treatment when they do test positive for monkeypox?

TINA: Yes. So there’s still a lot of confusion among the provider community and a lack of clarity about where to get treatments. And so meeting the patient demand for treatment has led some clinics simply to just not offer care, uh, bouncing patients from clinic to clinic to seek treatment. There are patients who need testing and then treatment that are being to other providers and access to these vaccines has been pretty, pretty low once again in some places. And so it's been pretty difficult, for some groups to get.

NIALA: So far, the vast majority of these cases have been in men who have sex with other men. What are we hearing from advocates in that community about the response to monkeypox?

TINA: There has been a lot of frustration and a lot of comparisons back to the start of the Aids pandemic, where there was a lot of anxiety, uh, about the potential stigma and anti-gay stigma that may come with this. And just a feeling of of being second class citizens, if you will. Because there did fee, like there was a lack of urgency early on, with the response to this virus.

NIALA: So if this response doesn't improve, could we see this spread far beyond primarily gay and bisexual men who have sex with other men?

TINA: Yes. Increasingly experts are saying that that is a possibility and that the window of opportunity to contain this outbreak is closing or has already closed. A bright spot to this virus and the way it spreads is that it doesn't appear to be airborne. So it spreads much more slowly. They've said, this is not the next COVID pandemic. However, we know how tricky viruses can be and how they can change, and the fear really is that it could change in a way to make it more easily spread throughout the general population and that this disease will become another disease that's endemic in the US.

NIALA: Axios’ Tina Reed. Thanks Tina.

TINA: Thank you Niala!

In a moment, vaccination rates lag for school aged kids. 

NIALA: Welcome back to Axios Today! I’m Niala Boodhoo.

Students across the country head back to school this month. And while COVID continues, and now monkeypox is a concern, experts are actually worried about school outbreaks of other diseases, since childhood vaccination rates have lagged for things like measles and mumps. Axios’ Arielle Dreher has that story from San Francisco – hi Arielle.


NIALA: Arielle, last month New York State reported the first case of polio in the US in almost a decade. Are we starting to see outbreaks of other diseases that could have been prevented through routine vaccinations?

ARIELLE: I think there's definitely cause for concern. When vaccination rates lag, there's always that risk, especially when the disease needs a pretty high herd immunity to not be introduced. Pre-pandemic in certain communities, we saw outbreaks of measles and mumps in communities with lower immunization rates. I think measles is a good example. It has a really high herd immunity about 95% or above needed to keep it out. So when a case is introduced, when there's less than 95% herd immunity, you're going to have an outbreak.

NIALA: Do we have a sense of nationally what vaccine hesitancy or immunization looks like when we're talking about, for example, measles.

ARIELLE: We do. The American Academy of Pediatrics tracks this pretty closely. The percent of children 24-months old who have received at least one dose, for measles, they estimate that's about 92% to 94% and that's a pre-pandemic percentage. So again, I just wanna drive home that in these local communities in a local neighborhood, and even as local as a classroom, right, that herd immunity percentage is really important to prevent outbreaks.

NIALA: And what do vaccine levels look like? What happened during the pandemic to that herd immunity among kids?

ARIELLE: That herd immunity dropped significantly because a lot of people didn't get routine immunizations. Now on the other hand, kids weren't in school, right? So we didn't see as many outbreaks of measles, mumps and other viruses. And when they did return to school, there were a lot of mitigation measures in place like masking, sending kids home when they didn't feel good. Now with those mitigation measures going away, and as we start into the new school year, there's more opportunities for viruses to transmit and we've seen out of season outbreaks of things like flu in the Los Angeles school district recently, the CDC reported an outbreak there at a school event in May. These are weird, out of season outbreaks and experts expect us to see more of those in the coming school months.

NIALA: Are we seeing the same levels of vaccine hesitancy for the COVID vaccine, which was recently approved for children?

ARIELLE: COVID vaccines for kids still have really, really low uptake percentages. I talked to the national association of school nurses for this story and school nurses are getting prepared. They are preparing for outbreaks, as they have the whole pandemic. And in fairness to them with less mitigation tools at their disposal. The family physicians I talk to are concerned that some of these outbreaks of COVID in classrooms might be higher and affect more kids this time around if we're dealing with a really contagious variant.

NIALA: Arielle Dreher covers healthcare for Axios from San Francisco. Thanks, Arielle.

Credit card balances are growing at the fastest pace in decades. And that debt will get costlier for borrowers to carry, as the Fed raises interest rates. I asked Axios’ Courtenay Brown: what's going on here?

COURTENAY BROWN: So early on in the pandemic, something relatively unexpected happened. Consumers paid down credit card debt at a really, really rapid rate, which is something you don't usually see during a downturn, but they were armed with stimulus checks, which helped buffer their finances. What's happening now is balances are ramping back up to pre-pandemic levels and at a historically pace. The Fed tracks this data, and they said that last quarter credit card balances jumped 13% from the same period a year ago, and that's the fastest pace in over 20 years. So two things are happening that explain the really rapid rise. The first is inflation things cost more so naturally the balances would be higher. And consumers may also be leaning on plastic a little bit more to buffer the shock they're feeling from inflation. The second thing that's happening is consumers are opening credit card accounts really quickly, more than 233 million accounts were open last quarter and that's the most since 2008. And overall there are more open credit card accounts than ever before. One thing that's key to watch is whether consumers can keep up with their credit card payments as the economy shows signs of slowing and credit card rates go up. Delinquencies are still really low right now, but the Fed says that there are some early signs that borrowers, especially lower income borrowers are starting to fall behind on their payments.

NIALA: Courtenay Brown is an economic reporter for Axios.

That’s all we’ve got for you today! 

I’m Niala Boodhoo - thanks for listening - stay safe and we’ll see you back here tomorrow morning.

Go deeper