Monkeypox Needs a Public Health Strategy for Adults

Courage and honesty, not politeness and signaling, will yield optimal results

The federal government just declared monkeypox a national public health emergency, but the game plan to tackle the spread is murky at best. A recent Hill piece asks, how do we explain the dangers of monkeypox to people who are most at risk of catching it without stigmatizing that particular group of people? The answer is much easier than what the experts quoted are saying: Just tell people the truth. Communicating during disease outbreaks and public health crises is about reasoning with people and providing them with actionable information. It isn’t about managing people’s feelings. While the medical effects of contracting monkeypox are the same in all people, the likelihood of contracting it right now is heavily influenced by individual behavior. Public health practitioners must communicate clearly.

COVID-19 is just the latest case where public health authorities, governors and mayors couldn’t help but beat around the bush about who was really at risk. One month into the pandemic, it was clear that the two main risk factors for COVID-19 were advanced age and elevated body mass index (BMI). But because public leaders were afraid to commit the modern sins of ageism and fat-shaming, they had everyone stay home for months on end—during which an estimated 42% of Americans gained more weight than they intended, thereby increasing their risk of suffering severe COVID. Yet it took a full six months of pandemic for the CDC to warn people that obesity is a risk factor.

Hiding the truth from people to avoid making them uncomfortable isn’t unique to public figures. Grandma’s fruit cake will always be the best dessert—at least while eating it at her dinner table. But the consequences of tiptoeing around a problem are far greater when the message is blasted out to the masses. On a large scale, a little politeness does a lot of damage.

And to be honest about it, we’re often less concerned about offending others than we are about being seen as offensive. Lawmakers expounding upon the need to avoid stigmatizing certain people are just trying to avoid bad press and please their base. In an ideal world, things wouldn’t be so, but such are politicians’ incentives.

None of the behaviors observed among public health authorities are surprising, but they are counterproductive and downright harmful: People who need to make behavioral changes to reduce risk of exposure are left unaware of their own risk, while those at low risk suffer the consequences of mass measures such as lockdowns, economic fallout and anxiety. Policymakers need to be encouraged in their truth-telling endeavors and publicly supported when met with criticism. So long as it is compassion and not fear that drives them, they will have nothing for which to apologize.

Compassion isn’t defined by standing by and cheering when someone is actively hurting themselves. Compassion should compel action for the good of others. A compassionate approach to tackling monkeypox involves three steps:

1. Sharing information on how monkeypox spreads and what behaviors put people most at risk of catching it;

2. Giving straightforward recommendations for how to protect oneself against the illness; and

3. Making reasonable accommodations for access to preventative and curative treatments.

Then, public health authorities need to promptly and honestly update their advice as behaviors change, viruses mutate and knowledge grows—and let people heed it as they will.

This is America. People are allowed to live on their own terms and enjoy (or endure) the consequences of their decisions. Undoubtedly, many people catching the same disease represent a risk to society by hurting families and communities on a large scale, overwhelming hospitals, draining public funds, and threatening economic prosperity. But the objective of public health emphatically isn’t to get people to take better care of themselves. It is to protect people from negative effects on their health stemming from factors outside their control.

Public leaders do the best job when they look out for their constituents, share truthful advice, and trust people to act like responsible adults. May this post count as a humble permission slip to say what needs saying.