100 Days of Monkeypox: Evaluating the U.S. Response to the Emerging Global Outbreak

The document analyzes the U.S. response to the 2022 monkeypox outbreak, noting that while biodefense preparations for smallpox provided essential vaccines and therapeutics, the actual rollout was hampered by insufficient testing, vaccine supply shortages, and regulatory hurdles. It highlights the risk of the virus becoming endemic in the U.S. and recommends increased funding for biodefense and health security.

• The United States possessed existing tests, vaccines, and therapeutics for monkeypox due to a biodefense strategy focused on weaponized smallpox, yet the virus's spread initially outpaced public health messaging and the activation of these countermeasures.
• Testing rates were insufficient during the early outbreak; for example, on June 23, the CDC had run only 1,058 tests despite 237 confirmed cases. Testing was further limited by a protocol requiring lesion swabs, which caused delays and missed patients without lesions.
• Vaccine supply was inadequate for the eligible population; as of July 31, the eligible U.S. population was estimated at 1.5 million, while the Strategic National Stockpile (SNS) had only 2,400 doses of the preferred JYNNEOS vaccine in May. To stretch supply, the FDA authorized an intradermal injection method on August 9 using only 20% of a standard dose.
• The antiviral TPOXX saw low utilization despite 1.7 million courses being available in the SNS; by July 22, only 223 people were prescribed the drug due to intensive CDC paperwork and internal healthcare system reviews required for its experimental use against monkeypox.
• There is a significant risk that monkeypox could become endemic in the United States by establishing itself in an animal vector, such as a rodent, particularly given the decline in smallpox vaccination.
• The Council on Strategic Risks recommends a funding model of "10 + 10 over 10," which entails investing $10 billion annually for biodefense and $10 billion annually for health security over the next decade.

APA

Regan, D. (2022). 100 Days of Monkeypox: Evaluating the U.S. Response to the Emerging Global Outbreak. The Council on Strategic Risks. https://councilonstrategicrisks.org/wp-content/uploads/2022/09/100-Days-of-Monkeypox_BRIEFER-34-2022_09_13.pdf

Chicago

Regan, Dan. 100 Days of Monkeypox: Evaluating the U.S. Response to the Emerging Global Outbreak. The Council on Strategic Risks, 2022. https://councilonstrategicrisks.org/wp-content/uploads/2022/09/100-Days-of-Monkeypox_BRIEFER-34-2022_09_13.pdf.

Wikipedia

{{cite report |last1=Regan |first1=Dan |title=100 Days of Monkeypox: Evaluating the U.S. Response to the Emerging Global Outbreak |publisher=The Council on Strategic Risks |date=12 September 2022 |url=https://councilonstrategicrisks.org/wp-content/uploads/2022/09/100-Days-of-Monkeypox_BRIEFER-34-2022_09_13.pdf |access-date=23 October 2026 |via=Climate Insights Directory}}

BibTeX

@techreport{regan2022100, author = {Regan, Dan}, title = {{100 Days of Monkeypox: Evaluating the U.S. Response to the Emerging Global Outbreak}}, institution = {The Council on Strategic Risks}, year = {2022}, month = sep, url = {https://councilonstrategicrisks.org/wp-content/uploads/2022/09/100-Days-of-Monkeypox_BRIEFER-34-2022_09_13.pdf}, urldate = {2026-10-23}, note = {Indexed by Climate Insights Directory} }