John Oliver discusses the recent monkeypox outbreak in the U.S., how we’ve fumbled our response to it, and some aspirations for this coming autumn.

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Our main story tonight concerns something that's been getting more and more urgent over the past 2 months.

It's an unpleasant surprise, and the longer we let it continue, the harder it'll be to stop.

Monkey pox has come as an unpleasant surprise and is becoming increasingly hard to stop.

For the past several months, you may have noticed monkey pox being discussed with an increasing sense of alarm.

now dozens of confirmed cases of monkeypox in the United States.

Cases skyrocketed from 1, 400 less than 2 weeks ago to nearly 3, 000 today.

The CDC now reporting more than 4, 600 cases.

More than 5, 200 cases reported more than 6, 300 cases now reported

currently the US leads the world in case count over

7, 000 It's true monkey box cases are rising sharply and that is the absolute worst collection of words that you're gonna hear this summer, aside from maybe, 50-year-old Dane Cook engaged a long-time 23-year-old girlfriend.

They're just an entire Timothee Chalamet apart.

But the spread of monkeypox is genuinely alarming.

Its most obvious symptom is skin lesions, which can, in severe cases, be extremely painful.

And while the pain is not remotely funny, people have been getting very creative in how they describe it.

It was like someone taking, like, a hole puncher all over my body, right under my skin.

It's like somebody takes a dull knife that is searingly hot and is cutting inside of you and then uses a toothbrush afterwards and brushes it.

Anytime it grazes something or touches something, it literally feels like someone's taking a potato peeler to your skin.

And this is not remotely the point, but sitting on shards of glass, while not entirely graphic, isn't exactly PG either.

If you took your kids to see Minions Rise of Gru, and the first 10 minutes was the yellow thumbs plopping their asses on shards of glass, You'd race your kids out of the theater immediately.

Sadly, as with COVID, there is a lot of misinformation flying around right now.

Online, there are theories like monkeypox can be caused by the COVID vaccine, which it can't, and that it escaped from a lab, which it didn't.

It seems a spreading virus, yet again, is bringing out the worst in people, including targeting those suspected of carrying it.

Take this TikTok video of a woman on the subway with an image of a monkey and a question mark, clearly implying she had monkey pox.

And when the woman in question found out, this is how she responded.

Hi, I am the girl from the video, and what you are watching is me sitting on the train, talking on the phone.

The skin condition that I have is called NF1, and the bumps that you see are tumors.

The tumors are benign, but they are still all over my skin and give me a lot of health complications, both physical and mental.

You know, I've come a long way, and I like me.

You know, I'm not that field, and I'm not about being vengeful.

5000 middle fingers to the dumb fuck that thought taking an unsolicited video of a complete stranger and stigmatizing them for a medical condition was a good idea.

TikTok is for discovering you've been opening freezer pops wrong your entire life.

-♪ ♪ -♪ Frustratingly, despite the fact we're still in the middle of the COVID pandemic, we seem to be replicating some of its key mistakes, from persecuting strangers to spreading misinformation, to badly mismanaging the public health response.

So tonight, we thought it'd be worth talking about monkeypox.

What it is, how we fumbled our response to it, and what we should do going forward.

It's part of the same family that causes smallpox, though thankfully, it's not nearly as transmissible or as fatal.

It usually presents in humans with fever, swollen lymph nodes, exhaustion, headache, and a rash, though it can also cause complications like blindness if the lesions reach your eyes, and in rare cases, can result in death.

Now, quick note on the name, despite being called Monkeypox, it didn't actually originate in monkeys.

It was first discovered in 1958 in monkeys in Denmark, but they likely got it from rodents, who are thought to be the main carriers.

In fact, it's endemic in rodents in Central and West Africa, where there have been sporadic outbreaks for decades now, and it's actually been transmitting between people continuously in Nigeria for at least 5 years.

Even had its own monkeypox outbreak nearly 20 years ago, which came about thanks to an unexpected culprit.

Health officials are investigating what appears to be another case of an animal virus that has jumped to human beings.

It's called monkeypox, and it may be linked to pet prairie dogs in the Midwest.

The Midwestern prairie dog is not a common pet.

But some pet stores have been selling them, along with other exotic animals from around the world.

And that, say investigators, is why 30 people today are suspected of having a disease that has never been seen before in this country.

Okay, I have 1 main question, and it's this.

Why the fuck would anyone want to own a prairie dog?

And you know me, I have an abounding love for the rodent community.

But, it's gonna be a hard pass for me on this little plague-ridden Freddy Krueger.

Also, quick shout-out to the absolute dipshit that came up with that name.

Pull 1 out for the stupidest friend of Laura Ingalls Wilder, who saw an animal that is generously a big hamster that fucked a meerkat with garden rakes for hands, and went, dog, and it somehow stuck.

Now, thankfully, we managed to contain that particular outbreak and put a stop to the sale of prairie dogs before person-to-person contact could begin.

And look, there is still a lot we don't know.

And information that we do have is still very much subject to change.

But as it stands, as of this taping, The vast majority of cases have been among gay and bisexual men and their sexual networks.

The virus spreads through sustained skin-to-skin contact, and it's currently believed to be spreading most commonly during sex.

Though, in rarer cases, it can spread through respiratory droplets, during prolonged face-to-face contact, or through bedding or towels used by someone with monkeypox.

And the thing is, not long ago, there was an expectation that this outbreak might be containable.

At the end of May, when there were roughly 130 confirmed cases outside of Africa, 1 WHO official said this.

This outbreak can still be contained, and it is the objective of the World Health Organization and member states to contain this outbreak and to stop it.

Yeah, that sounded pretty reassuring, didn't it?

And I, for 1, want to believe the words of the head of the Smallpox Secretariat, which is a very impressive-sounding job, while also sounding like the most depressing movie sequel of all time.

And to be fair, that optimism wasn't unwarranted.

There were many reasons to think that we could, and indeed should, quickly get this under control.

First, because monkeypox has been around for a while, we are at least somewhat familiar with it.

Also, because it's similar to smallpox, there is good reason to believe that the tools we already have to fight that work on monkeypox too.

So this was not like the early days of COVID, when we didn't know anything about anything.

We were lice-alling our groceries like they came out of the sewer.

Geraldo was on TV, claiming you could test for COVID by holding your breath.

And we did a show on the coronavirus on March 1st, 2020, in which the main advice that we gave our full, unmasked studio audience was to wash their hands.

I even did a little dance about it, and while I was clearly wrong about COVID, I was right about those moves.

I look like Julia Stiles in Save the Last Dance.

Very white and unnecessarily hyped up by the crowd.

But with monkeypox, we were in the fortunate position of having pre-existing tests, vaccines, and treatments.

Unfortunately, the rollout of each of them has been painfully flawed.

Testing for monkeypox was initially siloed within the CDC and its network of public health labs, of which there are around 70.

People also had to meet certain eligibility criteria to qualify for testing, making the whole process slow and cumbersome.

And slow and cumbersome are the last words you want to hear in the early days of a disease outbreak, apart from, of course, the opening lines of Imagine sung a cappella.

As of early June, we were only conducting 10 tests per day in total across the country, increasing to just 60 by the end of the month.

Now, thankfully, testing has ramped up since then, with the Biden administration finally allowing commercial labs to test as well, but barriers still very much remain.

For 1 thing, there is only 1 FDA-authorized test, which requires you to swab lesions.

And aside from being painful, that means you have to wait until they appear to even run a test, and they may not be the first symptom.

So until we develop and vet new forms of tests, like ones that can be used on saliva or with throat swabs, our results are going to lag.

But what's more, we ridiculously don't have a good system for gathering and sharing data.

Monkeypox was spreading for more than 2 months before states were even required to share data with the CDC, making tracking cases across the country incredibly difficult.

And the truth is, even communication within states can be absurdly antiquated.

You know, I talked to officials in Missouri and Florida who are counting monkeypox cases via fax.

I think we all in the United states kind of expect public health to work like Amazon Prime.

You know, we're gonna get our packages in 2 days and everything will be fixed.

But unfortunately, you know, public health in this country has been underfunded for decades.

Okay, first, the only way we think public health is like Amazon Prime is that they both force people to pee in plastic containers.

The only thing fax machines should be used for nowadays is for ending the sentence, -"Hey, remember fax machines?" And that is it.

So, we didn't know where the cases were, or how many there were, and whatever numbers that we did have were likely drastic undercounts because we weren't testing enough, which is already very bad.

Then, there's the vaccines, where again, we should have been in pretty good shape.

Government's actually been developing and stockpiling new smallpox vaccines since 9-11, when there were fears that it would be used as a bioweapon.

Just watch this segment from 2002, which features a familiar face.

Government began stockpiling smallpox vaccine last year, and has placed orders for tens of millions more doses.

We have enough material that if we needed to, God forbid a catastrophe of a massive attack, we would be able to have a vaccine for everyone in the country.

Yeah, there he is, Anthony Fauci, the Forrest Gump of catastrophic contagion.

But the point is, the government very smartly built up massive reserves of smallpox vaccine.

It is just 1 of the 1 ways that the war on terror made us safer.

But unfortunately, those huge stockpiles weren't available at the start of this monkeypox outbreak thanks to a number of key strategic errors.

For a start, incredibly, we let 20 million doses expire.

Which seems especially unconscionable given, as I mentioned earlier, multiple African countries have had outbreaks of monkeypox for decades now and might have appreciated a shot or 2.

Sharing vaccines would have served 2 purposes, basic human decency, but also abject selfishness, in that stopping outbreaks over there might well have prevented the current outbreak over here.

And yet, for some reason, we let the vaccine sit unused on a shelf in our reserves, like an expired Chobani, or a 90 million dollar movie on HBO Max.

And by the way, hi there, new business daddy.

Seems like you're doing a really great job.

I do get the vague sense that you're burning down my network for the insurance money, but I'm sure that that'll all pass.

-♪ We had more than 20 million vaccines available, but when this outbreak began, we were down to just 2, 400 usable doses, which is enough to fully vaccinate just 1, 200 people.

Now, we did have 300, 000 doses sitting in a warehouse in Denmark, but for some reason, officials waited weeks as the virus spread before finally deciding to ship them to the U.S.

And that sequence of bad decisions is why we've been seeing scenes like these.

Hundreds lined up for the monkeypox vaccine last week at this clinic in Manhattan.

I came here for like 3 days already because I don't have appointment.

I went to the website and the website crashed.

Been trying to get a vaccine for the last...

Tried at multiple vaccine centers and everyone's out of vaccines.

Vaccines are apparently the Beyonce concert tickets of healthcare.

Announced with little warning, gone in 30 minutes, and will likely have you screaming, you won't break my soul at the top of your fucking lungs.

Remember, monkeypox can be incredibly painful.

And there is a drug that shows promise in reducing those symptoms.

But it, too, is way harder to get than it should be.

An experimental drug that could help some people who have monkeypox is available, but the question is, can they get it?

The medication is called tecovirumat, brand name, T-pox.

There's no shortage of T-pox, but it's only FDA approved for smallpox.

For monkeypox, it's still considered an investigational drug.

The CDC has lifted some requirements so doctors can prescribe it under something called expanded access, but that involves hours of forms and extra appointments.

Yeah, and even if you found a doctor willing to do all of that, some patients are then finding themselves waiting days for the shipments of the drug to arrive from the strategic national stockpile, which just isn't great, considering, remember, that this can feel like sitting on shards of glass.

It is not a condition that you can just put off dealing with for a few days, like a cold or a UTI, if you're super tired.

-♪ ♪ -♪ ♪ Basically, every part of our early response to this made things harder than they needed to be.

And I will say, there have been some improvements recently.

We've seen some progress on testing, more vaccines are finally coming, with large numbers set to start arriving in October, and the paperwork for T-PoX has been streamlined somewhat.

So, if you think you need any of those, you should still absolutely be seeking them out.

But the delays we've seen in fixing these problems have been absolutely maddening, and it has been hard not to wonder whether the lack of urgency has had anything to do with who's been getting hit the hardest.

What I don't want to see for our community is the 1980s HIV all over again.

Where it wasn't talked about, It was known that it was out there, but there was no pressure to do anything about it, because, oh, it's just the gays.

You have to believe that if monkeypox were spreading largely through heterosexual sex, things would be drastically different.

By now, you'd probably be able to get a free vax with purchase at every J.Crew in the country.

Because listen, it is not homophobic to acknowledge who is currently most affected, which is gay and bisexual men, sex workers, and people who participate in sex with multiple partners.

What is homophobic is when you blame or shame the people who are suffering, or when you decide you don't need to care about this because you don't see their lives as valuable or their suffering as consequential.

And that is where there are strong echoes of the AIDS crisis in some of the discussion around monkeypox.

Just listen to Marjorie Taylor Greene, elected official and one-star Uber passenger, who dismissed it like this.

Of course, monkeypox is a threat to some people in our population, but we know what causes it, and that's pretty much, It's basically a sexually transmitted disease.

So it's not a threat to most of the population.

And people just have to laugh at it, mock it, and reject it.

If the way to get rid of something awful was for people to laugh at it and mock it, that woman clearly wouldn't be in Congress, and yet, here we all are.

Green also tweeted, if monkeypox is a sexually transmitted disease, why are kids getting it?

In an act of obvious dog-whistle bigotry, suggesting gay people are a danger to children, when what's clearly an actual danger to children is the QAnon Congresswoman who once tweeted, the kids at Uvalde needed JR-15s.

And I know there is a temptation, when you see homophobia like that, to push back and say, hey, hey, it's not just gay people, anyone can get monkeypox.

But it is also true that while anyone can get it, right now, certain people are getting it more.

And crucially, They are the ones who should be receiving the lion's share of the resources right now and specific, targeted public health guidance.

And the messaging here can admittedly be a bit of a minefield.

The queer community may be understandably reluctant to hear some straight person lecturing them about their sex lives, especially when that advice, historically, has so often come with an air of disapproval about it.

And some in this current crisis have been tone deaf.

1 public health official here in New York pushed for a more abstinence-based approach, posting on his website, if we had an outbreak associated with bowling, would we not warn people to stop bowling?

In fact, an openly gay health official responded by tweeting, a white straight cis man comparing sex to bowling tells me so much about straight sex, which honestly, that's a fair hit.

The official who wrote that tweet is actually now the deputy coordinator of the federal Monkeypox response, and he's been talking about this with a refreshing frankness.

Like in this official video, where he walks through practical steps to avoid exposure, and then offers this advice to people who think that they or their partner may have been exposed.

Consider the following ways to reduce the chance of spreading the virus.

Have virtual sex with no in-person contact.

Masturbate together at a distance without touching each other and without touching any rash or sores.

Remember to wash your hands with soap and water and disinfect fetish gear, sex toys, and any fabrics such as bedding, towels, clothing after having sex.

That is honestly some of the best communication of public health guidance I have ever seen.

It's helpful, it's specific, and it's non-judgmental.

And honestly, it's pretty good advice for everyone.

Far more people should be exploring virtual sex with no in-person contact.

Just make sure that you're not doing it in the middle of a work meeting, Jeffrey, although that really should not be that hard.

Community groups have been trying to frame health advice in a way that's much more sex positive, making it more likely to be well-received.

LGBT center with the very practical tip, Forget slutty summer, hold off for anal autumn, do it in cider donut season, which again, is excellent.

It's good advice for now, it's good advice for the fall, and it's also a pretty good slogan for Duncan.

And while good messaging is certainly welcome here, It is depressing that we have to rely so heavily on it in the first place, given the many systemic failures that have brought us to this point.

Well, in the short term, the next 6 to 8 weeks are going to be crucial.

So we need to be ramping up testing and data collection and getting vaccines and antivirals to those who need them the most.

We also need to make quarantining more logistically possible for people, because monkeypox can require as long as 4 weeks of isolation.

And for many, that is going to be difficult to manage without extra support.

But in the longer term, as if COVID had not already made this abundantly clear, we badly need to restructure our public health system so it is better able to respond to a viral outbreak.

Just listen to New York City's health commissioner.

We had a vaccine, we have a treatment, we had a test, and all of it was kind of rolled out more slowly than we would've liked because of the fact that our permanent public health infrastructure has not been invested in for decades.

Again and again, when we talk to public health professionals this week, there has been a sense that this was a gigantic fuck-up.

Jay Varma, an epidemiologist who previously worked at the CDC, told us...

You already have a test for, already have vaccine for, already have a drug your government paid for and developed and discovered and stockpiled.

Let's see how you respond to that." And we screwed it up.

Basically, On a scale from 1 to a hundred, we scored a no.

But the thing is, even if we do contain this outbreak, and even if we build up our public health infrastructure, there is a bigger conversation worth having here, because for far too long, We've indulged in the magical thinking that viruses that exist somewhere else, A, don't matter, and B, will stay there.

And monkeypox is such a clear example of how flawed and racist that thinking is.

We had 20 million doses of a vaccine that could have helped countries in Africa that were known to be high-risk for outbreaks, and we didn't help them.

The sudden global demand for vaccines means that currently, 0 doses are going to Nigeria and other countries in Africa, which I know sounds awful, but to be fair, indifference to those suffering from pox viruses has been the story of America from day 1.

And I know fixing all of this may feel daunting, but we are living through the alternative right now, and it's not great.

And think of it this way, if we can actually get our act together, maybe finally, this country, and indeed, the whole world, can have the anal autumn that we've all been promised.

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Monkeypox: Last Week Tonight with John Oliver (HBO)