Mpox and Bird Flu: Taking the Threat Seriously

The past month has been challenging for public health.

On August 14, the World Health Organization declared mpox a public health emergency of international concern, due to the rapid spread of a more transmissible variant. In the United States, bird flu, officially known as H5N1, has reached in Colorado, a concerning development since only cases have been reported this year.

While mpox and bird flu are distinct infectious diseases, they share a common thread: complacency in public health responses fueled by assumptions that containment is easily achievable. Despite a 2022 outbreak that infected nearly 100,000 people, mpox receded from public attention while continuing to and evolve into deadlier strains. Similarly, the U.S. response to bird flu, which initially jumped into mammals in 2022, was weak, lacking consistent messaging and concrete action.

This inertia surrounding infectious diseases stems from two key factors.

First, public health leaders are hesitant following the COVID-19 pandemic, having witnessed the backlash against proactive efforts to contain the virus. Anti-science aggression, populist outrage, relentless lawsuits, and at least 30 states have fueled this hesitation, further amplified by the upcoming U.S. elections and the polarization and disinformation they bring.

Second, there’s a sense that another pandemic cannot occur so soon after COVID-19—that these infectious diseases will inevitably burn themselves out as they have in the past. This is a “gambler’s fallacy,” and it may be causing the U.S. to underestimate the risks posed by mpox and bird flu, allowing two potential pandemics to simmer on the global stage.

This underestimation and delayed action have manifested in several failures concerning both diseases. For example, the U.S. saw between October 2023 and April 2024, while the more dangerous Clade 1b variant, which combines , started to spread in Africa. However, the U.S. Centers for Disease Control and Prevention (CDC) stopped updating their mpox outbreak case count , downplaying this added threat since case counts were not yet increasing. The CDC restarted public reporting in May, suggesting that the discontinuation might have been overly hasty and optimistic.

Our global health response to mpox mirrors this underestimation and delayed action. On August 7, the U.S. announced that it was donating to the Democratic Republic of the Congo, almost a year after Clade 1b was first reported there. For context, Africa CDC estimates it needs to control the current outbreak on the continent. In 2022, the U.S. failed to address mpox while it was confined to Africa, delaying action until the disease was spreading uncontrollably domestically; we are seeing history repeat itself in 2024.

For bird flu, the mortality rate can be , based on WHO case data. But as the New York Times , “Only recently has the [CDC] begun to mobilize real funding for a testing push, after a period of months in which various federal groups batted around responsibility and ultimate authority like a hot potato.” In the U.S., ignorance is bliss, with our public health leaders rolling the dice that this too shall pass.

So, it is perhaps unsurprising that the U.S. Department of Agriculture (USDA) detected bird flu in cattle after it happened, or that the agency has not (unless they cross state lines) nor . While decisions to keep these programs voluntary are multifactorial, they are likely influenced by political reluctance following COVID-19 and striking down vaccination requirements.

To be clear, the pandemic risk of mpox or bird flu is currently low. The transmission dynamics of mpox, requiring , make it more difficult to spread than SARS-CoV-2. Similarly, cases of bird flu have thus far been mild and limited in number. However, these are not absolute truths, but day-by-day assessments, which require real preparedness—measured in testing, ongoing surveillance, and forward planning.

There are no easy solutions for overcoming public health paralysis. But at a minimum, the U.S. needs better public health communication that not only emphasizes transparency but also holds our leaders accountable. Bringing to mpox and bird flu is one way to give Americans a new, positive memory of public health, fostering early, decisive action and realistic risk assessments.

With two rapidly evolving outbreaks, we cannot afford trepidation and false optimism. And, even as we work to make the U.S. safer, we cannot forget our global obligations to share vaccines, medicines, and resources. Global crises require global solidarity and collective action.