We are neither doctors nor public health experts here at Pebble but it doesn't require a PhD in either to see that The US response is not doing well when it comes to the spread of the monkeypox virus. The disease is reaching endemic levels and causing and local health emergencies to be declared around the country.

Finally, on Thursday, the US Federal government and the Biden administration declared a public health emergency. After months of assuring the public that vaccines were on the way and controlling the outbreak was well in hand, it now seems we need a formal and national health emergency declaration. It is about time: the US is leading the way with the most cases worldwide - over 25% of the global total.

This is pretty dispiriting. It is also wearily familiar.

Even worse, is the fact that we seem to be making very similar errors to the ones we made with Covid-19. Once again, we are struggling with the basics of a public health response: testing, tracing, data retrieval and analysis and swift vaccination of vulnerable populations.

We know what to do but we just don't seem remotely capable of doing it, let alone doing it quickly and efficiently.

If we aren't learning and we aren't improving then it is a pretty damning verdict of the last 2+ years of hyper-focus on public health. The response to the monkeypox outbreak provides greater evidence for something very problematic that many of us implicitly feel: our system of government struggles to adapt even to well-understood threats and provide a competent response level to predictable problems.

Keep in mind that monkeypox isn't an out-of-the-blue coronavirus like Covid-19; the relative of smallpox is a rare but well known (and studied) disease from West and Central Africa. It is far less transmissible and less virulent than something like Covid and yet.....

As we have stated before, if their expensive and overly complex regulatory state hurts more than it helps then can it really be a surprise when many citizens neither trust nor support their government.

You might be at low risk for the disease but make no mistake, this is a real problem for the country and all who inhabit it. And it clearly isn't Russian malefactors or Fox News that are responsible for our dysfunction here.The Democrats cannot blame budget cuts or Republican intransigence or Russian interference in this case either. We need to take a long look at our collective performance and ask what the heck is going on.

Here are some of the US lowlights at the time of writing:

• Our national "strategic" vaccine stockpile held almost zero vaccine despite the disease being a clear and growing threat this spring. We had 2400 doses, good enough for around 1200 people. That is pretty pitiful stuff when you are facing a serious and contagious disease.

• We also let 20 million doses of the same vaccine expire. And did almost nothing to replace them. It should be mentioned that this vaccine is also good against smallpox as well so it isn't some obscure product with little value.

• We had/have large amounts of the vaccine in bulk but, inexplicably, the FDA waited three weeks after the disease had arrived on our shores to ask for it to be bottled for distribution meaning that we had to wait for other orders to be shipped first. Those doses have still not arrived.​

• As a direct result of this comedy of errors, the disease is now both widespread and spreading incredibly quickly and we are still struggling to get large amounts of vaccine and adopt sensible measures. Apparently our best estimates are that we are distributing around 1.1 million doses whereas doctors estimate we need around 3.5 million.

• The bulk of the 5.5 million doses we have on the way will not arrive until....2023

• And, of course, testing has been scarce from the outset and continues to be insufficient. Properly gathering, centralizing and studying data is also going poorly.

In fact, this isn't just dispiriting, it is borderline depressing.

And we haven't even mentioned the fact that part of the reason for the delay is the fact that the FDA stopped conducting factory inspections during the pandemic and also delayed inspecting the critical vaccine storage facility in Denmark.​

This directly resulted in unnecessary delays in available vaccines arriving on our shores.

The decision to halt inspections hasn't been costly in the effort against Monkeypox alone either. It has impacted other medicines and treatments as well. That costs lives...and for what?

Any of this sound familiar?! It is enough to cause you to scream in frustration.

The end result, net-net, is that this virus is on the cusp becoming an endemic disease in the country at tremendous cost, health-wise as well as economic. It is also another big hit on the US' competence and overall reputation.

We have mentioned some of the failings with the FDA, the CDC and the overall approach to public health in this country before but we would like to remind you that:

This is not political - as the last few years have unfortunately demonstrated, our response to fast moving viral diseases is poor under either party. The rot is far more serious and far deeper than the failings of a particular political figure or philosophy. We can't get away with simply blaming a single Presidential administration anymore.

This is really bad!

Responding to dangerous public health emergencies is a large and critical part of our administrative and regulatory state that is simply underperforming massively and seems to feel zero accountability or sense of responsibility for their poor performance.

This should anger you and disappoint you. There should be no reason that the FDA stopped pharmaceutical factory inspections during a pandemic.

It goes without saying that if our garbageman can keep working then so can FDA employees. They are both intimately involved in public health. They are the very definition of critical employees.

We simply must, must do better than this. We cannot afford to constantly and continually have our government appear not only incompetent but willfully negligent of even the most basic common sense measures and .

If an airline or a restaurant chain or car company casually made errors (or simply dithered over decision making) that then cost human lives, there would be an immediate response with fines, court orders and serious litigation but when it comes to our inaction and incompetence of those responsible for public health, there isn't even a press conference.

Yes, the first rule should be "do no farm" but you can achieve plenty of harm via inaction. Or sludge like speed.

ox yet but thanks to our public health failings, the US now has the world's largest outbreak and you very likely will come to know someone afflicted.

So, what should you think about monkeypox? Even if you don't know anyone suffering from the disease you should be extremely concerned. The fact that it is now an endemic disease and the US has the largest outbreak is an utter disgrace. That it is severely and particularly affecting some communities in our country is a sign of a far greater issue and more worrying and enduring problem - one that affects us all.

Just like it is everyone's disease, it is also everyone's government.

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