Thailand’s Monkeypox Response Exposes World’s Cycle of Pandemic Neglect
A photograph accompanying a Bangkok Post report shows Thai health officials sanitizing a condo in Phuket, where the country’s first monkeypox case stayed. Hazmat suits, disinfectant, a condo turned clinical stage — the theater of biosecurity we’ve all come to know. But consider what’s not in the frame: a global health system perpetually bracing for the last pandemic, not preempting the next. We are trapped in a cycle of response, leaving us perpetually vulnerable. The question isn’t whether another pandemic will occur, but what it will be and if we’ll react with the same predictable (and inadequate) scramble.
The numbers — forty confirmed monkeypox cases this year, down from 676 in 2023 — offer a veneer of reassurance. The government is “stepping up monitoring,” focusing on international arrivals. “The variant currently circulating in Thailand is not considered severe,” assures Deputy Government Spokesman Anukul Pruksanusak. But these very reassurances are the warning. We shouldn’t find comfort in managing symptoms when the underlying disease festers: the brittle, reactive nature of global health infrastructure. Pandemics are not black swan events; they are inevitable outcomes of our interconnected world.
The government advises using condoms during sexual activity, particularly for those with multiple partners, as it can reduce the risk of monkeypox and other sexually transmitted infections such as HIV and syphilis. The latter has shown signs of increasing spread in recent months, he said.
These are band-aids on a dam about to break. Condom recommendations and increased screening address transmission, but not the conditions that allow transmission to escalate into epidemics. Consider the 2009 H1N1 pandemic. Governments rushed to stockpile Tamiflu, a neuraminidase inhibitor, for treatment. But a 2014 Cochrane review later found evidence that Tamiflu had “no proven ability to interrupt viral spread.' We invested in a solution that, arguably, wasn’t. This highlights a deeper problem: a tendency to reach for readily available tools, even if their efficacy is questionable, rather than investing in fundamental research and preparedness. Public health funding, tellingly, follows the disaster cycle: surging after outbreaks, then receding into pre-crisis levels, leaving countries and the WHO perpetually underprepared.
The inequities are starkest in the Global South. Dr. Ayoade Alakija, co-chair of the Africa Vaccine Delivery Alliance, powerfully argued that the global response to COVID-19 exposed a "moral failure” regarding vaccine access. It’s a pattern. The same dynamics play out in surveillance. The Institute for Health Metrics and Evaluation (IHME) estimates that only a fraction of global health spending is allocated to preventative measures in low-income countries. This creates a dangerous lag: pathogens can circulate, mutate, and spread globally before they are even identified, essentially outsourcing the risk to those least equipped to manage it.
We treat global health as an expense, not a critical infrastructure investment. The focus is on containment and treatment — slapping walls on a burning house — not on building fire-resistant materials: comprehensive surveillance networks, robust research pipelines, and, critically, equitable access to healthcare before an outbreak. Monkeypox in Thailand is a case study, a live test. But the broader lesson is this: the longer we defer investing in prevention, the more assured we can be of an outcome far more deadly, more costly, and more destabilizing than anything we’ve seen yet. Waiting is not a strategy; it’s a guarantee of exponential future suffering.
