As Covid-19 cases surge across the United States dominated by a highly transmissible subvariant and worry about Covid persists, some in the public have begun to voice concern about the new health threat of monkeypox, according to a new Annenberg Public Policy Center national survey.

While 1 in 3 Americans worry about getting Covid-19 in the next three months, according to the July survey, nearly 1 in 5 are concerned about contracting monkeypox, a disease endemic in parts of Africa whose spread to 75 countries across the globe led the World Health Organization (WHO) to declare a global health emergency on July 23, days after the survey was completed.

The nationally representative panel of 1,580 U.S. adults surveyed by SSRS for the Annenberg Public Policy Center (APPC) of the University of Pennsylvania from July 12-18, 2022, was the seventh wave of an Annenberg Science Knowledge (ASK) survey whose respondents were first empaneled in April 2021. The margin of sampling error (MOE) is ± 3.3 percentage points at the 95% confidence level. See the appendix and methodology for additional information.

The survey answers such questions as: How worried is the public about becoming infected with Covid-19 or monkeypox? Does the public possess basic knowledge about monkeypox? How widespread is misinformation about monkeypox?

Highlights

Conducted amid escalating cases of the coronavirus BA.5 omicron subvariant and the spread of monkeypox cases, the survey found that many people (80%) had seen, read, or heard something about monkeypox in the past month, but many lacked knowledge about the disease:

• 19% of Americans are worried about getting monkeypox in the next three months.
• 30% of those surveyed are worried about getting Covid-19 over the next three months.
• Nearly half (48%) are unsure whether monkeypox is less contagious than Covid.
• Two-thirds (66%) either are not sure or do not believe there is a vaccine for monkeypox.

It's important that the public calibrate its concerns to the reality of the risk of Covid-19 and monkeypox and act appropriately."

Kathleen Hall Jamieson, Director, Annenberg Public Policy Center

Monkeypox concerns

Monkeypox, a rare disease caused by an orthopoxvirus, is a less deadly member of the same family of viruses as smallpox, according to the Centers for Disease Control and Prevention (CDC). The disease, discovered in 1958, is typically characterized by rashes, according to the CDC, and is transmitted person-to-person by direct contact with the infectious rash, scabs, or body fluids, respiratory secretions, touching items that touched the infectious body fluid, by a pregnant person to a fetus through the placenta, or to and from infected animals. (For more information see this Q&A on monkeypox by APPC's FactCheck.org.)

In the current monkeypox outbreak about 2,900 cases were reported in the United States as of June 22, and more than 16,000 cases have been reported in 75 countries, according to the WHO.

Among the survey findings:

• Worry about contracting monkeypox: About 1 in 5 of those surveyed (19%) are somewhat (14%) or very worried (5%) about getting monkeypox in the next three months, while 81% are not too (41%) or not at all worried (40%).
  • Women are more worried about contracting monkeypox than men: Though the vast majority of cases to date in the United States are among men who have sex with men, 23% of women worry about contracting monkeypox vs. 15% of men.
• Covid-19: More Americans (30%) worry about getting Covid in the next three months, with 24% somewhat worried and 6% very worried.
  • Women are also more worried about Covid-19 than men: 33% of women are worried about contracting Covid vs. 27% of men.

Monkeypox knowledge

While many Americans are generally familiar with monkeypox, significant parts of the public lack important information about the disease – and how to protect themselves:

• Knowing how monkeypox spreads: A large majority (69%) knows that monkeypox usually spreads by close contact with an infected person, though a quarter of those surveyed (26%) are not sure whether that is true or false.
• Most do not know a monkeypox vaccine exists: In all, 2 in 3 Americans (66%) either are not sure (51%) whether a vaccine for monkeypox exists or do not think it exists at all (15%). One in 3 people (34%) correctly know that a vaccine for monkeypox exists. The Food and Drug Administration (FDA) has licensed a vaccine for preventing monkeypox infection and a vaccine licensed for smallpox is also available to prevent monkeypox infection, according to the CDC.
• Which is more contagious: Monkeypox or Covid? More than a third of those surveyed (36%) know that monkeypox is less contagious than Covid-19. But 14% incorrectly say monkeypox is just about as contagious as Covid-19 and nearly half (48%) are unsure. The CDC says monkeypox "is not known to linger in the air and is not transmitted during short periods of shared airspace" but through direct contact with an infected individual or materials that have touched body fluids or sores or through respiratory secretions during "close, face-to-face contact." An infectious disease expert, Anne Rimoin, told Vox monkeypox is "not as highly transmissible as something like smallpox, or measles, or certainly not Covid."
• Monkeypox and the Covid-19 vaccine: Most people (67%) say they think that getting a Covid-19 vaccine does not increase the likelihood of getting monkeypox, though over a quarter of respondents (28%) are not sure. There is no evidence to suggest this is true.
• Are people who have had Covid-19 at higher risk? A third of people (33%) report that having had Covid-19 does not of itself put one at a higher risk of infection with monkeypox, though nearly two-thirds (63%) are not sure if this is true. There is no evidence to suggest that having had Covid increases the risk of contracting monkeypox.
• Higher risk for people working with animals? Asked if the CDC advises that people who work with animals are at a higher risk of monkeypox, less than 1 in 10 respondents (9%) say yes. A third (34%) say no, while over half (57%) are not sure. Although the current outbreak involves human-to-human transmission, a 2003 outbreak in domesticated prairie dogs led to 47 U.S. human cases. Monkeypox can infect a range of mammals, including monkeys, anteaters, hedgehogs, prairie dogs, squirrels and shrews. Infected animals can spread the virus to people and it is possible that people who are infected can spread the virus to animals, says the CDC, which lists among higher-risk people who might consider vaccination "laboratory workers who handle culture or animals with orthopoxviruses."
• Higher risk for men who have sex with men? When asked whether the CDC advises that men who have sex with men are at a higher risk of infection with monkeypox, a third of those surveyed (33%) said yes. Two-thirds (66%) either said this is false or they did not know. The WHO says cases outside Africa in this outbreak have been mainly among men having sex with men, while cautioning that there is no evidence to suggest it will remain confined within those groups. In a Washington Post interview, CDC Director Rochelle Walensky said men who have sex with men are "the community most at risk."

"The time to reduce susceptibility to misinformation about monkeypox is now," Jamieson said. "It is critically important that public health professionals offer anxious individuals accurate information about the ways in which this virus is transmitted and infection prevented. Vaccinating those who are at highest risk should be a national priority."

Monkeypox misinformation and conspiracy theories

"As one would expect, conspiracy theorists have incorporated monkeypox into their pre-existing beliefs that, instead of emerging through natural processes, a spreading virus must have been bioengineered, intentionally released to accomplish a political objective, or is the byproduct of exposure to a pervasive new technology such as 5G," said Jamieson.

Most Americans reject conspiracy theories alleging that monkeypox was bioengineered in a lab or was intentionally released. However, here, too, the Annenberg ASK survey found that worrisome numbers have either accepted one of four conspiracy theories or are unsure whether they are true or false.

• Bioengineered in a lab: Over half of those surveyed (54%) reject as false the idea that monkeypox was bioengineered in a lab, though a third (34%) are not sure if that is true or false and 12% say this is probably or definitely true. There is no evidence of this.
  • Of the small minority who believe that monkeypox was bioengineered in a lab, 56% say the lab was in China; 16% say the United States; 15% Russia; 12% some other country.

• Intentional release (asked of a half-sample, MOE = ± 4.7 percentage points): Over half (56%) said that it was definitely or probably false to state that monkeypox was intentionally released, though 30% were not sure and 14% thought that was probably or definitely true. There is no evidence of this.

• Released to help Biden (asked of a half-sample, MOE = ± 4.7 percentage points): 71% reject as false the statement that monkeypox was intentionally released by scientists to deflect attention from the failures of the Biden administration. However, 19% said they were not sure whether this is true or false, and 10% said it was probably or definitely true. There is no evidence of this.
• Caused by exposure to 5G: A large majority (78%) correctly said it is false to assert that monkeypox is caused by exposure to a 5G signal, though 21% were not sure.