Monkeypox Public Health Emergency in US

  • On Thursday, HHS Secretary Xavier Becerra declared monkeypox a national public health emergency.
  • The announcement comes 12 days after the WHO declared the monkeypox outbreak a global emergency.
  • Vaccine supply is limited, and more than 6,600 cases have been confirmed.

On Thursday, the federal government declared the national outbreak of monkeypox — which has been spreading almost entirely among men who have sex with men — a public health emergency.

“We’re prepared to take our response to the next level in addressing this virus. We urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus,” Health and Human Services (HHS) Secretary Xavier Becerra said on a call to reporters.

News of the expected declaration was first reported Thursday by The Washington Post and subsequently The New York Times.

By designating monkeypox a public health emergency, the White House will be able to utilize emergency funds to fast-track testing, treatments, and vaccine shipments.

“I have no doubt that this is going to improve the federal government’s response,” David Harvey, executive director of the National Coalition of STD Directors, told Insider. “However, I did not hear an explicit mention of STI clinics who are on the front line of the response right now. We need emergency resources allocated yesterday.”

Since the first monkeypox case was diagnosed this year in mid-May, more than 6,610 cases have been confirmed. Many public health professionals believe that number is likely much higher.

The Biden administration’s declaration comes 12 days after the World Health Organization (WHO) deemed monkeypox a global emergency. Despite some disagreement among panelists, WHO director general Dr. Tedros Adhanom Ghebreyesus acted as the “tie breaker,” saying the rapid spread of the virus required urgent action, and for all member states to “act together in solidarity.”

A public health emergency declaration makes more funds available, and lets the CDC access more data

The HHS Secretary has the discretion to declare a public health emergency in the event of a major disaster, infectious disease outbreak, or attack.

Doing so allows the government and health agencies to cut through bureaucratic red tape that can slow down access to treatment and testing. For example, a public health emergency declaration permits measures including:

  • The Food and Drug Administration to authorize tests and treatments at a faster clip than usual, putting them through a fast-tracked review process;
  • Access to “no-year” funds — ie, money that is exclusively reserved for emergencies — to fund research and contact-tracing, and coordination between federal, state, and local health agencies;
  • The Centers for Disease Control and Prevention to request more data from local health networks to get a better sense of the spread of the disease.

Many experts have voiced their concern that this declaration is overdue. The first monkeypox case was detected in Massachusetts in mid-May. Within a month, there were 150 confirmed cases. One month later, the CDC had confirmed around 2,000 cases. Two weeks later, that number exceeded 5,000 cases.

“It’s about time,” Harvey said. “This declaration is late.”

Trying to make vaccine supply go further with ‘dose-sparing’

The US is racing to increase its supply of Jynneos, a smallpox vaccine that works against monkeypox. According to Becerra, 600,000 doses of Jynneos have been administered. While millions more doses have been secured, getting them to local health clinics is taking time, and vaccine appointments are getting booked up within minutes.

One technique the HHS hopes to trial is called “dose-sparing,” administering a fifth of the dose into the skin so five people can be immunized with one dose. This is done by sticking the needle within the skin to create “a pocket where the vaccine goes,” FDA commissioner Dr. Robert Califf explained on the call.

The HHS is working with the FDA on whether to allow this approach, with a decision expected in the next couple of days.

“We’re at a critical inflection point,” Califf said. “The goal has always been to vaccinate as many people as possible,” he said, adding that they are working “as quickly as we possibly can” to “significantly increase the number of doses available.”

Califf said he is confident that administering the shot this way triggers a robust immune response, and that healthcare professionals nationwide are capable of doing so, since the technique is near identical to a PPD skin test, which is routine in US healthcare settings.

dr. Kavita Patel, a primary care physician, said on Twitter that injecting in this way “might trigger a more efficient immune response,” and it is a strategy that is used already for some rabies and tuberculosis vaccines, but it’s also possible it “could result in less efficacy.”

Scientists at the National Institutes of Health are hoping to answer that very question with a new study, but it won’t be finished until November or December, at the earliest, as Stat reported Thursday.

“If there is evidence for the effectiveness of that, then that would be a strategy to stretch available vaccines,” Harvey said, while also emphasizing that men who have sex with men “deserve” to have “the best regimen of vaccine possible.”

“Shortages are just not acceptable,” he added. “Anything less than full effectiveness of vaccine doses treats gay and bi men and MSM [men who have sex with men] as second-class citizens.”

Monkeypox symptoms can vary widely

Doctors at major medical centers in Miami and San Francisco say many monkeypox cases are going unreported because providers don’t always know how to recognize the signs.

The outbreak has taken many experts by surprise, because patients are presenting with a wide array of symptoms which differ from historical literature on monkeypox, and images in medical textbooks. Some clinicians might also be skittish to ask patients about their sexual history.

Some patients have pox in their genital area that are so painful it makes it difficult to go to the bathroom, or lymph node swelling that makes it difficult to swallow. Others may have barely any signs of infection at all, other than perhaps a single pimple-like pock.

Common early symptoms include fevers, which can create confusion with COVID, and swollen lymph nodes in the groin are also a tell-tale sign.

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