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Monkeypox declared a public health emergency in United States

HHS announcement will allow officials to use more resources to contain quickly spreading virus

The Biden administration declared monkeypox a public health emergency on Thursday following pressure from lawmakers and health experts to open up more resources to contain the growing outbreak. 

Health and Human Services Secretary Xavier Becerra made the announcement in a media briefing alongside other top health and White House officials. 

“I want to make an announcement today that I will be declaring a public health emergency on monkeypox,” Becerra said. “We're prepared to take our response to the next level in addressing this virus and we urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus.” 

After cases were confirmed in over 70 countries, the World Health Organization gave the virus its highest-level warning, a public health emergency of international concern, on July 23. Health officials in several U.S. states — including New York, California, and Illinois — have followed suit, declaring health emergencies in the past few weeks. 

Becerra said he believes the U.S. has the tools to prevent monkeypox from becoming endemic citing the availability of testing, vaccines, and treatments. 

“There should be no reason why we can't stay ahead of this if we all work together and we all take on our respective responsibilities,” Becerra said. 

The first confirmed monkeypox case in the U.S. came on May 18 and since then the Centers for Disease Control and Prevention have reported almost 7,000 cases in the U.S. as of Wednesday. 

HHS announced an enhanced strategy to vaccinate and protect at-risk individuals from the virus in late June. A key part of that strategy was expanding access to the only vaccine approved by the Food and Drug Administration to protect against the virus: Jynneos. In late July, the agency announced it would be additional doses of the vaccine to over 1.1 million doses. 

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However, despite the government’s attempts to increase supply, demand is still outpacing available vaccines. Some major cities have limited second doses of the two-shot Jynneos to try and increase vaccine availability but many vaccine appointments are still booking within hours of going online. 

On Tuesday the White House announced Robert Fenton, a regional administrator for the Federal Emergency Management Agency, would coordinate the nation’s response to the virus as the White House national monkeypox response coordinator. Dr. Demetre Daskalakis was announced as his deputy coordinator. 

First discovered in 1958, monkeypox is part of the same family of viruses as smallpox and has similar symptoms but is rarely fatal. Monkeypox cases typical flu-like symptoms like fever, headache, chills, and muscle aches. It also causes a distinctive and painful rash. The virus can last for two to four weeks. 

Cases have been predominantly concentrated in urban areas and although anyone can become infected with the virus, the majority of cases are being reported by gay and bisexual men. The global health agency urged men who have sex with other men to limit sexual partners to help control the outbreak. 

The high spread among these populations is a result of how the virus spreads. It is transmitted through close skin-to-skin contact or through contaminated items such as towels or bedding. 

Robert Califf, commissioner of the FDA, said the country was at a critical inflection point in the response to the virus. 

“In recent days, it's become clear to all of us that given the continued spread of the virus, we're at a critical inflection point dictating the need for additional solutions to address the rise in infection rates,” Califf said. “The goal has always been to vaccinate as many people as possible, and for our part, HHS has been working closely with the manufacturer to accelerate the availability of additional doses as quickly as we possibly can.” 

Until more doses can be made available, however, the FDA is considering a new approach that would allow existing one-dose vials of the Jynneos vaccine to administer up to five separate doses. Califf said this approach is known as dose sparing and is done routinely with other vaccines. An announcement will be made in the coming days on if this approach will be used, Califf said. 

“This approach — which we're referring to as dose sparing — will change the method of administration of Jynneos which is currently administered subcutaneously. Under the proposed approach, one-fifth of the current vaccine would be administered intradermally.”

Califf said the intradermal approach — which places the vaccine between the layers of the skin instead of beneath — had advantages including an improved immune response. He stipulated that this method does not compromise safety or efficacy and urged anyone who has the opportunity to get vaccinated to do so. 

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“Please know we've been exploring all scientifically feasible options, and we believe this could be a promising approach,” Califf said. “It’s important to note that we will not be sacrificing the high-quality regulatory standards that Americas have come to expect.” 

Using lessons from the country’s Covid-19 response, Fenton said the government will be coordinating actions across agencies and with state and local leaders. Declaring a public health emergency helps the government respond to the virus and allows vaccines and treatments to be more accessible in communities with high infection rates. 

CDC Director Rochelle Walensky said that the most important thing the declaration will do is increase data sharing. 

“Most importantly, this declaration will also help us continue to expand public health ability to expedite data sharing so that we can have comprehensive and timely data available to inform public health decisions,” Walensky said.

Walensky said the public health emergency declaration will also help mobilize additional educational efforts on the ground to help inform the public on how to protect themselves from the virus. 

In order to stop the spread of the virus, the White House is doing outreach to LGBTQI+ communities. 

“In the coming days and weeks, we have plans to provide technical assistance to state and local health departments to develop and ramp up non-stigmatizing messaging as they prepare for any large gatherings in the coming weeks and months,” Daskalakis said. 

The White House said they are being particularly careful to make sure they are not only messaging the effect the virus has on these communities in a way that doesn’t create stigma but also counters stigma. 

“It's an opportunity for us to really be clear and to leverage the emergency to move faster, and also work as we have been, to make sure our messaging is tight and is intentionally designed not only to be stigma-free but to counter stigma,” Daskalakis said. 

The administration said that the U.S. is only using about 10% of its testing capacity at the moment and encouraged anyone suspected of having the virus to get tested. However, officials declined to provide a positivity rate citing how that rate could be interpreted. When testing for monkeypox, providers take multiple samples per patient but there is no standardization on how many samples so positivity rates would not be representative of positivity.

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Colorized transmission electron micrograph of monkeypox virus particles (gold) cultivated and purified from cell culture.