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The Biden administration is weighing whether to declare the nation’s monkeypox outbreak a public health emergency and also plans to appoint a White House coordinator to oversee the response as officials try to prevent the virus from entering the United States.
The White House and health agency leaders discussed over the weekend their next steps to fight the virus after the World Health Organization on Saturday declared monkeypox a public health emergency of international concern, the agency’s highest-level warning. About 17,000 cases have been confirmed outside Africa since May — including nearly 2,900 in the United States — as infections continue go up in countries where the virus does not occur historically.
While the new cases are overwhelmingly among gay and bisexual communities, experts warn that the virus is likely to spread to other groups. The first two cases of monkeypox in children in the US were confirmed on Friday, possibly the result of sharing a household with an infected adult. But federal health officials said there is still no evidence of sustained transmission among broader populations.
While some health officials believe an emergency declaration is needed to give the government powers to cut red tape and collect data on the spread of the virus, others argued the move was mostly symbolic and would not address vaccine shortages, barriers to treatment and other challenges that have hampered the U.S. response, said three people who wished anonymity, because were not authorized to comment.
Officials also raised questions about whether such a declaration was warranted for a virus that has yet to be linked to a single confirmed U.S. death. The strain of monkeypox implicated in this outbreak is associated with fever, lesions and severe pain that can last for weeks, in addition to complications in pregnant women, children and other vulnerable people.
Officials hope to make a decision on whether to declare an emergency later this week related to a planned announcement that about 800,000 additional doses of vaccine will be distributed after the closure under review by the Food and Drug Administration, two of the people said.
The decision is also complicated by domestic politics. Advocacy groups and health associations have called on the Biden administration to declare public health emergencies over abortion and gun violence, and the White House has said it is considering a broader climate change emergency declaration, sparking debate over which issues to be prioritized. The Biden administration also continued to renew public health emergency declarations that expire every 90 days for opioids and the coronavirus.
Officials at the Department of Health and Human Services acknowledged privately that it was unclear whether an emergency declaration was needed.
The declaration is “a tool that can be used both to align with WHO and to raise awareness, as well as to provide a significant rationale for HHS to use (albeit limited) tools that would assist in the response,” according to a memo sent to President Biden on Sunday, a copy of which was obtained by The Washington Post.
White House officials say the decision rests with HHS Secretary Xavier Becerra and that they remain concerned about the slow pace of the response. Patients say they still face days of delays in getting test results, doctors complain of bureaucratic barriers when trying to prescribe treatment, and officials like New York City Mayor Eric Adams (D) have called for more vaccine doses , as their existing supplies are quickly exhausted.
“Our focus is to get HHS moving as quickly as possible … it’s about strengthening and speeding up the response, not just going with a different name,” said an official familiar with the response, saying Biden was “pushing HHS to spread the distribution of the vaccines out the door and push the FDA to get approval for the vaccine in the next few days without a hitch.”
Becerra told CNN on Monday that his department was still reviewing the grounds for the declaration. “We want to get ahead [monkeypox]. You don’t want this to become a part of life. But how many people have died compared to covid?” he said. “Zero… We declare public health emergencies based on data and science, not our concerns.”
Some outside experts argue that a 90-day emergency declaration can be an important tool to focus the response.
“It can allow everyone to mobilize as much effort as possible,” said Jennifer Cates, who directs global health policy for the nonpartisan Kaiser Family Foundation. think tank. “To prevent this from becoming endemic – and hopefully not too late.”
Cates added that emergency declarations should be reserved for “truly unique events”, adding: “In the case of monkeypox, these criteria are met. It’s crossing states, it’s spreading fast, it’s never happened here before, and it has all these risks associated with it.
The White House is also moving closer to a national monkeypox coordinator after concluding the role is needed to manage the increasingly expansive response, which brought in Chief of Staff Ron Klein — who coordinated the U.S. Ebola response during the administration of Obama — as well as White House coronavirus coordinator Ashish Jha, infectious disease expert Anthony S. Fauci and dozens of other national security and health officials. Two people who were not authorized to discuss the plan said the administration was considering people with experience in outbreak response and government operations.
The White House declined to comment of the discussions.
Some worry that it may already be too late to stop the virus from taking a permanent hold in this country, based on the rapid rise in cases and difficulties in accessing tests.
“I think if we allow monkeypox to become endemic in the U.S. — and we may have already crossed that threshold — then it will be seen as one of the biggest public health failures in recent memory,” said Scott Gottlieb, who led the FDA during of the Trump administration and has advised the Biden administration on the coronavirus.
Biden officials have countered that the virus can still be contained, pointing to the United States’ stockpile of treatments and vaccines, as well as the rapidly growing availability of tests.
“There is no other place in the world where they have 300,000 doses of vaccines … distributed across the states like we have here in America,” Becerra said Monday.
Some health officials say declaring a state of emergency would allow the administration to unlock powers to collect data on monkeypox cases and vaccinations that are not currently shared with the federal government.
While the Centers for Disease Control and Prevention estimates that more than 1.5 million men who have sex with men are eligible for the vaccine, “we at CDC do not currently have data on who has been vaccinated,” CDC Director Rochelle said. Walensky at the Washington Post Live virtual event on Friday.
FDA officials also said they were waiting for the emergency decision before proceeding with a separate declaration that would speed up the use of medical countermeasures. A similar move during the coronavirus response allowed pharmacists to vaccinate young children and doctors to vaccinate out-of-state patients.
Meanwhile, those on the front lines say the response continues to be overly bureaucratic, leading to a byzantine maze for patients who test positive and can experience days of often searing pain. One New York man told The Post about an eight-day treatment saga that began last week as he navigated multiple providers who provided misleading or false information, including being turned away by an urgent care clinic.
Slow access to testing, treatment and vaccines in the early U.S. response to monkeypox is a “bit of a failure” that parallels missteps in the early response to the coronavirus, said Megan Raney, an emergency physician and academic dean of the School of Public Health at Brown University Health.
“I can’t help but wonder if part of the delay is that our public health workforce is so depleted,” Raney added. “Anyone who is available to work on epidemiology or contact tracing is already doing it on covid.”
Laurie McGinley and Lena H. Sun contributed to this report.
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