People protest during a rally calling for more government action to combat the spread of monkeypox in Foley Square on July 21, 2022 in New York City.
Jeena Moon | Getty Images
The Biden administration will declare monkeypox a public health emergency as the U.S. outbreak has become the largest in the world, the nation’s top health official said Thursday.
Health and Human Services Secretary Xavier Becerra’s emergency declaration will help mobilize more resources to fight the outbreak, which has spread rapidly since Boston health officials confirmed the first U.S. case. in May. The last time the United States declared a public health emergency was in response to Covid-19 in January 2020.
The United States on Thursday confirmed more than 6,600 cases of monkeypox in 48 states, Washington, DC and Puerto Rico, according to the Centers for Disease Control and Prevention. The true number of infections is likely higher than official data because patients can only get tested after developing a rash, which can take a week or more after initial exposure to the virus.
“In light of all of these developments and the changing circumstances on the ground, I want to announce today that I will be declaring a public health emergency,” Becerra told reporters on a call Thursday.
Monkeypox is rarely fatal and no deaths have been reported in the United States so far, but patients often suffer debilitating pain from the rash caused by the virus. Eight people have died from the disease globally during the current outbreak, mostly in Africa where health systems are not as robust as the United States. Spain and Brazil reported the first confirmed deaths from the virus outside Africa over the weekend.
Monkeypox is mainly spread through skin-to-skin contact during sex right now. Gay and bisexual men are currently most at risk of infection, according to public health officials. About 98% of patients who provided demographic information to clinics identified as men who have sex with men, according to the CDC. But anyone can catch the virus through close physical contact with an infected or contaminated person.
Scientists and public health officials fear that monkeypox could permanently circulate in the United States if faster action is not taken to contain the outbreak.
The WHO declared monkeypox a global health emergency last month. More than 26,000 cases of monkeypox have been reported in 87 countries, according to CDC data. The United States accounts for 25% of confirmed infections worldwide. Health authorities in the UK first alerted the world to the outbreak in May after confirming several cases there.
The global outbreak is highly unusual as monkeypox is spreading widely for the first time in North America and Europe, where the virus is not normally found. Historically, monkeypox has spread at low levels in remote areas of West and Central Africa where rodents and other animals carry the virus. Transmission between people was relatively rare in the past, with the virus usually jumping from animals to humans.
National and local emergencies
Congressional and local community lawmakers have criticized the pace of the federal government’s response, but Becerra said last week that HHS had done everything it could to increase resources to fight the outbreak. The health secretary said states must do more to prevent transmission and Congress must approve funding to support the outbreak response.
The largest outbreaks in the United States are in New York, California, Illinois, Florida, Georgia, Texas and DC. New York, Illinois and California declared state emergencies ahead of the federal declaration.
Public health officials fear the virus could begin to spread more within households across the population as infections rise. Although physical contact during sex is the main mode of transmission at present, people can also catch monkeypox from hugging, kissing and using contaminated towels and sheets. .
The CDC last month confirmed the first US cases of monkeypox in children, a toddler in California and a baby whose family was traveling to DC. The baby’s family is not a resident of the United States. The children are showing symptoms but are healthy and receiving the antiviral treatment tecovirimat, according to the CDC. Young children likely caught the virus through transmission within their families, according to the CDC.
Monkeypox can also be spread through respiratory droplets when people have sores in their mouths, but this requires prolonged face-to-face interaction, according to the CDC. Health officials do not believe monkeypox is spread through small aerosol particles like Covid. Respiratory droplets are heavier so they don’t stay airborne for as long, whereas Covid is an airborne virus, which is one of the reasons it’s so contagious.
Monkeypox usually started with flu-like symptoms and then progressed to a painful rash that can spread all over the body. But the symptoms of the current outbreak are unusual. Some people develop a rash first, while others have a rash without any flu-like symptoms. Many people have localized lesions on the genitals or anus, according to public health officials.
Patients typically recover in two to four weeks without additional medical treatment, according to the CDC. But some people are admitted to hospital because the rash is so painful.
In 2003, the United States experienced a small outbreak of monkeypox with dozens of confirmed and probable cases in six states. People got sick after coming into contact with prairie dogs. The pets were infected after being housed near small mammals imported from Ghana. The 2003 U.S. outbreak was the first time monkeypox was reported outside of Africa, according to the CDC.
Public health authorities are also concerned that as monkeypox spreads in the United States, the virus could become established in animal populations, making the virus even more difficult to eradicate from the country.
Supply of vaccines, tests and antivirals
The federal government has delivered more than 600,000 doses of the monkeypox vaccine, called Jynneos, to state and city health departments since May. CDC Director Dr. Rochelle Walensky acknowledged last month that demand for vaccines is outstripping supply, leading to long lines at clinics and protests in some cities.
HHS made 786,000 doses available for local authorities to begin ordering last Friday, which could help alleviate supply issues.
The United States has ordered more than 5 million additional doses with deliveries expected through mid-2023. An additional 11.1 million doses are stored in bulk in Denmark at manufacturer Bavarian Nordic, according to HHS. But those doses must be filled and finished before they can be administered, which will require additional congressional funding, according to HHS.
The Food and Drug Administration approved Jynneos in 2019 for adults 18 and older who are at high risk of exposure to monkeypox or smallpox. Jynneos is the only FDA-approved monkeypox vaccine in the United States. It is given in two doses 28 days apart.
The United States also has more than 100 million doses of an older generation smallpox vaccine, called ACAM2000, which is likely effective against monkeypox. But ACAM2000 can have serious side effects and is not recommended for people with weakened immune systems, such as HIV patients, pregnant women, and people with eczema and similar skin conditions.
The United States currently does not have real data on the effectiveness of vaccines in preventing disease in the current outbreak, according to the CDC. The vaccination campaign focuses on people with confirmed or suspected exposures and on men who have sex because they are at the greatest risk of infection.
The United States has increased its testing capacity to 80,000 per week after integrating several commercial labs last month. Becerra said last week that current testing demand is only a fraction of the total capacity the United States currently has.
The United States also has 1.7 million courses of the antiviral treatment tecovirimat in the national strategic stockpile. Health care providers use tecovirimat to treat patients with monkeypox, but prescribing the drug involves an extra layer of bureaucracy because the FDA has only approved it for smallpox. The CDC cut red tape last month to make it easier for doctors to prescribe tecovirimat.