The Biden administration is considering declaring the monkeypox outbreak a public health emergency as the number of cases in the US rose to more than 2,800 on Friday, a White House official said.
“It’s definitely a conversation that’s going on,” Ashish Jha, the White House’s Covid response coordinator, told reporters. “We’re looking at that, looking at the ways that response can be enhanced by declaring a public health emergency.”
Jha added that any statement would come from the Ministry of Health and Human Services.
His comments came as the World Health Organization was debating whether to take similar measures, expected to be taken as soon as Saturday, after the number of reported infections surpassed 16,000 worldwide. Around the world, monkeypox still primarily affects men who have sex with men and those who identify as homosexual or bisexual.
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In the US, health officials said about 99% of cases involve men who have sex with men and the median age of patients is 36. But the US Centers for Disease Control and Prevention said earlier Friday that two pediatric patients had been identified a week, raising concerns that the virus is making its way into other populations.
Jennifer McQuiston, the CDC’s deputy director for high-impact pathogens and pathology, said infections from people who are not part of the LGBTQ community are not surprising.
“While this outbreak is spreading in one particular social network right now, I think we’ve been messaged from the get-go that there could be cases that are occurring outside of those networks,” McQuiston said. “We have to be vigilant and ready to respond.”
As part of that effort, U.S. health officials said they are clarifying how Siga Technologies’ antiviral smallpox medication, Tpoxx, should be used in pediatric patients.
Earlier Friday, the CDC said it is streamlining the process health care providers must go through to prescribe Tpoxx. The change came after clinicians expressed frustration at the sheer amount of paperwork required to give patients the drug under a so-called extended access protocol, a regulatory mechanism that allows drugs to be used outside of their approval. The new process allows clinicians to virtually prescribe Tpoxx and, ideally, dramatically reduce the time spent filling out forms.
Despite the US having 1.7 million doses available through the Strategic National Stockpile, doctors have struggled to actually get the drugs to patients.
Earlier in July, Mary Foote, an infectious disease specialist with the New York City Department of Health and Mental Hygiene, said that about 20% to 25% of the monkey pox patients she saw required antivirals because their symptoms are so uncomfortable or painful. Foote also said her patients all responded well to the drug, with the most common side effect being a mild headache.
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Vaccine Distribution Challenges
The government has also said it is looking into another antiviral drug called Tembexa, made by Chimerix Inc. However, it has some serious side effects and has been little studied in humans.
Mordechai Levovitz, the clinical director of Jewish Queer Youth, a nonprofit, called the government’s response “unacceptable.” Levovitz said she has friends whose symptoms are so severe that they have had to seek prescriptions for painkillers. Some patients need to isolate themselves while they have lesions, and for those for whom remote work isn’t an option, that could mean a month away from a job.
The Biden administration has also faced challenges in allocating Bavarian Nordic A/S’s Jynneos vaccine to states and jurisdictions due to the limited supply of the shots. To date, health officials have deployed 300,000 doses of Jynneos and more shots are expected to come soon.
The US Food and Drug Administration recently completed an inspection of one of the Bavarian vaccine factories in Denmark, which has approximately 800,000 doses destined for the US. Jha said earlier this week that half of those doses would arrive this week, and the rest next week.
The US has a contract agreement with Bavarian Nordic for enough bulk vaccine to make approximately 13 million doses. This month, HHS announced two separate orders of 2.5 million doses; however, the majority of those injections will not be ready until 2023. According to the recently released White House research priorities for monkey pox, health officials plan to better understand the effectiveness of vaccines and whether using a single-dose strategy to conserve stock will still provide adequate protection against the virus.
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Another concern is the government’s lack of demographic information on vaccine distribution. HHS has said its vaccine strategy prioritizes communities at risk, but state health departments are not required to report demographic details of cases to the CDC.
Speaking at a Washington Post Live event Friday, CDC Director Rochelle Walensky said the “CDC currently has no data on who has been vaccinated.”