Consequences of declaring monkeypox a public health emergency in the United States

On August 4, the Biden administration declared monkeypox a public health emergency. The announcement comes after the World Health Organization declared monkeypox a public health emergency of international concern in July. This means that monkeypox poses a global public health risk through international spread, requiring a coordinated international response.

In the US, before the Biden administration’s declaration, a growing number of municipalities and even several states – California, Illinois and New York – had declared monkeypox a public health emergency.

A public health declaration allows the Secretary of Health and Human Services (HHS) to take certain actions to address the threat of disease or a public health crisis of some kind. Public health emergencies are not only declared for outbreaks of infectious diseases such as Covid-19 and monkeypox. For example, in October 2017, President Trump declared the “opioid crisis” a “public health emergency.”

Importantly, declaring a public health emergency frees up resources intended for an actual (or emerging) public health crisis. In the case of monkeypox, the federal government can now greatly increase vaccine production and availability, expand testing capacity, and make testing more convenient. The declaration also facilitates coordination among federal, state and local governments, particularly regarding access to testing and treatment in connection with a transmission prevention campaign for members of at-risk communities aimed at limiting the spread of the virus.

In addition, the declaration allows the Secretary of HHS to conduct and support investigations into the cause, treatment, or prevention of the disease or crisis, in addition to supporting advanced research and development and biomonitoring necessary to address the problem. Finally, it enables CDC to access the Infectious Disease Rapid Response Reserve Fund to prevent, prepare for, or respond to an infectious disease emergency.

According to the Centers for Disease Control and Prevention (CDC), more than 26,000 cases of monkeypox have been reported in 87 countries. With more than 6,500 confirmed cases, the US accounts for 25% of confirmed infections worldwide.

No deaths from monkeypox have yet been reported in the US, but in the latest global outbreak that began in May of this year, at least 6 deaths occurred outside the US. Additionally, between 3% and 13% of confirmed cases are hospitalized. Most hospitalizations are for pain management. Patients often suffer from debilitating pain from the skin rash caused by the virus. Skin lesions can appear anywhere on the body. Common systemic features preceding the rash included fever (62%), lethargy (41%), myalgia (31%), headache (27%), and enlarged lymph nodes (56%).

In addition to pain management, cited reasons for hospitalizations included pharyngitis limiting oral intake, encephalitis, eye lesions, acute kidney injury, and myocarditis.

Men who have sex with men are currently at the highest risk, but anyone can contract monkeypox. And in fact, a growing number of women and children have tested positive for the virus.

Monkeypox is definitely known to spread through direct contact with bodily fluids or wounds on the body of someone who has monkeypox, or through direct contact with material, such as clothing and underwear, that has touched bodily fluids or wounds. It can also spread through respiratory droplets when people have close face-to-face contact.

The US has increased testing capacity to 80,000 per week. However, current testing demand exceeds current US capacity for testing supplies.

In 2019, the Food and Drug Administration (FDA) approved a vaccine called Jynneos 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 US. It is administered in two doses with an interval of 28 days. On July 15, 2022, HHS’s Strategic Preparedness and Response Administration announced that it has ordered an additional 2.5 million doses of Jynneos to strengthen monkeypox preparedness, which will increase the federal government’s available supply to more than 6.9 million doses until the middle of ​2023

To date, HHS has provided 786,000 doses of Jynneos to state and local governments. But lawmakers and local communities criticized the speed of the response. And due to supply shortages, the FDA is now considering splitting Jynneos doses into fifths.

CDC Director Dr. Walensky acknowledged that demand for the vaccine is outpacing supply. An additional 11.1 million doses are stored in Denmark at the manufacturer Bavarian Nordic. However, these doses must be “filled and completed” before they can be administered, which would require additional funding from Congress.

The US also has more than 100 million doses of an older-generation smallpox vaccine called ACAM2000, which is believed to be effective against monkeypox. But ACAM2000 can have serious side effects and is not recommended for people with compromised immune systems, such as HIV patients, pregnant women and people with autoimmune diseases.

As for other treatments, the US has 1.7 million courses of the antiviral treatment tecovirimat in its strategic national stockpile. Some doctors use tecoxiramit to treat patients with monkeypox. But this drug is only FDA-approved for smallpox.

It is hoped that the declaration of a public health emergency will soon increase monkeypox testing and treatment, but also public health messaging to prevent the spread of the disease, especially in vulnerable communities.

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