On August 4, the Biden administration declared monkeypox a public health emergency. The announcement follows the World Health Organization, which declared monkeypox a public health emergency of international concern in July. This implies that monkeypox poses a global public health risk through international spread, requiring a coordinated international response.
In the US, prior to 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 statement enables the Secretary of Health and Human Services (HHS) to take specific action to address the threat of a disease or public health crisis of any kind. Public health emergencies are not only declared in the event of 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, a public health emergency declaration frees up resources earmarked for an actual (or looming) public health crisis. In the case of monkeypox, the federal government can now significantly scale vaccine production and availability, expand testing capacity, and make testing more convenient. The statement also facilitates coordination between federal, state and local agencies, particularly regarding access to testing and treatment in conjunction with a prevention campaign for members of vulnerable communities aimed at curbing the spread of the virus.
In addition, the statement permits the HHS secretary to conduct and support investigations into the cause, treatment, or prevention of the disease or crisis, and to support advanced research and development and biomonitoring needed to solve the problem at hand. Finally, the CDC provides access to the Infectious Disease Rapid Response Reserve Fund to prevent, prepare for, or respond to an infectious disease-related 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 at least 6 deaths have occurred outside the US in the most recent global outbreak that began in May this year. In addition, between 3% and 13% of confirmed cases were hospitalized. Most hospital stays are for pain management. Patients often experience debilitating pain due to the rash caused by the virus. Skin lesions can appear anywhere on the body. General systemic features preceding the rash include fever (62%), lethargy (41%), myalgia (31%), headache (27%), and enlarged lymph nodes (56%).
In addition to pain management, reasons for hospitalization include pharyngitis limiting oral intake, encephalitis, eye lesions, acute kidney injury, and myocarditis.
Men who have sex with men are currently most at risk, but anyone can contract monkeypox. And indeed, a growing number of women and children have tested positive for the virus.
What is definitely known is that monkeypox is spread through direct contact with bodily fluids or wounds on the body of a person who has monkeypox, or through direct contact with materials such as clothing and bedding that have come in contact with bodily fluids or sores. It can also spread through respiratory droplets when people are in close personal contact.
The US has increased testing capacity to 80,000 a week. However, current test demand exceeds current capacity in the US for test supplies.
In 2019, the Food and Drug Administration (FDA) approved a vaccine called Jynneos for adults ages 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. On July 15, 2022, the HHS Strategic Preparedness and Response Administration announced that it had ordered an additional 2.5 million doses of Jynneos to bolster monkeypox preparedness, increasing the federal government’s available supply to more through mid-year than 6.9 million doses will increase in 2023.
To date, HHS has provided 786,000 doses of Jynneos to state and local governments. However, lawmakers and local communities have criticized the pace of the response. And due to supply shortages, the FDA is now considering dividing Jynneos doses into fifths.
CDC Director Dr. Walensky has acknowledged that demand for the vaccine is outstripping supply. Another 11.1 million cans are stored in Denmark by the manufacturer Bavarian Nordic. However, these doses must be “bottled and finished” before they can be administered, which will require additional funding from Congress.
The US also has more than 100 million doses of an older-generation smallpox vaccine called ACAM2000, which is likely effective against monkeypox. However, 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.
In terms of other treatments, the US has 1.7 million courses of the antiviral treatment Tecovirimat in its strategic national stockpile. Some doctors use tecovirimate to treat monkeypox patients. However, this drug has only been approved by the FDA for smallpox.
It is hoped that the declaration of a public health emergency will soon ramp up testing and treatment for monkeypox, but also public health messaging to prevent the spread of the disease, particularly in vulnerable communities.