U.S. Health and Human Services Secretary Xavier Becerra on Thursday declared a national public health emergency for the monkeypox outbreak while other officials discussed increases in vaccine availability and testing, including a possible new way to get more doses out of a vial of Jynneos, the current vaccine used.
The designation follows California Governor Gavin Newsom issuing a state of emergency August 1. San Francisco's public health department declared a public health state of emergency July 29 because of the city's rapidly growing monkeypox outbreak. New York state also did so, and last weekend New York City followed suit.
On a teleconference call with reporters, Becerra said the declaration will allow officials "to take our response to the next level."
"We urge every American to take seriously" the threat of monkeypox, he added.
The monkeypox outbreak, which began in the U.S. in May, is primarily affecting men who have sex with men and their sexual partners. San Francisco had 386 reported cases as of August 2. On Thursday, Becerra said that the latest national numbers show 6,600 reported cases; last week it was 5,000.
In terms of the Jynneos vaccine, Dr. Robert Califf, a commissioner with the Food and Drug Administration, said the agency is considering injecting the doses intradermally, or under the skin. That would allow five doses per vial of Jynneos, he said.
"There are some advantages to that," he said of using what is called a dose-sparing approach. "We would not be sacrificing the high quality of the vaccine." The intradermal approach would basically mean sticking the needle under the skin and "creating a pocket" where the vaccine goes, Califf explained.
While monkeypox is not a new virus, the current outbreak is hitting the LGBTQ+ community hard. Dr. Demetre Daskalakis, a gay man who's director of the division of HIV/AIDS prevention at the Centers for Disease Control and Prevention, discussed the need for federal officials to work with organizations that serve the LGBTQ+ community and said that is ongoing. Daskalakis this week was also named deputy coordinator for the White House National Monkeypox Response by President Joe Biden.
"Monkeypox is not exclusively a sexually transmitted virus," he said, "but we recognize it's spreading more rapidly than previous outbreaks. We saw the virus spreading in the LGBTQ+ community and our work has been aggressively ongoing since Day 1."
Dr. Rochelle Walensky, director of the CDC, said that the public health emergency "will enhance our nation's response," to the outbreak. This can include personnel to deploy to help health centers and data sharing to inform public health decisions.
Also on the call was Robert Fenton, whom Biden named the coordinator for the White House's national monkeypox response. He has worked in the Federal Emergency Management Administration. He said his main job will be to coordinate across agencies, as he has done throughout his career.
"We will leave no stone unturned and work to end this outbreak," Fenton said.
House Speaker Nancy Pelosi (D-San Francisco) praised the declaration.
"The Biden administration's declaration of a public health emergency is a crucial step to stop the spread of monkeypox," Pelosi stated. "This action, which follows the lead of California, is welcome news: unlocking critical tools to strengthen our fight against this accelerating and painful public health threat.
"Across our nation, including in my hometown of San Francisco, we are already seeing monkeypox inflict serious harm — particularly, taking a disproportionate toll on our LGBTQ family, friends and neighbors. As we learned from the COVID crisis, we must act swiftly and decisively to get ahead and stay ahead of this virus."
Vaccines, treatment, testing
In terms of vaccines, Becerra said as of August 4 more than 600,000 doses of Jynneos have been delivered to states. He also said 14,000 treatments of TPOXX have been delivered, with another 1.7 million doses in the national stockpile.
Dawn O'Connell, with HHS, said the agency's vaccine strategy is to make 1.1 million doses of Jynneos available to state and other jurisdictions such as tribal governments. She said that 6.9 million doses will be secured. A shipment of 786,000 doses began being shipped this week. The next round of ordering doses for states will be August 15, she said.
In terms of treatment, TPOXX (tecovirimat) is an antiviral drug that is used to treat severe cases, but it is currently difficult to get. Califf said it's approved for smallpox but it's never been tested in humans for monkeypox.
"We think it will be effective, but we don't know," he said, adding that there are plans for a clinical trial.
Nevertheless, TPOXX is being used through an expanded access program but requires substantial paperwork for monkeypox cases.
Regarding testing, which started out woefully slow, as the Bay Area Reporter noted in an article this week, it is now ramping up dramatically, Walensky said.
In May, the CDC was the only agency authorized to test and was doing about 500 a week. Now, other labs are able to do the testing and Walensky said about 8,000 tests per week are being done. She encouraged "anyone who has a rash" to seek a test as the capacity now outpaces demand.
Daskalakis also talked about stigma and the federal government's messaging, not only to the LGBTQ+ community, but others as well.
"From the LGBTQ+ perspective, it's a clear statement that [the administration] values the lives of people and represents an important commitment to the community," he said, adding that messaging will be stigma-free "and to counter stigma."
Walensky said that the CDC has held many listening sessions and weekly calls with health officials throughout the country.
Becerra was asked if the outbreak can be contained.
"We continue to marshal the tools we need. We have the vaccine and continue to receive vaccine. We may have more," he said, referring to the intradermal method officials are considering. "We have all the infrastructure in place. There should be no reason we can't get ahead of this."
Fenton said the whole effort of the government working with community-based organizations will help. He and others noted that vaccines are being distributed to more rural areas, not just the major cities with lots of cases like San Francisco, Los Angeles, and New York.
HIV/AIDS and social justice organizations were pleased with the emergency declaration but cautioned more is needed
"This declaration of a national emergency on monkeypox is a good first step from the federal government," stated Paul Kawata, executive director of NMAC, a national HIV/AIDS organization. "This declaration will allow federal agencies to prioritize resources to provide vaccinations and outreach for those at risk of infection."
"However, it is only a first step and there are many questions that must be answered," Kawata added. "How will vaccinations be rolled out? How will the federal government ensure not just access to vaccinations but equity in that access? When will the CDC recommend that all gay, bisexual, and other men who have sex with men get vaccinated? How will they make that happen, given issues of stigma and vaccine hesitancy? And how can this be done in the current political climate without further stigmatizing the LGBTQ community?"
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