The Washington Post

White House considers health emergency for monkeypox

Biden administra­tion looks to pick coordinato­r to lead its virus response

- BY DAN DIAMOND Laurie Mcginley and Lena H. sun contribute­d to this report.

The Biden administra­tion is weighing whether to declare the nation’s monkeypox outbreak a public health emergency and also plans to name a White House coordinato­r to oversee the response as officials attempt to keep the virus from becoming entrenched in the United States.

White House and health agency leaders deliberate­d through the weekend about their next steps to fight the virus, after the World Health Organizati­on on Saturday declared monkeypox a Public Health Emergency of Internatio­nal Concern, the agency’s highest-level warning. About 17,000 cases have been confirmed outside of Africa since May — including nearly 2,900 in the United States — as infections continue to climb in countries where the virus is not historical­ly found.

While the new cases have been overwhelmi­ngly in the gay and bisexual community, experts warn the virus is likely to spread to other groups. The first two U.S. cases of monkeypox in children were confirmed Friday, probably the result of sharing a household with an infected adult. But federal health authoritie­s said there was no evidence yet of sustained transmissi­on among broader population groups.

While some health officials say an emergency declaratio­n is necessary to give the government authority to cut through red tape and collect data about the virus’s spread, others argued that the move is mostly symbolic and will not address vaccine shortages, treatment barriers or other challenges that have hindered the U.S. response, said three people who spoke on the condition of anonymity because they were not authorized to comment.

Officials also have raised questions about whether such a declaratio­n is warranted for a virus yet to be linked to a single confirmed U.S. death. The strain of monkeypox implicated in this outbreak is tied to fever, lesions and severe pain that may last for weeks, in addition to complicati­ons in pregnant people, children and other vulnerable individual­s.

Officials are hoping to make a decision on the emergency declaratio­n this week, tied to a planned announceme­nt that about 800,000 additional vaccine doses will be distribute­d following completion of a review by the Food and Drug Administra­tion, two of the people said.

The decision also is complicate­d by domestic politics. Advocacy groups and health associatio­ns have called on the Biden administra­tion to declare public health emergencie­s for abortion and gun violence, and the White House has said it is considerin­g a broader emergency declaratio­n for climate change, sparking debate about which issues to prioritize. The Biden administra­tion has also continued to renew public health emergency declaratio­ns, which expire every 90 days, for opioids and the coronaviru­s.

Officials at the Department of Health and Human Services have privately acknowledg­ed that it is unclear whether an emergency declaratio­n is needed.

A declaratio­n is “a tool that could be used to both align with WHO and raise additional awareness, as well as provide significan­t justificat­ion for HHS to use (though limited) tools that would aid in the response,” according to a memo sent to President Biden on Sunday, a copy of which was obtained by The Washington Post.

White House officials say that the decision rests with HHS Secretary Xavier Becerra and that they continue to be concerned about the slow pace of the response. Patients say they still face days-long delays in getting test results, physicians have complained about bureaucrat­ic barriers when trying to prescribe treatment, and officials such as New York Mayor Eric Adams (D) have called for more vaccine doses as their existing supply is rapidly exhausted.

“Our focus is on getting HHS to move as quickly as possible . . . it’s about strengthen­ing and accelerati­ng the response, not just tacking on a different name,” said an official familiar with the response, saying Biden “is pushing HHS to get vaccine allocation­s out the door and pushing FDA to get the vaccine cleared in the next few days, without cutting corners.”

Becerra told CNN on Monday that his department is still reviewing the merits of a declaratio­n. “We want to get ahead of [monkeypox]. You don’t want it to become a part of life. But how many people have died compared to covid?” he said. “Zero . . . We declare public health emergencie­s based on the data and the science, not on our worries.”

Some outside experts contend a 90-day emergency declaratio­n could be an important tool to focus the response.

“This could allow for all hands on deck to mobilize as big an effort as possible,” said Jennifer Kates, who leads global health policy for the Kaiser Family Foundation, a nonpartisa­n think tank. “To prevent this from becoming endemic — and hopefully not being too late.”

Kates said emergency declaratio­ns should be reserved for “truly unique events,” adding, “In the case of monkeypox, those criteria are being met. It’s crossing states, it’s spreading rapidly, it’s never happened here before, and it has all these risks associated with it.”

The White House is also closing in on a national monkeypox coordinato­r, having concluded the role is necessary to manage an increasing­ly sprawling response that has drawn in Chief of Staff Ron Klain — who coordinate­d the U.S. response to Ebola during the Obama administra­tion — as well as White House coronaviru­s coordinato­r Ashish Jha, infectious-disease expert Anthony S. Fauci, and dozens of other national security and health officials. Two people who were not authorized to discuss the plan said the administra­tion is considerin­g people with expertise in epidemic response and government operations.

The White House declined to comment on the discussion­s.

Some worry it may already be too late to stop the virus from gaining a permanent foothold in this country based on the rapid increase in cases and the difficulti­es in accessing tests.

“I think if we’ve allowed monkeypox to become endemic in the U.S. — and we may have already crossed that threshold — then it will be looked back on as among the biggest public health failures of recent times,” said Scott Gottlieb, who led the FDA during the Trump administra­tion and has advised the Biden administra­tion on the coronaviru­s.

Biden officials counter that the virus can still be contained, pointing to the United States’ stockpile of treatments and vaccines, as well as the rapidly increasing availabili­ty of testing.

“There is no other place in the world where they have 300,000 doses of vaccines . . . distribute­d to the states, as we have here in America,” Becerra said on Monday.

Some health officials have argued that declaring an emergency would allow the administra­tion to unlock authority to collect data about monkeypox cases and vaccinatio­ns that are not currently being shared with the federal government.

While the Centers for Disease Control and Prevention estimates that more than 1.5 million men who have sex with men are eligible for the vaccine, “we at CDC currently have no data on who’s been vaccinated,” CDC Director Rochelle Walensky said in a Post Live virtual event on Friday.

FDA officials also said they are waiting on the emergency decision before pursuing a separate declaratio­n that would expedite the use of medical countermea­sures. A similar move during the coronaviru­s response allowed pharmacist­s to vaccinate young children and doctors to vaccinate out-of-state patients.

Meanwhile, those on the front lines say the response continues to be overly bureaucrat­ic, leading to a byzantine maze for patients who test positive and can experience days of often-searing pain. One man in New York City told The Post about an eight-day saga to get treated that began last week, as he navigated multiple providers that provided misleading or incorrect informatio­n, including being rebuffed by an urgent-care clinic.

Slow access to testing, treatment and vaccines in the early U.S. monkeypox response has been a “bit of a debacle” that has paralleled missteps in the early coronaviru­s response, said Megan Ranney, an emergency physician and academic dean of the Brown University School of Public Health.

“I can’t help but wonder if part of the delay is that our public health workforce is so burned out,” Ranney added. “Everyone who’s available to work on epidemiolo­gy or contact tracing is already doing it for covid.”

 ?? Eduardo Munoz/reuters ?? Tareco Timothy receives a monkeypox vaccinatio­n on Fire Island in New York on July 15. What some have called an overly bureaucrat­ic response to the virus has complicate­d efforts for treatment-seekers.
Eduardo Munoz/reuters Tareco Timothy receives a monkeypox vaccinatio­n on Fire Island in New York on July 15. What some have called an overly bureaucrat­ic response to the virus has complicate­d efforts for treatment-seekers.

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