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 is a global public health risk through international spread, which requires a coordinated international response.
In the US, before the Biden administration’s announcement, 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 a disease or a public health crisis of some kind. Public health emergencies are not only declared in case of outbreaks of infectious diseases such as Covid-19 and monkey pox. 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 emerging) public health crisis. In the case of monkeypox, the federal government can now significantly scale up vaccine production and availability, expand testing capacity, and make testing more convenient. The proclamation also facilitates coordination between federal, state, and local authorities, especially in relation to access to testing and treatment in conjunction with a prevention awareness campaign for members of at-risk communities, with the goal of limiting the spread of the virus .
In addition, the declaration allows the Secretary of HHS to conduct and support research into the cause, treatment, or prevention of the disease or crisis, in addition to supporting advanced research and development and biosurveillance necessary to address the problem. Finally, it allows CDC to access the Infectious Disease Emergency 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, which began in May of this year, at least 6 deaths occurred outside the US. Additionally, between 3% and 13% of confirmed cases have been hospitalized. Most hospitals are about pain management. Patients often suffer debilitating pain from the skin rash caused by the virus. Skin lesions can appear anywhere on the body. Common systemic features preceding the rash include fever (62%), lethargy (41%), myalgia (31%), headache (27%), and lymph node enlargement (56%).
In addition to pain management, reported reasons for hospitalization include pharyngitis limiting oral intake, encephalitis, ocular lesions, acute kidney injury, and myocarditis.
Men who have sex with men are currently at the highest risk, but anyone can get monkeypox. And, in fact, 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 sores on the body of someone who has monkeypox, or by direct contact with materials, such as clothing and linens, that have touched bodily fluids or sores. 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 demand for testing exceeds current US capacity for testing supplies.
In 2019, the Food and Drug Administration (FDA) approved a vaccine called Jynneos for adults age 18 and older who are at high risk of exposure to chickenpox or chickenpox. Jynneos is the only FDA-approved monkeypox vaccine in the US. It is given in two doses with a difference of 28 days. On July 15, 2022, HHS’s Strategic Preparedness and Response Administration announced that it had ordered an additional 2.5 million doses of Jynneos to enhance monkeypox preparedness, which will increase the federal government’s available supply to more than 6, 9 million doses by mid-2023.
So far, HHS has made 786,000 doses of Jynneos available to state and local governments. But lawmakers and local communities criticized the pace of the response. And because of supply shortages, the FDA is now considering splitting Jynneos doses into fifths.
CDC director Dr. Walensky, has acknowledged that demand for the vaccine is outstripping supply. An additional 11.1 million doses are in storage in Denmark with the manufacturer Bavarian Nordic. However, these installments must be “filled and completed” before they can be disbursed, 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 weakened immune systems, such as HIV patients, pregnant women and people with autoimmune disorders.
As for other treatments, the US has 1.7 million courses of the antiviral treatment tecovirimat in its strategic national stockpile. Some doctors use tecovirimat 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 speed up monkeypox testing and treatment, as well as public health messages to prevent the spread of the disease, particularly in vulnerable communities.