Friday, February 3, 2023

Biden administration weighs declaring monkeypox a health emergency

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The Biden administration is weighing whether to declare the country’s monkeypox outbreak a public health emergency and also plans to name a White House coordinator to oversee the response as officials try to prevent the virus from taking root in the United States.

The heads of the White House and health agencies discussed over the weekend their next steps to fight the virus, after the World Health Organization on Saturday declared that monkeypox was a public health emergency of international concern, the agency’s highest level warning. About 17,000 cases have been confirmed outside Africa since May — including nearly 2,900 in the United States — as infections continue to rise. up in countries where the virus has not historically been found.

While the new cases have largely been in the gay and bisexual community, experts warn that the virus is likely to spread to other groups. First two U.S. cases of monkeypox in children were confirmed on Friday, possibly the result of the separation of a family with an infected adult. But federal health authorities said there was still no evidence of sustained transmission among broader population groups.

While some health officials believe that an emergency declaration is necessary to give the government authority to cut red tape and collect data on the spread of the virus, others argued the move is largely symbolic and will not address vaccine shortages, treatment barriers and other challenges that have hampered the US response, said three people who spoke on condition of anonymity because they were not authorized to comment.

Officials have also raised questions about whether such a declaration is warranted for a virus that has yet to be linked to a single confirmed US death. The type of monkeypox implicated in this outbreak is associated with fever, lesions and severe pain that can last for weeks, in addition to complications in pregnant women, children and other vulnerable people.

Officials hope to make a decision on the emergency declaration later this week, in connection with a planned announcement that about 800,000 additional doses of vaccines will be distributed after the end of a review by the Food and Drug Administration, two of the people said.

The decision is also complicated by domestic politics. Advocacy groups and health associations have called on the Biden administration to declare public health emergencies abortion AND gun violenceand the White House has said it is considering a broader one emergency declaration on climate change, sparking debate about which issues should be prioritized. 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 statement is “a tool that can be used to connect with WHO and raise additional awareness, as well as provide a meaningful justification for HHS to use tools (albeit limited) that would assist in the response “, according to a memo sent to the President. Biden on Sunday, a copy of which was obtained by The Washington Post.

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

“Our focus is on HHS moving as quickly as possible … it’s about strengthening and expediting the response, not just tapping another name,” said an official familiar with the response, saying Biden “it’s pushing HHS to release vaccine allocations. the door and pushing the FDA to clear the vaccine in the coming days, without cutting corners.”

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

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

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

Kates added that emergency declarations should be reserved for “really 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 there are all these risks associated with it.”

The White House is also moving closer to a national monkeypox coordinator after concluding the role is needed to manage an increasingly widespread response that has drawn 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 that 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 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’s going to be looked at as one of 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 growing availability of testing.

“There’s no other country in the world where they have 300,000 doses of vaccines … distributed across states like we have here in America,” Becerra said Monday.

Some health officials have argued that declaring an emergency would allow the administration to unblock authority to collect data about monkeypox cases and vaccines 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 has been vaccinated,” CDC Director Rochelle Walensky said in a . Washington Post Live virtual event Friday.

FDA officials also said they are waiting for 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 patients overseas.

Meanwhile, those on the front lines say the response continues to be overly bureaucratic, leading to a Byzantine labyrinth for patients who test positive and may experience days of often severe pain. A New York City man told The Post of an eight-day saga to get treatment that began last week as he navigated multiple providers who provided misleading or inaccurate information, including being turned down by a clinic. of emergency care.

Slow access to testing, treatments and vaccines in the early U.S. monkeypox response has been “a disappointment” that has paralleled mistakes in the early coronavirus response, said Megan Ranney, an emergency physician and the School’s academic dean. Brown University 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 is available to work on epidemiology or contact tracing is already doing it for Covid.”

Laurie McGinley and Lena H. Sun contributed to this report.

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