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 implies that monkeypox poses a global risk to public health 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 some states — California, Illinois and New York — had declared monkeypox a public health emergency.
or Public Health Statement 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 monkeypox. For example, in October 2017, President Trump declared the “opioid crisis” a “public health emergency.”
Importantly, a public health emergency declaration releases 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 statement also facilitates coordination between federal, state and local authorities, particularly regarding access to testing and treatment in connection with a contact prevention campaign with members of at-risk communities aimed at curbing the spread of the virus.
Moreover, the statement GRANTS The Secretary of HHS to conduct and support investigations 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 in question. Finally, it enables CDC to access the Infectious Disease Rapid 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 U.S., but in the latest worldwide outbreak, which began in May of this year, at least 6 deaths occurred outside the U.S. Additionally, between 3% and 13% of confirmed cases have been hospitalized. Most hospitalizations are for pain management. Patients often suffer debilitating pain from the rash caused by the virus. Skin lesions can occur anywhere on the body. Common systemic features before the rash include fever (62%), lethargy (41%), myalgia (31%), headache (27%), and enlarged lymph nodes (56%).
In addition to pain management, cited reasons for hospitalizations have included pharyngitis limiting oral intake, encephalitis, eye 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, an increasing number of women and children have tested positive for the virus.
What is definitely known is that monkeypox spread through direct contact with body fluids or sores on the body of someone who has monkeypox, or by direct contact with materials, such as clothing and linen, that have touched the body 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, the current demand for testing exceeds the current capacity in the US in terms of 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 monkeypox or smallpox. Jynneos is the only FDA-approved monkeypox vaccine in the U.S. It is given in two doses 28 days apart. 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 bolster monkeypox preparedness, which will increase the federal government’s available supply to more than 6.9 million doses until mid-2023.
So far, HHS has 786,000 doses of Jynneos available for state and local authorities. But lawmakers and local communities have criticized the pace of the response. And because of the supply shortage, the FDA is now considering splitting Jynneos doses into fifths.
CDC Director Dr. Walensky has admitted this The demand for the vaccine is greater than the supply. An additional 11.1 million doses are in storage in Denmark with the Nordic Bavarian manufacturer. However, these doses must be “filled 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, that is likely to be effective against monkeypox. But ACAM2000 can have serious side effects and is not recommended for those with compromised 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 national strategic stockpile. Some doctors are using tecovirim to treat patients with monkeypox. But, this drug is only approved by the FDA for smallpox.
It is hoped that declaring a public health emergency soon will speed up monkeypox testing and treatment, but also public health messages about preventing the spread of the disease, especially in vulnerable communities.