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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 try to prevent the virus from spreading to the United States.
Leaders from the White House and health agencies deliberated over the weekend about their next steps to fight the virus, after the World Health Organization on Saturday declared monkeypox an emergency of public health 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. to climb in countries where the virus is not historically found.
Although the new cases have mostly been in the gay and bisexual community, experts warn that the virus is likely to spread to other groups. The first two U.S. cases of smallpox in children were confirmed Friday, likely the result of sharing a household with an infected adult. But federal health officials said there was still no evidence of sustained transmission among broader population groups.
Although some health officials believe 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 U.S. response, three said people who spoke on condition of anonymity because they were not authorized to comment.
Officials have also raised questions about whether that statement is warranted for a virus that has yet to be linked to a single confirmed death in the United States. The strain of monkeypox involved in this outbreak is linked fever, injuries and severe pain that can last for weeks, as well as complications in pregnant women, children and other vulnerable people.
Officials expect to make a decision on the emergency declaration later this week, tied to an expected announcement that an additional 800,000 doses of vaccine will be distributed after the end. from a Food and Drug Administration review, 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 for abortion and gun violence, and the White House has said it is considering a broader climate change emergency declaration, sparking debate on which topics 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 acknowledged privately that it is unclear whether an emergency declaration is needed.
A statement is “a tool that could be used to align with WHO and raise additional awareness, as well as to provide a meaningful rationale for HHS to use (albeit limited) tools to 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 they remain concerned about the slow pace of the response. Patients say they still face days-long delays in getting test results, doctors have complained of bureaucratic hurdles when trying to prescribe treatment, and officials like New York Mayor Eric Adams (D) have requested more doses of vaccines as their current supply is fast. exhausted
“Our focus is to get HHS moving as quickly as possible … it’s about strengthening and speeding up the response, not just going under a different name,” said an official familiar with the response, saying that Biden “is pushing HHS to pull vaccine allocations.” the door and push 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 plea. “We want to move forward [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 data and science, not our 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 at 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 it has all these risks associated with it.”
The White House is also moving toward a national monkeypox coordinator, having concluded that the role is needed to manage an increasingly expansive 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 health and safety officials . Two people who were not authorized to discuss the plan said the administration is considering people with experience in epidemic response and government operations.
The White House declined to comment about the discussions.
Some worry that it may already be too late to prevent the virus from taking hold in this country because of the rapid increase in cases and the difficulty of accessing tests.
“I think if we have allowed monkeypox to become endemic in the United States, and we may have already crossed that threshold, then it will be looked back on as one of the biggest public health failures of recent times,” said Scott Gottlieb, who he directed the FDA during the Trump administration and has advised the Biden administration on the coronavirus.
Biden officials respond that the virus can still be contained, pointing to the availability of U.S. treatments and vaccines, as well as the rapidly increasing availability of tests.
“There is no other place in the world where they have 300,000 doses of vaccines … distributed in the states, like we have here in America,” Becerra said Monday.
Some health officials have argued that declaring an emergency would allow the administration to unlock authority to collect data on smallpox cases and vaccines that is not currently 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, “currently at CDC we do not have 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 making a separate statement 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 remains too bureaucratic, resulting in a byzantine maze for patients who test positive and can experience days of often searing pain. A New York City man told The Post about an eight-day saga to get treatment that began last week as he navigated multiple providers who provided misleading or incorrect information, including being rejected by a care clinic urgent
Slow access to testing, treatment and vaccines in the first U.S. smallpox response has been a “bit of a debacle” that has paralleled missteps in the early response to the coronavirus, he said. said Megan Ranney, emergency physician and academic dean at 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 depleted,” Ranney added. “Everyone who is available to work in epidemiology or contact tracing is already doing it because of covid.”
Laurie McGinley and Lena H. Sun contributed to this report.