Biden administration weighs in on declaring monkeypox a health emergency

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The Biden administration is considering whether to declare the nation’s monkeypox outbreak a public health emergency and also plans to appoint a White House coordinator to oversee the response as officials try to keep the virus from spreading. put down roots in the United States.

The White House and health agency leaders deliberated over the weekend on their next steps to fight the virus, after the World Health Organization declared monkeypox on Saturday an emergency of public health of international concern, the agency’s highest warning. Around 17,000 cases have been confirmed outside Africa since May – including nearly 2,900 in the United States – as infections continue to rise. ascend in countries where the virus is not historically found.

While 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 on Friday, likely the result of sharing a household with an infected adult. But federal health officials said there was not yet evidence of sustained transmission among broader population groups.

While some health officials say an emergency declaration is needed to give the government the authority to cut red tape and collect data on the spread of the virus, others argued the move was mostly symbolic and would not address vaccine shortages, treatment barriers and other challenges that have hampered the response American, 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 statement is warranted for a virus that is not yet linked to a single confirmed death in the United States. The strain of monkeypox implicated in this outbreak is linked to fever, severe lesions and 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, linked to an expected announcement that around 800,000 additional vaccine doses will be distributed after completion. of 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 for abortion and gun violence, and the White House has said it is considering a broader emergency declaration for the climate change, sparking a debate on the issues to be prioritized. The Biden administration also continued to renew public health emergency declarations, which expire every 90 days, for opioids and the coronavirus.

Department of Health and Human Services officials have privately acknowledged that it is unclear whether an emergency declaration is required.

A statement is “a tool that could be used both to align with the WHO and raise awareness, as well as provide meaningful justification for HHS to use (albeit limited) tools that would aid 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 continue to be concerned about the slow response. Patients say they still face days-long delays in getting test results, doctors have complained about bureaucratic hurdles when trying to prescribe treatment, and officials such as New York City Mayor Eric Adams (D) have requested more vaccine doses as their existing supply is quickly running out.

“Our goal is to get HHS moving as quickly as possible…it’s about strengthening and accelerating the response, not just changing its name,” an official familiar with the response said, saying that Biden was “pushing HHS for vaccine allocations.” the door, and pushing the FDA to get the vaccine approved in the next few days, without cutting corners.

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

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

“It could get all hands on deck to put the most effort into it,” said Jennifer Kates, who leads global health policy for the nonpartisan Kaiser Family Foundation. thinking group. “To prevent this from becoming endemic – and I hope it’s not too late.”

Kates added that emergency declarations should be reserved for ‘truly unique events’, adding: ‘In the case of monkeypox, those criteria are met. It crosses states, it spreads fast, it’s never happened here before, and it has all of these risks associated with it.

The White House is also closing in on a national monkeypox coordinator, having concluded the role is needed to manage an increasingly sprawling response that has drawn in Chief of Staff Ron Klain – who coordinated the US response to Ebola under the Obama administration — along with 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 was considering people with expertise in epidemic response and government operations.

The White House declined to comment. on the debates.

Some fear that it is already too late to prevent the virus from taking a lasting hold in this country due to the rapid increase in cases and the difficulties in accessing tests.

“I think if we allowed monkeypox to become endemic in the United States – and we may have already crossed that threshold – then it will be considered one of the greatest public health failures of recent times,” said Scott Gottlieb, who led the FDA during the Trump administration and advised the Biden administration on the coronavirus.

Biden officials counter that the virus can still be contained, pointing to the US stockpile of treatments and vaccines, as well as the growing availability of tests.

“There is no other place in the world where they have 300,000 doses of vaccines … distributed to 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 the power to collect data on monkeypox cases and vaccinations that are 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, “we at the CDC currently have no data on who has been vaccinated. “said CDC Director Rochelle Walensky in a Washington Post Live. virtual event Friday.

FDA officials also said they were awaiting the emergency decision before pursuing a separate statement that would expedite the use of medical countermeasures. A similar decision 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 too bureaucratic, leading to a Byzantine maze for patients who test positive and who can experience days of often searing pain. A New York man told the Post about an eight-day saga to seek treatment that began last week as he navigated several providers who provided misleading or incorrect information, including being rebuffed by a treatment clinic emergency.

Slow access to testing, treatment and vaccines early in the US response to monkeypox was a “bit of a debacle” that paralleled missteps in the early coronavirus response, said Megan Ranney, MD 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 because our public health staff are so exhausted,” Ranney added. “Anyone who is available to work on epidemiology or contact tracing is already doing so for covid.”

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

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