People protest during a rally to demand more government action to combat the spread of monkeypox at Foley Square on July 21, 2022 in New York City. The Biden administration is undergoing a course correction in its response to the monkeypox outbreak after weeks of logistical and bureaucratic delays in providing tests, treatments and vaccines.
Moon Paradise | Getty Images News | Getty Images
The Biden administration is undergoing a course correction in its response to the monkeypox outbreak after weeks of logistical and bureaucratic delays in providing tests, treatments and vaccines.
People close to the administration said Biden officials admit that they are now playing a catch-up game where case numbers are growing faster than initially expected, noting that the number of infections has jumped from tens to thousands in a short period of time.
As part of its new approach, the administration is working to significantly increase the number of people vaccinated against monkeypox and improve access to experimental treatment for those infected, as well as appointing a monkeypox coordinator to manage the response from the White House across agencies and with state and local governments.
However, the administration faces a maze of hurdles, according to dozens of doctors on the front lines and former public health officials who spoke to NBC News.
said Julie Morita, who advised President Joe Biden on Covid during the transition and led the Chicago Department of Public Health for nearly two decades.
“Public health needs adequate resources, it needs to ramp up the vaccine supply, and communication efforts really need to be intensified. But all of these things can happen and can lead to this outbreak being brought under control. It’s not too late,” Morita said. .
This week, New York and California were among several states declaring public health emergencies, while the Centers for Disease Control and Prevention reported infections in all but two states. According to NBC News’ analysis of CDC data, the seven-day average of new cases reported rose from 45 on July 11 to 214 just two weeks later.
In total, the United States has reported nearly 6,000 cases since the beginning of May. The total worldwide exceeds 20,000.
With the virus spreading almost entirely among men who have sex with men, management strategy has largely focused on vaccinating high-risk individuals, including men who have multiple male partners in a two-week period or those they know. open.
Recently, though, administration officials have urged other men who have sex with men to limit high-risk behaviors, such as having multiple partners, until the outbreak is under control. They try to get the word out to the LGBT community through dating apps, at events and sharing with community leaders.
This is a shift in strategy from earlier in the summer when officials focused on vaccinating only those infected and their contacts. As infections swelled last month, state and local health officials have been unable to keep up with the infection rate, a person familiar with these efforts said.
The White House on Tuesday named Robert Fenton the national coordinator for the monkeypox response, with Demeter Daskalakis as deputy coordinator. The two will hold their first press conference on the response efforts on Thursday.
“The president is always looking for ways we can do more to stop the spread of monkeypox,” an administration official said. “And with Bob Fenton and Dr. Daskalakis at the helm as White House coordinators, we will further ramp up our full and urgent government response.”
The federal government said it plans to ship more than 700,000 doses to states, in addition to the 300,000 already designated, but officials have not detailed plans for any additional doses.
“Once the data showed that this outbreak was different from previous outbreaks and transmissible quickly, we scaled up our overall response, rapidly accelerating schedules to provide more than one million doses of vaccines,” the administration official said.
Doctors and public health officials say vaccine doses have been slow to come in, and doctors worry there won’t be enough to meet demand, driven in part by people at high risk of infection, such as health care workers and men in monogamous relationships.
In San Francisco, local officials have ordered 35,000 doses for the city, but so far have only received about 12,000, said Tyler Temer, CEO of the San Francisco AIDS Foundation. He said his clinic has 10,000 people on a waiting list and has received just over 1,000 doses.
For the vaccine to be most effective, a person needs two doses.
In New York City, demand has also outpaced supply. Among a major group in which infections were particularly high — black men who have sex with other men — demand was low, said Celine Gunder, an infectious disease specialist in New York. She said more work needs to be done to reach those most at risk, many of whom lack health insurance, do not have a primary care doctor or are stigmatized for having sex with other men.
“What we see among the cases is that roughly 30% to 40% of the cases are in men of color or transgender women, however, if you look at who’s lining up to get vaccinated, the vast majority are white men, whether it’s in New York City Where me or my teammates are in Atlanta, we’re seeing the same thing happen,” Gunder said. “And that’s a concern because you’re not reaching that vulnerable population.”
Some states may also see a delay in getting vaccine doses because the federal government has said it won’t ship the entire state’s allocation of vaccines until it starts sharing data on infection rates and demographics, something some states argue they can’t do because it’s privacy laws, Marcus said. Plessia, chief medical officer of the Association of State and County Health Officials.
For those who do become infected, doctors say they face hours of paperwork in order to come up with a smallpox treatment called Tpoxx that is believed to work on monkeypox patients. Gaunder and other doctors said this process discouraged some providers from treating monkeypox patients.
The federal government has tried to simplify the process, but because Tpoxx is not approved by the Food and Drug Administration for treating monkeypox, government officials want to make sure they have data on who receives it to gauge its safety and effectiveness. Someone familiar with the process.
Public officials and doctors said they are pressing the White House to declare a public health emergency, a move that could free up Covid funding for use in fighting monkeypox, remove some administrative barriers to accessing Tpoxx and improve data sharing between states and the federal government. .
“Declaring a federal public health emergency will help mitigate some of the problems we currently have, but resources should follow,” said David Harvey, executive director of the National Coalition of Sexually Transmitted Diseases Managers.
Internally, frustrations about the administration’s response have led to some finger-pointing between the White House and the Department of Health and Human Services, people close to the administration said.
The White House said it would allow Health and Human Services Secretary Xavier Becerra to decide whether to declare a public health emergency.
Many of the problems doctors and health officials wrestle with over the monkeypox response are similar to those they faced during the Covid pandemic — a lack of testing, mixed messages, and a lack of enough vaccines to meet demand. While monkeypox is a much different virus from Covid – thought to spread mostly through skin-to-skin contact, rather than through the air – it has highlighted flaws still in the government’s ability to respond to new outbreaks.
“We are fundamentally unprepared in public health for a crisis response,” said Andy Slavett, who led the White House’s response to Covid during Biden’s first year in office. “And we have a very beleaguered public health system to boot. These are the things that Congress needs to fix, that inside the administration needs to fix. There are huge demands for this work, and there are reforms that have to happen.”