U.S. Declares Monkeypox a Public Health Emergency—Here's What That Means

Following in the footsteps of the World Health Organization, the Biden Administration has just declared monkeypox an emergency.

monkeypox

Monkeypox is now a public health emergency, both in the U.S. and globally. Following on the heels of the World Health Organization's July 23 announcement, the Biden administration has just declared monkeypox a public health emergency in response to the significant rise in cases around the country.

"We are prepared to take our response to the next level in addressing this virus. We urge every American to take monkeypox seriously," Health and Human Services (HHS) Secretary Xavier Becerra said in a Twitter statement.

White House Press Secretary Karine Jean-Pierre, in a press briefing on Thursday, added that the public health emergency declaration will "accelerate the vaccine production and distribution. This includes new dosing strategies that have the potential to increase the number of available doses by five fold."

For the WHO's July 23 declaration of a global health emergency, Director-General Tedros Adhanom Ghebreyesus acted as a "tie breaker" after members of the International Health Regulations Emergency Committee failed to come to a consensus on the announcement.

"We have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little, and which meets the criteria in the International Health Regulations," Dr. Ghebreyesus said in a statement. "For all of these reasons, I have decided that the global monkeypox outbreak represents a public health emergency of international concern."

Monkeypox is a virus that's related to smallpox, but it's much milder. It has been endemic in Western and Central Africa for nearly 50 years, but the scale of this outbreak is unprecedented. Right now, Dr. Ghebreyesus added, the virus seems to be largely spreading between men who have sex with men, and the majority of new cases are in Europe.

Worldwide, there have been more than 26,864 confirmed cases of monkeypox in 88 countries, according to data from the Centers for Disease Control and Prevention (CDC). In the U.S. alone, there are 6,617 confirmed cases.

Here's what to know about monkeypox's new status as a public health emergency, both in the U.S. and abroad, and what it means for the trajectory of the outbreak.

Declaring Monkeypox a Public Health Emergency

Monkeypox is not a particularly deadly disease—it's rarely fatal, and is self-limiting, which means it can clear up on its own in a matter of weeks. But there are certain advantages for giving the virus a public health emergency distinction, explained David Weber, MD, MPH, distinguished professor of medicine, pediatrics, and epidemiology at the University of North Carolina Chapel Hill.

"[Naming a virus a PHEIC] does help mobilize support among all the member nations of the UN for increasing planning, making resources available for combating the illness, building up supplies of drugs and vaccines, and making the public more aware of the nature of the problem," Dr. Weber told Health.

In the U.S., naming an outbreak a public health emergency allows HHS and the CDC to use funds to manage the health crisis.

As part of declaring monkeypox a public health emergency, the WHO has made recommendations for countries based on presence of monkeypox cases, modes of transmission, and manufacturing abilities.

In countries experiencing human-to-human transmission of monkeypox, the goal, according to the WHO, is to:

  • Stop transmission and protect vulnerable groups
  • Intensify surveillance and public health measures
  • Strengthen clinical management and infection prevention and control in healthcare settings
  • Accelerate research of vaccines, treatments, and other tools
  • Establish travel recommendations to avoid further spread

There are, however, concerns that designating monkeypox a global health emergency could further stigmatize gay and bisexual men, the community that has been most affected by the recent outbreak. Another stipulation of the declaration is to ensure that does not happen.

"It is exceptionally important that the existence of a public health emergency of international concern and the intensification of surveillance and control efforts are not used as a means of coercive surveillance or for imposition of measures that would impede the dignity and human rights of the people affected," Mike Ryan, MD, MPH, executive director of the WHO Health Emergencies Program, said during a media briefing.

A Version of Monkeypox That's Not Well Understood

Aside from the growing number of monkeypox cases worldwide, there are a number of other factors for this specific monkeypox outbreak that went into the WHO's decision to name it a public health emergency.

The virus's rapid spread—especially to countries that have not typically seen it before—was one deciding factor, Dr. Ghebreyesus said his statement. CDC data shows that the majority of cases are in countries that have not historically reported monkeypox.

The specific monkeypox virus being seen in this outbreak also looks different from the virus that was previously known to cause disease. This strain of monkeypox, though related to the endemic West African monkeypox virus, has a number of mutations, Dr. Weber said. This means that it's unpredictable, compared to what's typically known about the virus.

Though it's unclear how those mutations are affecting the virus, there are a few things that have become apparent in the current outbreak. "This is by far the largest outbreak we've ever seen, and there clearly is sustained human-to-human transmission," Dr. Weber said. "Now, whether it's actually more infectious or it's just spreading in the same mechanisms still needs to be further worked out, but it's clearly different than earlier outbreaks."

Along with increased human-to-human transmission, the symptoms of this monkeypox virus also look slightly different. Monkeypox was previously known to present as fever, chills, swollen lymph nodes, and large amounts of monkeypox lesions on the body, according to Dr. Weber.

But "what we're seeing with this outbreak is many people don't have fevers at all," Dr. Weber said. "Many don't have chills or other body symptoms before they develop the rash; [and] the rash, instead of having many lesions, can have only a few lesions on the body or even a single lesion."

U.S. Response to Monkeypox

In the U.S. specifically, the response to the monkeypox has come under fire in the past weeks, being called "sluggish." Although the first cases of monkeypox were reported in May, it wasn't until late June when the U.S. Department of Health and Human Services (HHS) increased testing capacity, giving access to monkeypox tests to commercial laboratories.

Now, five commercial lab companies—Aegis Science, Labcorp, Mayo Clinic Laboratories, Quest Diagnostics, and Sonic Healthcare—have the ability to test for the disease. As of Monday, the CDC estimates that 80,000 specimens can be tested for monkeypox weekly.

Another pain point: vaccine distribution.

The FDA also came under fire last week when The New York Times reported that the agency let more than 20 million monkeypox vaccines expire in storage over the last decade.

"When the first two cases were known by the CDC back in May we were meeting the moment at that time," Press Secretary Jean-Pierre said Thursday. "So now again, it's spreading much more rapidly, the dynamic of it has changed."

And even with the monkeypox vaccines that the U.S. did have available, there were still delays initially in getting shots into arms.

The U.S. currently has two vaccines that can protect against monkeypox: ACAM2000, an older vaccine initially meant for smallpox but that can also protect against monkeypox; and Jynneos, a newer vaccine that has a lower supply.

Although the U.S. has millions of doses of ACAM2000 stockpiled in its Strategic National Stockpile (SNS), the vaccine carries adverse risks people with certain health conditions. That makes Jynneos the preferred option, but at first, the U.S. was only able to offer up 56,000 doses when it first started implementing monkeypox prevention strategies.

On July 7, the HHS announced it was making 144,000 Jynneos doses available, with another 2.5 million doses ordered and expected through the end of 2022 and into 2023.

That number has increased to 5.5 additional doses ordered, White House Press Secretary Jean-Pierre said on Thursday. On August 2, the White House also named two coordinators to lead a Monkeypox Response Team, which is aiming to help increase vaccinations, tests, and treatments to curb the monkeypox outbreak.

Despite the slower response, the U.S. does have strategies in place to help slow the spread of monkeypox—a luxury that many other places do not have. "Some of these countries have much less access to diagnostics and vaccines, making the outbreak harder to track and harder to stop," Dr. Ghebreyesus said in a July 20 video shared to Twitter.

That brings us back to the necessity of calling monkeypox a public health emergency: so that countries across the globe are encouraged to share information with one another about vaccines, drug treatments, diagnostic techniques, and other strategies so that, hopefully, cases don't spike out of control, Dr. Weber said.

"We do need to think of equity as well, and helping countries that don't have as much access as developed countries to therapies and vaccines to be able to obtain those for treating their own populations," Dr. Weber said. "Because ultimately, we want to reduce monkeypox everywhere, because that helps us as well."

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