WASHINGTON – The Biden administration is making a course correction in its response to the monkeypox outbreak after weeks of logistical and bureaucratic delays in delivering tests, treatments and vaccines.
Biden officials admit they are catching up now as case numbers are rising faster than originally expected, people close to the administration said, noting the number of infections has risen from tens to thousands in a short space of time.
As part of its new approach, the administration is working to dramatically increase the number of people vaccinated against monkeypox and improve access to an experimental treatment for those infected, in addition to naming a monkeypox coordinator to interagency and manage the White House response with state and local governments.
Still, the administration faces a maze of roadblocks, according to a dozen frontline doctors and former public health officials who spoke to NBC News.
“I feel like we still have the ability to continue to control this, but it’s really about sourcing the resources,” said Julie Morita, who advised President Joe Biden during the Covid transition and nearly the Chicago Department of Public Health led two decades.
“Public health needs to be adequately resourced, vaccine supplies need to be increased, and communication efforts really need to be stepped up. But all of these things can happen and lead to controlling this outbreak. It’s not too late,” Morita said.
This week, New York and California were among numerous states to declare public health emergencies, while the Centers for Disease Control and Prevention reported infections in all but two states. According to an NBC News analysis of CDC data, the seven-day average of reported new cases rose from 45 on July 11 to 214 just two weeks later.
Overall, the US has reported nearly 6,000 cases since early May. The total number worldwide exceeds 20,000.
Because the virus is currently spreading almost exclusively among men who have sex with men, the administration is of the opinion strategy has largely focused on vaccinating those at highest risk, including men who have had multiple male partners within a two-week period or those with known exposure.
More recently, however, administration officials have urged other men who have sex with men to reduce risky behaviors, such as multiple partners, until the outbreak is under control. They try to spread the word in gay, transgender and bisexual communities through dating apps, at events and by working with community leaders.
This is a change of strategy from earlier in the summer when officials focused on only vaccinating those who were infected and their close contacts. But as infections skyrocketed over the past month, state and local health officials have not been able to keep up with the infection rate, a person familiar with the effort said.
The White House on Tuesday appointed Robert Fenton as national coordinator for monkeypox control, with Demetre Daskalakis as deputy coordinator. The two will hold their first press conference on the response effort on Thursday.
“The President is always looking at ways we can do more to stop the spread of monkeypox,” said an administration official. “And by bringing Bob Fenton and Dr. With Daskalakis at the helm as White House coordinators, we will further step up our urgent government-wide response.”
The federal government has said it will ship more than 700,000 cans to states in addition to the 300,000 already allocated, but officials have no detailed plans for more cans.
“Once data showed that this outbreak was different from previous ones and was spreading rapidly, we expanded our comprehensive response and rapidly reduced timelines to make over one million doses of vaccine available,” the administration official said.
Doctors and public health officials say doses of the vaccine have been slow to arrive and doctors fear demand will not be enough, now being driven in part by those at lower risk of infection such as health care workers and men in monogamous relationships.
In San Francisco, local officials have requested 35,000 doses for the city, but only around 12,000 doses so far, said Tyler Temeer, CEO of the San Francisco AIDS Foundation. His clinic has 10,000 people on a waiting list and has received just over 1,000 doses, he said.
For the vaccine to be most effective, a person must receive two doses.
In New York City, too, demand has far outstripped supply. But in a key group where infections were particularly high — black men who have sex with other men — demand has been low, said Celine Gounder, an infectious disease specialist in New York. She said more work needs to be done to reach the most vulnerable, many of whom don’t have health insurance, don’t have a GP or are stigmatized for having sex with other men.
“What we’re seeing among the cases is that about 30% to 40% of the cases are black males or transgender females, and yet if you look at who is lining up for a vaccination, the vast majority are white males, whether it is is in New York City, where I am, or my colleagues down in Atlanta, we see the same thing happening,” Gounder said. “And that’s worrying because you’re not reaching that high-risk population.”
Some states may also be experiencing a delay in obtaining their vaccine doses, as the federal government has announced it will not ship a state’s entire vaccine allocation until they begin sharing data on infection rates and demographics, which some states argue They can’t do this because of privacy laws, said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials.
For those who do get infected, doctors say they face hours of paperwork to gain access to a smallpox treatment called Tpoxx, which is thought to work in monkeypox patients. That process has deterred some providers from treating monkeypox patients, Gounder and other doctors said.
The federal government has tried to streamline the process, but since Tpoxx isn’t approved by the Food and Drug Administration to treat monkeypox, government officials want to make sure they get data on who’s receiving it to gauge its safety and effectiveness, a said Person familiar with the process.
Officials and doctors said they are urging the White House to declare a public health emergency, a move that will free up Covid funds for monkeypox, remove some administrative barriers to accessing Tpoxx, and limit data sharing between states and the federal government could improve .
“Declaring a federal public health emergency will help alleviate some of the issues we are facing right now, but resources must follow,” said David Harvey, executive director of the National Coalition of STD Directors.
Internally, frustrations over 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 has announced it will let Health and Human Services Secretary Xavier Becerra decide whether to declare a public health emergency.
Many of the problems doctors and public health officials are grappling with in relation to the monkeypox response are similar to those they faced during the Covid pandemic – a lack of testing, mixed messages and not enough vaccines to meet demand to satisfy. Although monkeypox is a very different virus from Covid – thought to be spread primarily through skin-to-skin contact rather than airborne – it has highlighted the shortcomings in the government’s ability to respond to new outbreaks to react.
“We’re not fundamentally crisis-response-focused in public health,” said Andy Slavitt, who led the White House response to Covid during Biden’s first year in office. “And on top of that we have a very ailing public health system. These are things that Congress needs to fix, that those within the administration need to fix. There are big requests for this work and there are reforms that need to be done.”
https://www.nbcnews.com/politics/white-house/white-house-scrambles-play-catch-monkeypox-response-rcna41305 White House scrambles to catch up on monkeypox response