Jul 29, 2022 - Health

Flooding the zone to contain monkeypox

Illustration of a hand holding a syringe underneath a giant red dot.

Illustration: Aïda Amer/Axios

Despite ballooning case counts, the Biden administration believes it can stay ahead of and eventually end the monkeypox outbreak in the U.S. by flooding states with additional vaccine doses in the next week.

Why it matters: It's a political gamble. If the virus keeps spreading and demand outstrips doses, the administration will have to ask Congress for more money or declare a public health emergency to free up additional resources.

Driving the news: Health and Human Secretary Xavier Becerra ruled out the immediate need for either option on Thursday but said HHS is monitoring the country's response to an outbreak that's resulted in nearly 5,000 confirmed cases.

  • "We'll weigh any decision based on the response we're seeing throughout the country; we need to stay ahead of this and end this outbreak," Becerra told reporters.
  • Declaring a public health emergency would enable the CDC to collect data and details about questions like how many close contacts of infected people are getting vaccinated and if any of them got the virus.
  • But it could also put a significant crimp in testing until the FDA officially authorizes individual tests.
  • "That would be a major problem if we were back in that space," Jeffrey Klausner, public health professor at the University of Southern California School of Medicine, told Axios, recalling similar issues during the early days of the COVID-19 pandemic.

Some public health experts maintain the administration isn't doing enough.

  • "The United States must continue to ramp up vaccine supply and must move swiftly to implement a comprehensive distribution approach to significantly increase equitable access to vaccines," said Daniel McQuillen, president of the Infectious Diseases Society of America.

By the numbers: So far HHS has distributed 338,000 Jynneos vaccine doses to states and jurisdictions, but federal officials do not know how many of those doses have actually made it into arms.

  • Starting this weekend, states and local jurisdictions can order more doses from a tranche of 786,000 that HHS is making immediately available.
  • HHS' emergency preparedness branch has secured and ordered 5.5 million additional doses through early next year.
  • The U.S. has the bulk drug ingredients for 11.1 million more, but would need large sums to strike contracts with manufacturers.
  • Spending could reach as high as $7 billion, which Congress would need to approve, the Washington Post reported this week.
  • "We don't know what's next, and we need to be prepared for additional spread into broader populations," Dawn O'Connell, administrator at HHS' Administration for Strategic Preparedness & Response, told reporters Thursday.

Where things stand: The virus remains largely confined to gay and bisexual men, federal health officials said Thursday.

  • Immunity through infection or vaccination could offer prolonged immunity, experts say.
  • But getting vaccines out quickly to those who need them is critical, Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, told Axios, and even one dose of the two-dose regimen is better than nothing.
  • "I don't think it's a foregone conclusion that this won't be controlled; I think over time, it will be controlled," Adalja said.
  • The United Kingdom, which has grappled with an outbreak since May, recently started to see a decline in confirmed cases.
  • Anyone can get infected through close, intimate contact.
  • Close household contacts, including two children, have tested positive, and people can transmit monkeypox through other means, like respiratory droplets.

The big concern: Localities are running short on supplies, and many public and sexual health clinics are still trying to play catch up.

  • Washington D.C. Health was forced to cancel second-dose appointments this week, and shortages have led to inequities in testing, treatment and vaccinations, Axios' Chelsea Cirruzzo writes.
  • In Chicago, health officials are warning people to not share drinks, vape pens and to check one another for symptoms before having sex with a new partner.
  • San Francisco declared a state of emergency on Thursday over the monkeypox outbreak, allowing the city to increase testing and vaccine distribution, Axios' Nick Bastone writes.
  • Despite the FDA easing the regulatory process to access the antiviral treatment tecovirimat, experts say it should be even easier to access, especially because the U.S. has 1.7 million doses in its stockpile to use.

The bottom line: With vaccination, testing and treatment available, it's possible to curtail the outbreak before it becomes a wildfire, Ali Khan, dean of the College of Public Health at the University of Nebraska, told Axios.

"It's never too late: the problem is the longer you wait, the more elbow grease that's required to get the job done," Khan said.

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