Proponents warn US risks losing control of monkeypox

Infectious disease experts and public health advocates warn that the Biden administration has been too slow in responding to the monkeypox outbreak and that the US risks losing control of the disease.

The monkeypox response mirrors the worst parts of the early days of the coronavirus pandemic, they say, with very limited testing and a slow vaccine rollout leading to a virus spreading undetected.

“Where we have fallen behind is streamlining testing, making vaccines available and streamlining access to the best therapies. All three areas have been bureaucratic and slow, meaning we haven’t been able to get this outbreak under control,” said David Harvey, executive director of the National Coalition of STD Directors (NCSD).

Unlike COVID-19, monkeypox is not a new virus and the strategies to reduce its spread are well known. Biden’s administration officials said they were confident in their approach.

“We as a global community have known it for decades. We know how it spreads. We have tests that help identify people who are infected. We have vaccines that are very effective against it,” Ashish Jha, White House coronavirus response coordinator, said at a recent briefing.

According to the Centers for Disease Control and Prevention (CDC), there are 460 cases in 30 states, Puerto Rico and DC, although experts say this number is almost certainly an undercount, as many people who may be infected do not yet have access to widespread disease. to test.

The government is ramping up its response by expanding testing capacity and broadening access to vaccinations, although critics say the efforts may be coming too late.

“We have been screaming for a month about how bad the diagnostic situation is for monkeypox. And that was really an obvious mistake, which could have been prevented, and it’s very clear that this administration hasn’t learned lessons from early COVID,” said James Krellenstein, co-founder of HIV treatment advocacy group Prep4All.

Jon Andrus, an adjunct professor of global health at George Washington University’s Milken Institute School of Public Health, said the US is lucky that monkeypox isn’t as contagious as COVID-19, or as deadly, because the public health system is underfunded and overdone. is fragmented.

“I think we will keep repeating these mistakes because that is our track record. That’s our track record. We’ve had, what, more than five or six waves of COVID, and we seem to be a bit taken aback each time,” Andrus said. “To stop the transmission, we all have to read from the same page. We all have the same roadmap.”

The administration expanded testing to commercial labs in late June, so providers will soon be able to order tests directly from the labs where they’ve built relationships and jump through fewer hoops.

But it took more than a month for that move to happen, increasing testing capacity from about 8,000 tests per week to 10,000 for the entire system.

Demand is also not evenly distributed across public health lab networks; it’s concentrated in urban areas like New York City, leading to backlogs and frustrated patients waiting days for test results.

Health officials of the Biden administration this week praised efforts to expand testing.

“I strongly encourage all health care providers to have a high clinical suspicion of monkeypox in their patients,” CDC director Rochelle Walensky said during a conversation with reporters. “Patients with a suspicious rash should be tested.”

Monkeypox testing is a relatively simple process of taking a skin lesion. Unlike COVID-19, the CDC already had a previously developed test, but patients were limited to a limited number of specific criteria to qualify for testing.

“We already had tests available. We already had vaccines available. We really should have been a lot more aggressive with testing…and I think this appeals to some of the bureaucracy of both FDA [Food and Drug Administration] and CDC,” said Celine Gounder, an infectious disease specialist and general public health editor at Kaiser Health News.

“They could have done it sooner to get the commercial labs on board. Get academic medical centers tested, hospital labs to develop their own PCR tests. I mean, that’s not very hard to do,’ said Gounder.

The White House is also scaling up its vaccination program, announcing a plan to immediately ship tens of thousands of doses of Jynneos, the only FDA-approved vaccine specifically for monkeypox.

More than a million doses will be made available throughout the year. The CDC is also broadening the eligibility criteria to allow individuals with confirmed monkeypox exposures and suspected exposures to be vaccinated, rather than just those with a confirmed case.

But activists and experts say the administration has moved too slowly and the updated vaccination strategy is nowhere near enough.

“We think this outbreak has already gotten out of hand. So we didn’t include it. Vaccines will not contain it at this time. Because we don’t have enough. Getting them in arms is an expensive and intensive process,” said Harvey of the NCSD.

New York City and Washington, DC, began offering the vaccines to men who have sex with other men or who may have been exposed to the virus. But both cities ran out of supplies less than a day after the launch of their local immunization initiatives. DC Health had to close access about 10 minutes after recordings were made available.

There are about 56,000 Jynneos doses in the strategic national stockpile that will be allocated immediately, officials said, and the government plans to allocate 296,000 doses in the coming weeks.

The US has tens of millions of doses of the smallpox vaccine ACAM2000, but that injection has more dangerous and serious side effects.

According to a spokesperson for Denmark-based manufacturer Bavarian Nordic from Jynneos, 300,000 doses have already been delivered or will arrive in the coming days.

Another 1.1 million filled doses are still under FDA inspection, which is due to end in the coming weeks.

The government also owns bulk materials totaling as many as 15 million doses, but they are still frozen and the administration has not told the company how it plans to have those doses filled.

“U.S. taxpayers have spent money buying and manufacturing these doses so they can be used quickly in the event of an outbreak,” says Prep4All’s Krellenstein.

“Here we have an outbreak and my friends are literally being turned down for vaccination because the Biden administration can’t figure out how to get a million doses from a freezer in Denmark to the United States,” Krellenstein added.

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