Implications of Monkeypox being declared a public health emergency in the US

On August 4, the Biden administration declared monkeypox a public health emergency. The announcement comes on the heels of the World Health Organization that declared monkey pox a public health emergency of international concern in July. This means that monkeypox poses a global public health risk through international spread, requiring a coordinated international response.

In the US, prior to the Biden administration’s statement, a growing number of municipalities and even several states—California, Illinois and New York—had declared monkeypox a public health emergency.

A public health statement empowers the Secretary of Health and Human Services (HHS) to take certain actions to address the threat of a disease or some crisis to public health. Public health emergencies are not only declared in the event of outbreaks of infectious diseases such as Covid-19 and monkey pox. For example, in October 2017, President Trump declared the “opioid crisis” a “public health emergency.”

Importantly, a public health emergency declaration releases funds earmarked for an actual (or emerging) public health crisis. In the case of monkeypox, the federal government can now significantly scale up vaccine production and availability, expand testing capacity, and make testing easier. The statement also facilitates coordination between federal, state and local authorities, especially regarding access to testing and treatment in conjunction with a prevention campaign for members of the at-risk communities, aimed at curbing the spread of the virus.

In addition, the statement empowers the Secretary of HHS to conduct and support investigations into the cause, treatment, or prevention of the disease or crisis, in addition to supporting advanced research and development and biosurveillance necessary to address the problem. . Finally, it allows the CDC to access the Infectious Diseases Rapid Response Reserve Fund to prevent, prepare for, or respond to an infectious disease emergency.

More than 26,000 cases of monkeypox have been reported in 87 countries, according to the Centers for Disease Control and Prevention (CDC). With more than 6,500 confirmed cases, the US accounts for 25% of confirmed infections worldwide.

No deaths from monkeypox have yet been reported in the US, but the latest global outbreak, which began in May this year, has left at least 6 fatalities outside the US. In addition, between 3% and 13% of confirmed cases are hospitalized. Most hospitalizations are for pain relief. Patients often suffer debilitating pain from the rashes caused by the virus. Skin lesions can occur anywhere on the body. Common systemic features prior to the rash include fever (62%), lethargy (41%), myalgia (31%), headache (27%), and enlarged lymph nodes (56%).

In addition to pain management, reasons for hospitalizations included pharyngitis restricting oral intake, encephalitis, eye lesions, acute kidney injury, and myocarditis.

Men who have sex with men are currently most at risk, but anyone can contract monkey pox. And in fact, a growing number of women and children have tested positive for the virus.

What is definitively known is that monkey pox is spread through direct contact with bodily fluids or sores on the body of someone who has monkey pox, or through direct contact with material, such as clothing and bedding, that has touched bodily fluids or sores. It can also spread through respiratory droplets when people have close personal contact.

The US has increased testing capacity to 80,000 per week. Nevertheless, the current demand for testing exceeds current capacity in the US in terms of testing supplies.

In 2019, the Food and Drug Administration (FDA) approved a vaccine called Jynneos for adults ages 18 and older who are at high risk of exposure to monkeypox or smallpox. Jynneos is the only FDA-approved monkeypox vaccine in the US. It is given in two doses 28 days apart. On July 15, 2022, HHS’s Administration of Strategic Preparedness and Response announced it had ordered an additional 2.5 million doses of Jynneos to bolster monkeypox preparedness, which will increase the federal government’s available supply to more than 6 halfway through. .9 million doses. 2023.

So far, HHS has made 786,000 doses of Jynneos available to state and local authorities. But lawmakers and local communities have criticized the pace of the response. And because of supply shortages, the FDA is now considering dividing Jynneos doses into fifths.

CDC Director Dr. Walensky has acknowledged that demand for the vaccine exceeds supply. Another 11.1 million doses are stored in Denmark at the manufacturer Bavarian Nordic. However, these doses must be “filled and finished” before they can be administered, requiring additional funding from Congress.

The US also has more than 100 million doses of an older-generation smallpox vaccine called ACAM2000, which is likely effective against monkeypox. But ACAM2000 can have serious side effects and is not recommended for people with compromised immune systems, such as HIV patients, pregnant women, and people with autoimmune disorders.

As for other treatments, the US has 1.7 million courses of the antiviral treatment tecovirimat in its strategic national stockpile. Some doctors use tecovirimat to treat monkey pox patients. But this drug is only approved by the FDA for smallpox.

It is hoped that the announcement of a public health emergency will soon lead to more monkeypox testing and treatment, as well as public health messages about preventing the spread of the disease, particularly in vulnerable communities.

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