After news broke that the US had declared monkeypox a public health emergency, friends and family began asking me, an infectious disease epidemiologist, if monkeypox was about to cause widespread death and chaos. I assured them that the August 4, 2022 Public Health Emergency Declaration is about government resource allocation. Like the World Health Organization’s statement that monkeypox is a public health emergency of international concern, the US statement does not call for non-at-risk individuals to make any changes in their lives.
There have been no deaths from monkeypox in the US yet, but more than 7,000 cases have been diagnosed so far and the spread of the virus to nearly every state is alarming. While most cases still occur in men who have sex with men, the virus is also transmitted through nonsexual skin-to-skin contact, raising the risk of people in other populations contracting the infection. The federal statement aims to slow the spread of the virus among men who have sex with men and prevent it from spreading to new communities.
What is a public health emergency?
Presidents and state governors have the authority to declare a state of emergency when there is a potentially life-threatening situation and the resources routinely allocated to emergency services are insufficient to cope with the situation.
For example, the governor of Kentucky declared a state of emergency in late July 2022 after devastating flooding in the eastern part of the state. The governor requested and received federal assistance to help respond to the flooding. The statement did not mean more flooding was expected. It has just made additional resources available to rescue stranded people and provide essential services, such as shelter and drinking water, to displaced persons.
Likewise, Monkeypox’s emergency statement doesn’t mean the government expects millions more cases in the coming month. It’s about helping health agencies get the vaccines and other tools they need to slow the spread of the virus.
Does the public health emergency demand action from the public?
No. The main thing the emergency statement does is help the U.S. Department of Health and Human Services get more of the funding and other resources it needs to protect the public from a more widespread monkeypox outbreak. At this point, monkey pox is an emergency for the U.S. government’s public health authorities to deal with. It is not an emergency for the public at this time. The purpose of the emergency declaration is to prevent monkeypox from becoming a more widespread threat to public health.
What will the US government do now?
According to the Ministry of Health and Human Services, two important measures will be taken at this stage of the outbreak.
First, the government will step up its efforts to protect at-risk communities by trying to get new vaccine doses faster and increasing access to tests and treatments. Officials are also working with LGBTQI+ communities to educate men who have sex with men about reducing their risk of contracting the monkeypox virus.
Second, the emergency statement calls on all states and other jurisdictions to share data with the Centers for Disease Control and Prevention. It also authorizes the Centers for Medicare and Medicaid Services to collect data on monkeypox testing and hospitalizations. These actions will provide the Department of Health and Human Services with better data on where monkeypox occurs so that the agency can distribute vaccines and the antiviral medication tecovirimat (Tpoxx) to the states and cities that need it most.
Will the statement boost vaccine supply?
The Jynneos vaccine is the only monkeypox-specific vaccine currently approved by the US Food and Drug Administration. The increased demand for monkeypox vaccines has exhausted most of the world’s existing supply of Jynneos. It will be several months before additional doses are manufactured. These new doses are expected to be delivered between late 2022 and mid-2023.
However, the emergency statement explains that the government could use a “new dose-saving approach that could increase the number of doses available by up to five times” — an approach called fractional dosing — to make the vaccine available to more people.
The package insert for the Jynneos vaccine states that it should be given in two 0.5 milliliter doses four weeks apart. The emergency statement outlines a strategy where people will instead be given two 0.1-milliliter doses. If the lower dose is as effective as the full dose, up to five times more people can be vaccinated with the same amount of vaccine.
Fractional dosing is not a new strategy. During a yellow fever epidemic in sub-Saharan Africa in 2016, clinical trials showed that a small fraction of the approved vaccine dose was as effective as a full dose at conferring immunity.
For the current outbreak of monkeypox in the US, the National Institutes of Health will evaluate whether a smaller dose of monkeypox vaccine can be effective, and whether one injection provides about as much protection as two doses.
The emergency statement does not call on schools, businesses, nursing homes or individuals to change their behavior in any way or prepare for future restrictions. Declaring Monkeypox a public health emergency will only increase the resources available to help the government protect the public from this contagious disease.