Implications of monkeypox declared a public health emergency in the United States

On August 4, the Biden administration declared monkeypox a public health emergency. The announcement follows the World Health Organization‘s declaration of monkeypox a public health emergency of international concern in July. This implies that monkeypox poses a global public health risk due to its international spread, which requires a coordinated international response.

In the United States, before the Biden administration’s declaration, 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 allows the Secretary of Health and Human Services (HHS) to take certain actions to address the threat of any disease or public health crisis. Public health emergencies are not only declared in the event of outbreaks of infectious diseases such as Covid-19 and monkeypox. For example, in October 2017, President Trump declared the “opioid crisis” a “public health emergency.”

It is important to note that a declaration of public health emergency frees up resources allocated to an actual (or emerging) public health crisis. In the case of monkeypox, the federal government can now dramatically increase vaccine production and availability, expand testing capacity, and make testing more convenient. The declaration also facilitates coordination between federal, state and local authorities, particularly regarding access to testing and treatment in conjunction with a prevention campaign among members of at-risk communities, aimed at curbing the spread of the virus. virus.

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

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

No monkeypox-related deaths have yet been reported in the United States, but in the last global outbreak, which began in May of this year, at least 6 deaths occurred outside the United States. Additionally, between 3% and 13% of confirmed cases have been hospitalized. Most hospitalizations are for pain management. Patients often suffer debilitating pain from the rash caused by the virus. Skin lesions can occur anywhere on the body. Common System Features preceding the rash include fever (62%), lethargy (41%), myalgia (31%), headache (27%) and enlarged lymph nodes (56%).

Besides pain management, reasons cited for hospitalizations include oral intake limiting pharyngitis, encephalitis, eye damage, acute kidney injury, and myocarditis.

Men who have sex with men are currently most at risk, but anyone can get monkeypox. And, in fact, increasing numbers of women and children have tested positive for the virus.

What is known for certain is that monkeypox spreads by direct contact with bodily fluids or wounds on the body of a person with monkeypox, or by direct contact with materials, such as clothing and linens, that have touched bodily fluids or wounds. It can also spread through respiratory droplets when people have close, face-to-face contact.

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

In 2019, the Food and Drug Administration (FDA) approved a vaccine called Jynneos for adults 18 and older who are at high risk of exposure to monkeypox or smallpox. Jynneos is the only FDA-approved monkeypox vaccine in the United States. It is given in two doses 28 days apart. On July 15, 2022, the HHS Administration for Strategic Preparedness and Response announced that it had ordered an additional 2.5 million doses of Jynneos to bolster monkeypox preparedness, which will increase available supply from the federal government to more than 6.9 million doses by the middle of 2023.

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

CDC director Dr. Walensky acknowledged that vaccine demand exceeds supply. An additional 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, which will require additional funding from Congress.

The United States 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 weakened immune systems, such as HIV patients, pregnant women, and people with autoimmune diseases.

As for other treatments, the United States has 1.7 million tecovirimat antiviral treatments in its national strategic stockpile. Some doctors use tecovirimat to treat patients with monkeypox. But, this drug has only been approved by the FDA for smallpox.

It is hoped that the declaration of a public health emergency will soon expedite testing and treatment for monkeypox, but also public health messaging on preventing the spread of the disease, especially in vulnerable communities.