The federal government plans to ‘step up our work’ on monkeypox after WHO declaration 

Following the World Health Organization’s declaration of monkeypox as a global health emergency on Saturday, the federal government is ramping up its own efforts to respond to the outbreak and trying to keep up with the demand for vaccines.  

The outbreak started in May and now there are over 16,000 cases worldwide and about 2,500 in the United States. The first two cases of monkeypox in children in the United States were recently confirmed and they were “adjacent to the community most at risk,” which is gay men, said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, during an interview with Washington Post Live on Friday. There have been no deaths in the United States from the current outbreak. 

In a statement after the WHO’s announcement Saturday declaring the emergency, Raj Panjabi, director of White House Pandemic Preparedness Office, recapped the Biden administration's efforts to expand testing and vaccine access and educate communities most at risk, but said “that is not enough.” Repeating what the Health and Human Services Department has said, he added: “We must step up our work to aggressively combat this virus and protect communities in the United States that have been affected by monkeypox.” 

Dr. Ashish Jha, White House COVID-19 response coordinator, who has been working on the monkeypox response, said during interviews on the Sunday news shows he is supportive of the WHO’s decision to declare monkeypox a global health emergency, its highest level of alert. 

“Whether we declare a public health emergency here or not will be based on the facts on the ground and what that declaration will allow us to do,” said Jha on “Fox News Sunday.” “No decisions have been made on that so far.” On CBS’s “Face the Nation,” he noted that it is up to HHS officials to make that decision. 

“We're going to continue to look at all sorts of policy options,” Jha continued. “Right now, we think we can get our arms around this thing, but obviously, if we need further tools, we will invoke them as we need them.” 

When asked during the White House briefing on Monday if he had a timing update on the possible emergency declaration, Jha reiterated that the decision is up to HHS “and with any outbreak that evaluation almost sort of begins [on] day one.” Jha said he believes HHS Secretary Xavier Becerra “will make that decision when he thinks that doing so will help with the response.”  The “conversations are ongoing.”

Fifty House Democrats sent a letter to President Biden on Thursday urging his administration to declare a public health emergency for monkeypox, among other actions. Declaring the emergency “would make available a number of authorities to accelerate the federal response and tap into additional resources to procure vaccines and distribute them swiftly across the country,” wrote the lawmakers. “We also welcome the administration’s close consultation with Congress if supplemental appropriations might be needed.”

More Pressure and Questions on the Response

Other members of the president’s party have also put pressure on the administration recently to further scale up its monkeypox response. 

Sen. Patty Murray, D-Wash., chairwoman of the Senate Health, Education, Labor and Pensions Committee, wrote in a letter to Becerra last Tuesday that she is “concerned with the state of the U.S. response to monkeypox” and requested a briefing from HHS officials by August 2. Reps. Adam Schiff, D-Calif., and Carolyn Maloney, D-N.Y, who signed onto the 50-member letter, also sent their own letters to Becerra last Tuesday and Wednesday respectively. Maloney, chairwoman of the House Oversight and Reform Committee, also asked for a briefing and her committee has since been in touch with the department. 

Dawn O’Connell, HHS assistant secretary for preparedness and response, “has spoken to multiple key members about monkeypox and our ongoing response. We’ve also briefed the Hill broadly,” a HHS spokesperson told Government Executive on Monday, “and have ongoing briefings scheduled for this week. We will brief any members who ask and we don’t have any outstanding requests that we haven’t yet fulfilled.” 

CBS’s Margaret Brennan asked Jha in particular about complaints from Schiff as well as from the mayors of New York City and San Francisco, who have argued that the federal government is not doing enough on the monkeypox response. 

“What I would acknowledge is that when we started two months ago, we had a limited supply of vaccines. We have obtained more than any other country, probably more than every other country combined. We have acted swiftly,” Jha replied. “We've gotten 800,000 doses from Denmark over to the United States, just in the last week. We're going to be getting those out in the upcoming couple of weeks.” He added that monkeypox has been around for about 60 years and there were already vaccines and tests for it. 

Since the monkeypox outbreak began HHS has made 374,000 vaccine doses available for ordering and delivered over 191,000 of them to states and cities for free, according to a fact sheet HHS released on Thursday outlining the administration’s vaccine, testing and treatment achievements. “When factoring in doses already delivered to the [strategic national stockpile], those pending at the supplier, and replacement doses, the federal government will have access to more than 6.9 million doses by mid-2023.”

Separately, the CDC, along with the Food and Drug Administration, last Friday made it easier for health care providers to offer the treatment for monkeypox to their patients through a new streamlined process. 

CDC Faces Data Issues Again

Walensky said during the interview with Washington Post Live on Friday that monkeypox is very different from COVID-19 because they already had years of research on monkeypox as well as a test for it. “But I do want to articulate that we’ve never seen the demand for testing that has taken over,” she said. 

There is “one key important similarity” between COVID and monkeypox, which is the “CDC’s inability to see the data in real time,” said Walensky. “While we have been working with our [HHS Assistant Secretary for Preparedness and Response] colleagues to get vaccines out to jurisdictions, we at CDC currently have no data on who has been vaccinated.” When people asked if the administration's distribution and allocation strategy is working, “We at CDC have no authority to receive those data and we haven’t received any of it.” Data on cases “are coming in,” but the CDC only knows about 50% of the race and ethnicity for those cases and about 80% of the ages. 

Science Officials Plot Research Agenda 

Top officials from the White House Office of Science and Technology said in a blog post last week that while the federal government has “rapidly scaled its efforts” to mitigate the monkeypox outbreak, there are some “difficult questions that have arisen during this outbreak.” That is what their new research plan, developed with other government experts, seeks to answer. 

The seven research areas are centered on: characteristics of the virus, safety and effectiveness of the vaccines and therapeutics and equitable distribution of them, diagnostic tools, evaluation of medical countermeasures, environmental risks and mitigation practices, public health communication, and equity and stigma reduction. This list is subject to change as the outbreak evolves. 

This article was updated at 6 p.m. with comments from HHS and Dr. Jha at the White House briefing.