While the new cases have been overwhelmingly in the gay and bisexual community, experts warn the virus is likely to spread to other groups. The first two U.S. cases of monkeypox in children were confirmed Friday, probably the result of sharing a household with an infected adult. But federal health authorities said there was no evidence yet of sustained transmission among broader population groups.
While some health officials believe an emergency declaration is necessary to give the government authority to cut through red tape and collect data about the virus’s spread, others argued the move is mostly symbolic and will not address vaccine shortages, treatment barriers and other challenges that have hindered the U.S. response, said three people who spoke on the condition of anonymity because they were not authorized to comment.
Officials also have raised questions about whether such a declaration is warranted for a virus yet to be linked to a single confirmed U.S. death. The strain of monkeypox implicated in this outbreak is tied to fever, lesions and severe pain that may last for weeks, in addition to complications in pregnant women, children and other vulnerable people.
Officials are hoping to make a decision on the emergency declaration later this week, tied to a planned announcement that about 800,000 additional vaccine doses will be distributed following completion of a review by the Food and Drug Administration, said two of the people.
The decision also is complicated by domestic politics. Advocacy groups and health associations have called on the Biden administration to declare public health emergencies for abortion and gun violence, and the White House has said it is considering a broader emergency declaration for climate change, sparking debate about which issues to prioritize. The Biden administration has also continued to renew public health emergency declarations, which expire every 90 days, for opioids and the coronavirus.
Officials at the Department of Health and Human Services have privately acknowledged that it is unclear whether an emergency declaration is needed.
A declaration is “a tool that could be used to both align with WHO and raise additional awareness, as well as provide significant justification for HHS to use (though limited) tools that would aid in the response,” according to a memo sent to President Biden on Sunday, a copy of which was obtained by The Washington Post.
White House officials say the decision rests with HHS Secretary Xavier Becerra, and that they continue to be concerned about the slow pace of the response. Patients say they still face days-long delays in getting test results, physicians have complained about bureaucratic barriers when trying to prescribe treatment, and officials such as New York Mayor Eric Adams (D) have called for more vaccine doses as their existing supply is rapidly exhausted.
“Our focus is on getting HHS to move as quickly as possible … it’s about strengthening and accelerating the response, not just tacking on a different name,” said an official familiar with the response, saying Biden “is pushing HHS to get vaccine allocations out the door, and pushing FDA to get the vaccine cleared in the next few days, without cutting corners.”
Becerra told CNN on Monday that his department is still reviewing the merits of a declaration. “We want to get ahead of [monkeypox]. You don’t want it to become a part of life. But how many people have died compared to covid?” he said. “Zero … We declare public health emergencies based on the data and the science, not on our worries.”
Some outside experts contend a 90-day emergency declaration could be an important tool to focus the response.
“This could allow for all hands on deck to mobilize as big an effort as possible,” said Jennifer Kates, who leads global health policy for the Kaiser Family Foundation, a nonpartisan think tank. “To prevent this from becoming endemic — and hopefully not being too late.”
Kates added that emergency declarations should be reserved for “truly unique events,” adding, “In the case of monkeypox, those criteria are being met. It’s crossing states, it’s spreading rapidly, it’s never happened here before, and it has all these risks associated with it.”
The White House is also closing in on a national monkeypox coordinator, having concluded the role is necessary to manage an increasingly sprawling response that has drawn in Chief of Staff Ron Klain — who coordinated the U.S. response to Ebola during the Obama administration — as well as White House coronavirus coordinator Ashish Jha, infectious-disease expert Anthony S. Fauci, and dozens of other national security and health officials. Two people who were not authorized to discuss the plan said the administration is considering people with expertise in epidemic response and government operations.
The White House declined to comment on the discussions.
Some worry that it may already be too late to stop the virus from gaining a permanent foothold in this country based on the rapid increase in cases and the difficulties in accessing tests.
“I think if we’ve allowed monkeypox to become endemic in the U.S. — and we may have already crossed that threshold — then it will be looked back on as among the biggest public health failures of recent times,” said Scott Gottlieb, who led the FDA during the Trump administration and has advised the Biden administration on the coronavirus.
Biden officials counter that the virus can still be contained, pointing to the United States’ stockpile of treatments and vaccines, as well as the rapidly increasing availability of testing.
“There is no other place in the world where they have 300,000 doses of vaccines … distributed to the states, as we have here in America,” Becerra said on Monday.
Some health officials have argued that declaring an emergency would allow the administration to unlock authority to collect data about monkeypox cases and vaccinations that are not currently being shared with the federal government.
While the Centers for Disease Control and Prevention estimates that more than 1.5 million men who have sex with men are eligible for the vaccine, “we at CDC currently have no data on who’s been vaccinated,” CDC Director Rochelle Walensky said in a Washington Post Live virtual event on Friday.
FDA officials also said they are waiting on the emergency decision before pursuing a separate declaration that would expedite the use of medical countermeasures. A similar move during the coronavirus response allowed pharmacists to vaccinate young children and doctors to vaccinate out-of-state patients.
Meanwhile, those on the front lines say the response continues to be overly bureaucratic, leading to a byzantine maze for patients who test positive and can experience days of often-searing pain. One man in New York City told The Post about an eight-day saga to get treated that began last week, as he navigated among multiple providers that provided misleading or incorrect information, including being rebuffed by an urgent care clinic.
Slow access to testing, treatment and vaccines in the early U.S. monkeypox response have been a “bit of a debacle” that has paralleled missteps in the early coronavirus response, said Megan Ranney, an emergency physician and academic dean of the Brown University School of Public Health.
“I can’t help but wonder if part of the delay is that our public health workforce is so burned out,” Ranney added. “Everyone who’s available to work on epidemiology or contact tracing is already doing it for covid.”
Laurie McGinley and Lena H. Sun contributed to this report.