Biden administration considering public health emergency in response to monkeypox outbreak

The Biden administration is considering declaring a public health emergency in response to the growing monkeypox outbreak, a senior White House health official said on Friday.

Dr. Ashish Jha, the White House Covid response coordinator, said the administration is looking at how a public health emergency declaration might bolster the U.S. response to the outbreak.

"There's no final decision on this that I'm aware of," Jha said. "It's an ongoing, but a very active conversation at HHS."

Health and Human Services Secretary Xavier Becerra has the authority to declare a public health emergency under the Public Health Services Act. A declaration can help mobilize federal financial assistance to respond to a disease outbreak.

The U.S. has reported more than 2,500 monkeypox cases so far across 44 states, Washington, D.C., and Puerto Rico, according to the Centers for Disease Control and Prevention. The largest outbreaks are in New York, California, Illinois, Florida, D.C. and Georgia.

The Biden administration's response to the outbreak has come under scrutiny from Congress as infections rise. Fifty House Democrats, in a letter to President Joe Biden this week, called for the administration to declare a public health emergency in response to the outbreak.

Senate Health Committee Chair Patty Murray, in a letter to HHS Secretary Becerra, said she is worried about the U.S. response to the outbreak. Murray said some patients and health-care providers do not have the information and resources they need to test for monkeypox and respond to the outbreak.

CDC Director Rochelle Walensky said last week that demand for the vaccines is outstripping the available supply. Many people are struggling to get vaccinated amid long lines outside clinics.

The U.S. has shipped more than 300,000 doses of the monkeypox vaccine, called Jynneos, to city and state health departments so far, Jha told reporters Friday. The Food and Drug Administration is in the process of authorizing an additional 786,000 doses stored at the manufacturer Bavarian Nordic's facility in Denmark for distribution in the U.S.

Jha said some of those shots have started shipping and will arrive in the U.S. this week and next week. The doses can be delivered to city and state health departments once FDA authorization is complete, Jha said. The U.S. has also ordered another 5 million doses that will be delivered through the middle of 2023, according to HHS.

Monkeypox is primarily spreading through skin-to-skin contact during sex. Right now, men who have sex with men are at the highest risk of infection, but anyone can catch the virus through close physical contact. People generally recover in two to four weeks, but the virus causes lesions that can be very painful. No deaths have been reported in the U.S.

The CDC on Friday confirmed the first two cases of monkeypox in children. One case is a toddler in California, and the other is an infant who is not a U.S. resident. The cases are not related and the children likely caught the virus due to transmission within their household, according to CDC.

The children are both in good health and are receiving the antiviral treatment tecovirimat, according to the CDC. Dr. Jennifer McQuiston, a CDC official, told reporters Friday that the health agency is working to make it easier for clinicians to prescribe tecovirimat to patients.

Prescribing tecovirimat for monkeypox comes with an additional layer of bureaucracy right now because it is only FDA approved for smallpox. Monkeypox is in the same virus family as smallpox, but it causes milder disease.

McQuiston said more than 97% of patients with monkeypox who provide demographic information are gay, bisexual or other men who have sex with men.

"While this outbreak is spreading in a particular social network right now, I think we've messaged from the start that there could be cases that occur outside those networks and that we need to be vigilant for it and ready to respond and message about it," McQuiston told reporters.

The U.S. has the capacity to conduct 80,000 monkeypox tests a week after bringing on several commercial labs this month, according to the CDC. But the tests swab the lesions that caused by the virus, which can take weeks from the initial exposure to develop. This means the U.S. likely does not have an accurate picture of how many people are infected because patients can only get tested once symptoms develop.