White House struggles to catch up to monkey pox response

WASHINGTON – The Biden administration is undergoing a course correction in its response to the monkeypox outbreak after weeks of logistical and bureaucratic delays in providing tests, treatments and vaccines.

Biden officials acknowledge they are now catching up as the number of cases grows faster than initially expected, said people close to the government, noting that the number of infections has risen from tens to thousands in a short space of time.

As part of its new approach, the government is working to dramatically increase the number of people vaccinated against monkeypox and improve access to experimental treatment for those infected, in addition to appointing a monkeypox coordinator to monitor the White House’s response. Home about agencies and with state and local governments.

Still, the government faces a maze of hurdles, according to a dozen frontline doctors and former public health officials who spoke to NBC News.

“I feel like we still have the ability to control this, but it’s really a matter of getting the resources,” said Julie Morita, who advised President Joe Biden on Covid during the transition and the Chicago Department of Health. Public Health nearly two decades.

“Public health needs to be adequately funded, vaccine supply needs to be increased, and communication efforts really need to be stepped up. But all of those things can happen and lead to containment of this outbreak. It’s not too late,” Morita said.

This week, New York and California were among many states to declare public health emergencies, while the Centers for Disease Control and Prevention reported infections in all but two states. According to an NBC News analysis from CDC data, the seven-day average of reported new cases rose from 45 on July 11 to 214 just two weeks later.

In total, the US has reported nearly 6,000 cases since early May. The total exceeds 20,000 worldwide.

With the virus currently spreading almost entirely among men who have sex with men, the government has strategy is largely focused on vaccinating the most at-risk individuals, including men who have had multiple male partners in a two-week period or men with known exposure.

More recently, however, government officials have urged other men who have sex with men to reduce risky behaviors, such as having multiple partners, until the outbreak is under control. They’re trying to get that word out to gay, transgender, and bisexual communities through dating apps, at events, and connecting with community leaders.

That’s a shift in strategy from earlier in the summer, when officials focused on vaccinating only those infected and their close contacts. But as the number of infections soared in the past month, state and local health officials were unable to keep up with the number of infections, said a person familiar with the efforts.

The White House on Tuesday appointed Robert Fenton as the national coordinator for monkeypox response, with Demetre Daskalakis as deputy coordinator. The two will hold their first press conference on the response efforts on Thursday.

“The president is always looking for ways we can do more to stop the spread of Monkeypox,” said a government official. “And by having Bob Fenton and Dr. Daskalakis at the helm as White House coordinators, we will step up our urgent, full-scale response from the government.”

The federal government has said it plans to ship more than 700,000 doses to states, in addition to the 300,000 already allocated, but officials have no detailed plans for additional doses.

“As the data showed that this outbreak was different from the previous one and spread quickly, we scaled up our comprehensive response and quickly accelerated timelines to make more than a million doses of vaccines available,” the board official said.

Doctors and public health officials say doses of the vaccine have been slow to arrive, and doctors are concerned there won’t be enough to meet demand, driven in part now by people at lower risk of getting infected, such as health professionals and men in monogamous relationships.

In San Francisco, local officials requested 35,000 doses for the city, but so far they only have about 12,000 doses, said Tyler Temeer, CEO of the San Francisco AIDS Foundation. His clinic has 10,000 people on a waiting list and has received just over 1,000 doses, he said.

For the vaccine to be most effective, a person must receive two doses.

Image: Gerald Febles shows monk pox lesions on his hands on July 3, 2022 in New York.  (Benjamin Ryan / NBC News)

Image: Gerald Febles shows monk pox lesions on his hands on July 3, 2022 in New York. (Benjamin Ryan / NBC News)

In New York City, the demand is also much greater than the supply. But among a key group where infections were particularly high — black men who have sex with other men — demand was low, said Celine Gounder, an infectious disease specialist in New York. She said more work needs to be done to reach those most at risk, many of whom don’t have health insurance, don’t have a primary care doctor or are stigmatized for having sex with other men.

“What we see in the cases is that about 30% to 40% of the cases are men of color or trans women of color, and yet if you look at who is queuing for vaccination, the vast majority are white men, whether it’s in New York City where I am or my colleagues in Atlanta, we’re seeing the same thing happening,” Gounder said. “And that’s a concern because you’re not reaching that high-risk population.”

Some states may also be delayed in getting their vaccine doses because the federal government has said it won’t send a state’s full allotment of vaccines until they start sharing data on infection rates and demographics, something some states claim they can’t. do because of privacy laws, said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials.

For those who become infected, doctors say they have to wait hours of paperwork to access a smallpox treatment called Tpoxx that is believed to work in monkeypox patients. That process has discouraged some health care providers from treating patients with monkeypox, Gounder and other doctors said.

The federal government has tried to streamline the process, but because Tpoxx is not approved by the Food and Drug Administration for the treatment of monkeypox, government officials want to make sure they get data on who is receiving it to measure its safety and effectiveness, said one person familiar with the process.

Officials and doctors said they are pushing for the White House to declare a public health emergency, a move that could free up Covid funding for monkeypox use, remove some administrative barriers to accessing Tpoxx and share would improve data between states and the federal government.

“Declaring a federal public health emergency will help alleviate some of the problems we currently face, but resources must follow suit,” said David Harvey, executive director of the National Coalition of STD directors.

Internally, frustrations with the government’s response have led to a finger point between the White House and the Department of Health and Human Services, people close to the government said.

The White House has said it will let Secretary of Health and Human Services Xavier Becerra decide whether to declare a public health emergency.

Many of the issues doctors and health officials are grappling with around the monkeypox response are similar to those encountered during the Covid pandemic — a lack of testing, mixed messages and not enough vaccines to meet demand. While monkeypox is a very different virus to Covid — it’s believed to be spread primarily through skin-to-skin contact, not the air — it has highlighted the shortcomings that remain in the government’s ability to respond to new ones. outbreaks.

“We are not fundamentally set on public health for crisis response,” said Andy Slavitt, who led the White House response to Covid during Biden’s first year in office. “And we have a very beleaguered public health system to boot. Those are things that Congress has to solve, that have to be solved within the government. There are great demands for that work, and there are reforms that are needed.”

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