Health and Science

White House scrambles to play catch-up on monkeypox response

Shannon Pettypiece
People protest during a rally calling for more government action to combat the spread of monkeypox at Foley Square on July 21, 2022 in New York City. The Biden administration is undergoing a course correction in its response to the monkeypox outbreak after weeks of logistical and bureaucratic delays providing testing, treatments and vaccines.
Jeenah Moon | Getty Images News | Getty Images

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

Biden officials acknowledge they are now playing catch-up as case numbers grow faster than initially expected, said people close to the administration, noting the number of infections has jumped from dozens to thousands in a short amount of time.

As part of its new approach, the administration is working to drastically increase the number of people vaccinated against monkeypox and improve access to an experimental treatment for those infected, in addition to naming a monkeypox coordinator to manage the response from the White House across agencies and with state and local governments.

Still, the administration faces a maze of obstacles, according to a dozen doctors on the frontlines and former public health officials who spoke with NBC News.

"I feel like we still have the opportunity to continue 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 led the Chicago Department of Public Health for nearly two decades.

"Public health needs to be resourced adequately, the vaccine supply needs to be increased, and communication efforts really need to be ramped up. But all those things can happen and can lead to control of this outbreak. It's not too late," Morita said.

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

In total, the U.S. has reported nearly 6,000 cases since the beginning of May. The total worldwide exceeds 20,000.

With the virus currently spreading almost entirely among men who have sex with men, the administration's strategy has largely been focused on vaccinating the most high-risk individuals, which include men who have had multiple male partners in a two-week period or those with known exposure.

More recently, though, administration officials have urged other men who have sex with men to cut down on high-risk behavior, like having multiple partners, until the outbreak is under control. They're attempting to get that word out to gay, transexual and bisexual communities through dating apps, at events and engagement with community leaders.

That's a shift in strategy from earlier in the summer when officials were focused on vaccinating only those who had been infected and their close contacts. But as infections ballooned in the past month, state and local health officials were not able to keep pace with the rate of infections, said a person familiar with the efforts.

Illumina CEO Francis DeSouza on sequencing monkeypox to develop vaccines, diagnostics
Illumina CEO Francis DeSouza on sequencing monkeypox to develop vaccines, diagnostics

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

"The President is always looking at ways we can do more to stop the spread of Monkeypox," said an administration official. "And by having Bob Fenton and Dr. Daskalakis at the helm as White House coordinators, we will ramp up our urgent, whole of government response even more."

The federal government has said it plans to ship more than 700,000 doses to states, on top of the 300,000 already allocated, but officials haven't detailed plans for any additional doses.

"Once the data showed that this outbreak was different than past ones and transmitting rapidly, we scaled up our comprehensive response, rapidly accelerating timelines to make over one million doses of vaccines available," the administration 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 from those at lower risk of getting infected, like health care workers and men in monogamous relationships.

In San Francisco, local officials requested 35,000 doses for the city but so far have only around 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 gotten just over 1,000 doses, he said.

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

Not clear that monkeypox is confined to gay and bisexual groups, says WHO
Not clear that monkeypox is confined to gay and bisexual groups, says WHO

In New York City, demand has also far outstripped supply. But among one key group where infections have been particularly high — Black men who have sex with other men — demand has been 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 lack health insurance, don't have a primary care doctor or are stigmatized for having sex with other men.

"What we're seeing among cases is that some 30% to 40% of cases are in men of color or trans women of color, and yet, if you look at who's lining up for vaccination, the vast majority is white men, whether it's in New York City where I am or my colleagues down in Atlanta, we are seeing the same thing play out," said Gounder. "And that is a concern because you're not reaching that high risk population."

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

For those who do get infected, doctors say they face hours of paperwork in order to get access to a smallpox treatment called Tpoxx that's believed to work on monkeypox patients. That process has discouraged some providers from treating monkeypox patients, Gounder and other doctors said.

The federal government has tried to streamline the process, but because Tpoxx isn't approved by the Food and Drug Administration for treating monkeypox, government officials want to ensure they are getting data on who is receiving it to gauge its safety and effectiveness, said a person familiar with the process. 

Public 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 to be used for monkeypox, remove some administrative barriers to accessing Tpoxx and improve data sharing between states and the federal government.

"The declaration of a federal public health emergency will help alleviate some of the problems we currently have, but resources must follow," said David Harvey, executive director of the National Coalition of STD Directors.

Internally, frustrations over the administration's response have led to some finger-pointing between the White House and Department of Health and Human Services, said people close to the administration.

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

Many of the issues doctors and health officials have been grappling with around the response to monkeypox are similar to those faced during the Covid pandemic — a lack of testing, mixed messaging and not enough vaccines to meet demand. While monkeypox is a much different virus than Covid — it is believed to be spread mostly through skin-to-skin contact, not through the air — it has highlighted the flaws that remain in the government's ability to respond to new outbreaks.

"We're not fundamentally set up in 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've got a very beleaguered public health system to boot. Those are things that Congress needs to fix, that those within the administration needs to fix. There are big requests for that work, and there are reforms that need to happen."