U.S. declares health emergency over monkeypox outbreak

Philadelphia health officials welcomed the federal government’s decision to declare a public health emergency Thursday to bolster the response to the monkeypox outbreak.

Philadelphia Health Commissioner Cheryl Bettigole said the move could create funding for the city Department of Public Health to partner with LGBTQ-focused organizations to disseminate information and vaccines.

“This is what we’ve been wanting,” she said, noting the federal government hasn’t shared how much funding the city might receive. “We do need help.”

But she said the move does not resolve national vaccine shortages that have left Philadelphia with nowhere near enough vaccines to meet its growing needs.

The city is currently offering just one dose of the vaccine, rather than the CDC’s recommended two-dose series. Even with rationing, the city likely needs around double the supply it currently has been allotted, about 5,000 doses as of this week, Bettigole said.

“People legitimately feel they should be vaccinated, and they’re right,” she said.

People who have called Philadelphia’s hotline, 215-685-5488, to inquire about vaccinations have found themselves waiting in virtual lines behind 100 people or more. Bettigole described the call volume as “huge.”

The U.S. Department of Health and Human Services announcement will free up federal money and other resources to fight the virus that has infected more than 6,600 Americans. Monkeypox can cause fever, body aches, chills, fatigue, and pimple-like bumps on many parts of the body.

The declaration comes as the Biden administration has faced criticism over monkeypox vaccine availability. As in Philadelphia, clinics in major cities such as New York and San Francisco say they haven’t received enough of the two-shot vaccine to meet demand, and some have had to stop offering the second dose to ensure supply of first doses.

» READ MORE: Monkeypox vaccine limits cause frustration and fear in Philly

The White House said it has made more than 1.1 million doses available and has helped to boost domestic diagnostic capacity to 80,000 tests per week.

The monkeypox virus spreads through prolonged and close skin-to-skin contact, including hugging, cuddling, and kissing, as well as sharing bedding, towels, and clothing. The people who have gotten sick so far have been primarily men who have sex with men. But health officials emphasize that the virus can infect anyone.

Philadelphia reported 84 cases as of Tuesday, the latest figure available. This is almost half of Pennsylvania’s 173 cases. New Jersey is reporting 188 cases. The official tallies, however, are widely considered an undercount.

Bettigole also worries the city isn’t able to notify all the people who have been exposed to monkeypox because the nature of how monkeypox is spreading makes contact tracing difficult.

“If people are having anonymous sex they’re not going to be able to get us contacts,” she said.

Philadelphia currently is prioritizing for vaccines people with known exposures to the virus, since those administered vaccines before showing symptoms have a good chance of staving off the worst of the infection. The U.S. so far has not reported any deaths, but monkeypox causes lesions and rashes that can be extremely painful and last for up to a month.

The vaccine being distributed, JYNNEOS, is recommended for two-dose series over 28 days. A single shot of the vaccine appears to provide robust protection against the illness for the short term, and second doses are still effective if they are administered more than a month after the first dose.

The most effective treatment for monkeypox, the drug TPOXX, is also in limited supply, Bettigole said. The city has enough to provide only 51 treatments, and distribution is complicated by paperwork required by federal authorities.

Bettigole says she is seeking more doses for Philadelphia.

HHS Secretary Xavier Becerra announced the emergency declaration during a call with reporters. During the call, Food and Drug Administration Commissioner Robert Califf said regulators were reviewing an approach that would stretch supplies by allowing health professionals to vaccinate up to five people — instead of one — with each vial of JYNNEOS.

Under this so-called “dose-sparing” approach, physicians and others would use a shallower injection under the skin, instead of the subcutaneous injection currently recommended in the vaccine’s labeling.

Califf said a decision authorizing that approach could come “within days.”

That would require another declaration, to allow the government to alter its guidelines on how to administer the vaccine, officials said.

» READ MORE: Are you at risk of getting monkeypox? Here’s everything you need to know.

Under the declaration, HHS can draw from emergency funds, hire or reassign staff to deal with the outbreak, and take other steps to control the virus.

Thursday’s declaration is an important — and overdue — step, said Lawrence Gostin, a public health law expert at Georgetown University.

“It signals the U.S. government’s seriousness and purpose, and sounds a global alarm,” he said.

For example, the announcement should help the federal government to seek more information from state and local health officials about who is becoming infected and who is being vaccinated. That information can be used to better understand how the outbreak is unfolding and how well the vaccine works.

A public health emergency can be extended, similar to what happened during the COVID-19 pandemic.

Gostin said the U.S. government has been too cautious and should have declared a nationwide emergency earlier. Public health measures to control outbreaks have increasingly faced legal challenges in recent years, but Gostin said he didn’t expect that to happen with monkeypox.

“It is a textbook case of a public health emergency,” Gostin said. “It’s not a red- or a blue-state issue. There is no political opposition to fighting monkeypox.”

The government’s decision comes after others have made similar declarations.

Last week, the World Health Organization called monkeypox a public health emergency, with cases in more than 70 countries. A global emergency is WHO’s highest level of alert, but the designation does not necessarily mean a disease is particularly transmissible or lethal.

California, Illinois, and New York have all made declarations in the last week, as have New York City, San Francisco, and San Diego County.

Earlier this week, the Biden administration named top officials from the Federal Emergency Management Agency and the Centers for Disease Control and Prevention to serve as the White House coordinators to combat monkeypox.

This story has been updated to clarify that the national declaration could mean additional funding for Philadelphia.

This article contains information from the Associated Press.