As Monkeypox Spreads, US Plans to Declare a Health Emergency

As monkeypox continues to surge in the United States, President Biden’s health secretary plans to declare a national health emergency, perhaps as soon as Thursday, according to a federal official familiar with the discussions.

The declaration, which many experts said was long overdue, would signal that the outbreak now represents a significant threat to Americans and set in motion a variety of measures devised to turn the tide. It would give federal agencies the power to direct money toward developing and evaluating vaccines and drugs, to access emergency funding and to hire additional workers to help manage the outbreak, which began in May.

The World Health Organization declared a global health emergency over the outbreak on July 23.

Mr. Biden has been under intense pressure from activists and public health experts to move more aggressively to combat the monkeypox outbreak. But top federal health officials have thus far resisted declaring an emergency. Xavier Becerra, the secretary of health and human services, has said repeatedly that he is considering it.

Earlier this week, however, Mr. Biden named a veteran emergency response official and a respected infectious disease specialist to coordinate the monkeypox response from the White House — a sign that the administration is stepping up its efforts.

Supplies of the monkeypox vaccine, called Jynneos, have been severely constrained, and the administration has been sharply criticized for moving too slowly to expand the number of doses. Declaring the emergency would not ease that shortage, but the administration may take steps to allow quicker access to tecovirimat, the drug recommended for treating the disease.

News of the administration’s plans was first reported by the Washington Post.

As of Wednesday, the United States had recorded nearly 7,000 monkeypox cases, with the highest rates per capita in Washington, New York and Georgia. More than 99 percent of the cases are among men who have sex with men.

The virus is transmitted mostly during close physical contact; the infection is rarely fatal — no deaths have been reported here — but can be very painful. The United States has among the highest rates in the world, and the number is expected to rise as surveillance and testing improve.

Declaring monkeypox an emergency sends “a strong message that this is important, that it must be dealt with now,” said Anne Rimoin, an epidemiologist at the University of California, Los Angeles, and a member of the WHO’s advisory panel on monkeypox.

dr Rimoin is one of the scientific advisers who urged the WHO to categorize monkeypox as a “public health emergency of international concern,” a designation the organization has used only seven times since 2007. With panelists divided on the matter, Dr. Tedros Adhanom Ghebreyesus, the WHO’s director general, overruled the advisers to declare monkeypox an emergency, a status currently held by only two other diseases, Covid-19 and polio.

The WHO’s declaration told member countries that they should take the seriously outbreak, dedicate significant resources to containing it, and cooperate with other nations by sharing information, vaccines and drugs.

In the United States, demands for stronger action against monkeypox have intensified. Recently, Representative Adam Schiff, Democrat of California, called on the Biden administration to step up the manufacturing and distribution of vaccines, and develop a long-term strategy for combating the virus.

Senator Patty Murray, Democrat of Washington State, who leads the health committee, pushed the Department of Health and Human Services to provide a detailed account of the steps it is taking to contain the outbreak.

AIDS activists, who have been sharply critical of the administration, have been pushing for an emergency declaration for weeks.

“This is all too late,” said James Krellenstein, a founder of PrEP4All, at an advocacy group. “I don’t really understand why they didn’t do this weeks ago.”

Lawrence O. Gostin, director of the O’Neill Institute for National and Global Health at Georgetown University, described an emergency declaration as a “a pivotal turning point in the monkeypox response, after a lackluster start.”

The decision to declare an emergency is likely to be politically unpopular, said Dr. Carlos del Rio, an infectious disease physician at Emory University in Atlanta. He noted that many in Congress had been pressing the administration to lift the public health emergency for Covid-19.

Still, “I think it’s long overdue for the US to declare the monkeypox outbreak a public health emergency,” he said.

The emergency designation would allow the FDA to authorize measures that can diagnose, prevent or treat monkeypox, without having to go through the agency’s usual exhaustive review. The agency relied heavily on this provision to speed tests, vaccines and treatments for the coronavirus.

Declaring an emergency also gives the Centers for Disease Control and Prevention more access to information from health care providers and from states. Federal agencies like the CDC cannot compel states to share data on cases or vaccinations.

During the outbreak, federal health officials have regularly shared information on testing capacity or on the number of vaccines shipped to states. But the CDC’s data on the number of cases was that of local public health departments, and the number of people vaccinated, or their demographic information, is mostly unavailable.

“We are again really challenged by the fact that we at the agency have no authority to receive those data,” Dr. Rochelle Walensky, the CDC’s director, said at an event hosted recently by The Washington Post.

The agency is working to broaden its access to state data, but in the meantime, the information is spotty and unreliable. Local health departments are underfunded, understaffed and exhausted after more than two years of grappling with the Covid-19 pandemic.

“A declaration of this monkeypox outbreak as a public health emergency is important, but more important is to step up the level of federal state and local coordination, fill our gaps in vaccine supply and get money appropriated from Congress to address this crisis,” said Gregg Gonsalves, an epidemiologist at Yale School of Public Health and an adviser to the WHO on monkeypox.

“Otherwise we’re talking about a new endemic virus sinking its roots into this country.”