Health

As Monkeypox Spreads, U.S. Plans to Declare a Health Emergency

As monkeypox continues to surge in the United States, the Biden administration plans to declare a public health emergency, perhaps as soon as Thursday, according to a federal official familiar with the discussions.

The declaration 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 expedite 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.

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 it may 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.

What to Know About the Monkeypox Virus


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What is monkeypox? Monkeypox is a virus similar to smallpox, but symptoms are less severe. It was discovered in 1958, after outbreaks occurred in monkeys kept for research. The virus was primarily found in parts of Central and West Africa, but in recent weeks it has spread to dozens of countries and infected tens of thousands of people, overwhelmingly men who have sex with men. On July 23, the World Health Organization declared monkeypox a global health emergency.

What are the symptoms? People who get sick commonly experience a fever, headache, back and muscle aches, swollen lymph nodes, and exhaustion. A few days after getting a fever, most people also develop a rash that starts with flat red marks that become raised and filled with pus. On average, symptoms appear within six to 13 days of exposure, but can take up to three weeks.

How does it spread? The monkeypox virus can spread from person to person through close physical contact with infectious lesions or pustules, by touching items — like clothing or bedding — that previously touched the rash, or via the respiratory droplets produced by coughing or sneezing. Monkeypox can also be transmitted from mother to fetus via the placenta or through close contact during and after birth.

I fear I might have monkeypox. What should I do? There is no way to test for monkeypox if you have only flulike symptoms. But if you start to notice red lesions, you should contact an urgent care center or your primary care physician, who can order a monkeypox test. Isolate at home as soon as you develop symptoms, and wear high-quality masks if you must come in contact with others for medical care.

What is the treatment for monkeypox? If you get sick, the treatment for monkeypox generally involves symptom management. Tecovirimat, an antiviral drug also known as TPOXX, occasionally can be used for severe cases. The Jynneos vaccine, which protects against smallpox and monkeypox, can also help reduce symptoms, even if taken after exposure.

Who can get the vaccine? Jynneos vaccine is most commonly used to prevent monkeypox infections, and consists of two doses given four weeks apart. It  has mostly been offered to health care workers and people who have had a confirmed or suspected monkeypox exposure due to limited supplies, though new doses should become available in the coming months. A few states, including New York, have also made vaccines available among higher-risk populations.

I live in New York. Can I get the vaccine? Adult men who have sex with men and who have had multiple sexual partners in the past 14 days are eligible for a vaccine in New York City, as well as close contacts of infected people. Eligible people who have conditions that weaken the immune system or who have a history of dermatitis or eczema are also strongly encouraged to get vaccinated. People can book an appointment through this website.

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 W.H.O.’s advisory panel on monkeypox.

Dr. Rimoin is one of the scientific advisers who urged the W.H.O. 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 W.H.O.’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 W.H.O.’s declaration told member countries that they should take the outbreak seriously, dedicate significant resources to containing it, and cooperate with other nations by sharing information, vaccines and drugs.

Health And Human Services Secretary Xavier Becerra.Credit…Pete Marovich for The New York Times

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 the contain the outbreak.

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 U.S. to declare the monkeypox outbreak a public health emergency,” he said.

The emergency designation would allow the F.D.A. 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 C.D.C. 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 C.D.C.’s data on the number of cases lag 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 C.D.C.’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 W.H.O. on monkeypox.

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

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