The Biden administration on Thursday declared monkeypox a public health emergency, giving the administration more flexibility in responding to the outbreak—a move that many public health experts said is long overdue.

Why the US response to monkeypox is drawing comparisons to Covid-19

Monkeypox declared a public health emergency

Monkeypox has quickly spread throughout the world to 87 countries, including 80 countries that historically had not seen the disease before, USA Today reports. In response, the World Health Organization (WHO) on July 23 said the outbreak qualifies as a global health emergency.

Monkeypox first arrived in the United States in May and has rapidly spread throughout the country. According to HHS Secretary Xavier Becerra, there were fewer than 5,000 monkeypox cases in the United States last week. As of Thursday, there are more than 6,600 cases.

The virus transmits person-to-person, typically through close contact with infected lesions on the skin or other contaminated objects, USA Today reports. According to CDC, nearly all monkeypox cases in the United States have resulted from male-to-male sexual contact.

The public health emergency declaration will give the government flexibility in responding to the outbreak and the stigma around the disease among men who have sex with men (MSM), according to Demetre Daskalakis, deputy coordinator of the White House's new national monkeypox response team.

"This is a very clear statement of the value of the lives of people who are in the LGBTQ community," he said. "It also represents an important commitment by the administration to the community."

"We're prepared to take our response to the next level in addressing this virus," Becerra said, adding that "we urge every American to take monkeypox seriously, and to take responsibility to help us tackle this virus."

In addition to the declaration, FDA Commissioner Robert Califf noted the United States has ordered more doses of the Jynneos vaccine, which is used to prevent monkeypox, and is considering adjusting how the vaccine is administered.

According to Califf, if the vaccine is injected intradermally (rather than the current subcutaneous method), the same dosage of the vaccine could yield as many as five times the number of doses. Califf said FDA is optimistic about the approach and that a final decision on splitting doses this way should be coming "within the next few days," adding that "it's important to note that overall safety and efficacy profile will not be sacrificed for this approach."

CDC Director Rochelle Walensky said those most at risk for monkeypox infection will be prioritized for vaccination, including those living with HIV, MSM, and those eligible for preventive HIV therapy.

Reaction

Experts have criticized what they consider a slow response by the Biden administration to a serious public health threat.

"We have 5% of the world's population and 25% of the world's cases," said Carlos del Rio, an infectious disease physician at Emory University. "That, to me, honestly, is a failure. We were caught sleeping at the wheel."

However, experts say the public health emergency declaration is a welcome development. "It's absolutely welcome," said Andrew Noymer, an epidemiologist at the University of California, Irvine. "It's many weeks overdue, but it's the right move."

Lawrence Gostin, a health law expert at Georgetown University, said the declaration is "a pivotal turning point in the monkeypox response, after a lackluster start," adding that the declaration "signals the U.S. government's seriousness and purpose, and sounds a global alarm."

According to Gostin, the government should have declared a public health emergency sooner. Measures to control outbreaks have seen an increasing number of legal challenges, but Gostin said he doesn't believe that will happen with monkeypox.

"It is a textbook case of a public health emergency," he said. "It's not a red or a blue state issue. There is no political opposition to fighting monkeypox."

The public health emergency declaration will give monkeypox a higher profile in the medical community as well, according to Tom Inglesby, director of the Johns Hopkins Center for Health Security.

"It should help galvanize more testing and more health care provider awareness, especially in places outside the big cities where the level of attention to this has been far less," he said. "This is a strong attempt to try to elevate the message higher than it has been," he added. "People need to be looking for it, familiar with it, and be testing for it."

"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 the Yale School of Public Health and an adviser to WHO on monkeypox.

"Otherwise," he added, "we're talking about a new endemic virus sinking its roots into this country." (Groppe/Weintraub, USA Today, 8/4; Dreher, Axios, 8/5; Stolberg/Mandavilli, New York Times, 8/4; Scribner, Axios, 8/4; Branswell, STAT News, 8/4; Miller et al., Associated Press, 8/5; Goodman/Langmaid, CNN Health, 8/4)