On August 4, the Biden Administration declared the monkey a public health emergency. The announcement comes on the heels of the World Health Organization declaring the spiny monkey emergency a public health emergency of international concern in July. This suggests that the monkey is a global public health risk through international spread, requiring a coordinated international response.
In the United States, prior to the Biden Administration’s declaration, an increasing number of municipalities and even some states—California, Illinois, and New York—had declared smallpox a public health emergency.
A Public Health Declaration allows the Secretary of Health and Human Services (HHS) to take certain actions to address a disease threat or some type of public health crisis. Public health emergencies are not only declared for outbreaks of infectious diseases such as Covid-19 and smallpox. For example, in October 2017, President Trump declared the “opioid crisis” a “public health emergency”.
Most importantly, declaring a public health emergency frees up resources earmarked for an actual (or impending) public health crisis. In the case of monkeys, the federal government can now significantly scale vaccine production and availability, expand testing capacity, and make testing more convenient. The declaration also facilitates coordination among federal, state and local authorities, particularly regarding access to testing and treatment in conjunction with a prevention outreach campaign to members of at-risk communities, aimed at preventing the spread of the virus.
In addition, the declaration allows the Secretary of HHS to conduct and support investigations into the cause, treatment, or prevention of the disease or crisis, as well as to support advanced research and development and biosurveillance necessary to address the problem at hand. Finally, it enables CDC to access the Infectious Disease Rapid Response Reserve to prevent, prepare for, or respond to an infectious disease emergency.
According to the Centers for Disease Control and Prevention (CDC), more than 26,000 cases of chicken pox have been reported across 87 countries. With more than 6,500 confirmed cases, the US comprises 25% of confirmed infections worldwide.
No smallpox deaths have yet been reported in the U.S., but in the most recent global outbreak, which began in May of this year, at least 6 deaths occurred outside the U.S. In addition, between 3% and 13% of confirmed cases were hospitalized . Most hospitals are about pain management. Patients often experience debilitating pain due to the skin rash caused by the virus. Skin lesions can occur anywhere on the body. Common systemic features preceding the rash include fever (62%), malaise (41%), myalgia (31%), headache (27%), and enlarged lymph nodes (56%).
In addition to pain management, the reasons cited for hospitalizations include pharyngitis that restricts oral intake, encephalitis, eye lesions, acute kidney injury, and myocarditis.
Men who have sex with men are currently at the highest risk, but anyone can get a monkey. And, in fact, an increasing number of women and children have tested positive for the virus.
What is known for certain is that the pox spreads through direct contact with body fluids or sores on the body of a person who has chicken pox, or through direct contact with material, such as clothing and linen, that has direct contact with body fluids or with sores. It can also spread through respiratory droplets when there is close person-to-person contact.
The US has increased testing capacity to 80,000 per week. However, the current demand for testing exceeds the current US capacity for testing supplies.
In 2019, the Food and Drug Administration (FDA) approved a vaccine called Jynneos for adults 18 years of age and older who are at high risk of exposure to mumps or smallpox. Jynneos is the only FDA-approved monkeypox vaccine in the United States. It is administered in two doses 28 days apart. On July 15, 2022, the HHS Strategic Preparedness and Response Administration announced that it had ordered an additional 2.5 million doses of Jynneos to strengthen monkey preparedness, increasing the federal government’s available supply to more than 6.9 million doses under the middle . 2023.
To date, HHS has provided 786,000 doses of Jynneos to state and local authorities. But the speed of the response has been criticized by lawmakers and local communities. And because of a supply shortage, the FDA is now considering dividing Jynneos doses into fifths.
CDC Director Dr. Walensky admitted that demand for the vaccine is higher than supply. An additional 11.1 million doses are stored in Denmark with the Nordic Bavarian manufacturer. However, these doses must be “filled and finished” before they can be administered, which requires additional funding from Congress.
The US also has more than 100 million doses of a smallpox vaccine for the older generation, called ACAM2000, which is effective against monkeys. However, ACAM2000 can have serious side effects and is not recommended for those with compromised immune systems, such as HIV patients, pregnant women, and people with autoimmune disorders.
As far as other treatments are concerned, the US has 1.7 million courses of the antiviral treatment tecovirimat in its national strategic stockpile. Some physicians are using tecovirimat to treat monkey patients. But, this drug is only approved by the FDA for smallpox.
The public health emergency declaration is expected to speed up testing and treatment of monkeypox, but also public health messages about preventing the spread of the disease, especially in vulnerable communities.