White House scrambles to play catch-up on monkeypox response

Officials in the administration have admitted that they need to do more because the number of cases has grown faster than they thought it would.

WASHINGTON — After weeks of logistical and bureaucratic delays in getting tests, treatments, and vaccines to people with monkeypox, the Biden administration is making changes to how it is handling the situation.
People close to the administration have said that the number of infections has gone from dozens to thousands in a short amount of time, and that Biden administration officials admit they are now playing catch-up.
As part of its new plan, the administration is trying to get a lot more people vaccinated against monkeypox and make it easier for those who have it to get an experimental treatment. They are also trying to name a “monkeypox coordinator” who will manage the response from the White House and work with state and local governments.
Still, a dozen doctors on the front lines and former public health officials who talked to NBC News said that the administration faces a maze of problems.
Julie Morita, who advised President Joe Biden on Covid during the transition and ran the Chicago Department of Public Health for nearly 20 years, said, “I think we still have the chance to keep this under control, but we need the resources to do it.”
“There should be enough money for public health, the number of vaccines should be increased, and communication should be stepped up. But all of those things can happen, and if they do, this outbreak can be stopped. Morita said, “It’s not too late.”

This week, many states, including New York and California, declared public health emergencies. The Centers for Disease Control and Prevention also found infections in all but two states. NBC News looked at CDC data and found that the average number of new cases reported every seven days went from 45 on July 11 to 214 just two weeks later.
Since the beginning of May, nearly 6,000 cases have been reported in the U.S. The total number is more than 20,000.
Since the virus is almost entirely spreading among men who have sex with other men, most of the government’s efforts have been focused on vaccinating people who are at the highest risk, such as men who have had multiple male partners in the last two weeks or who have been exposed.
More recently, though, administration officials have asked other men who have sex with other men to stop doing high-risk things like having multiple partners until the outbreak is under control. They are trying to spread the word to gay, transexual, and bisexual communities by using dating apps, going to events, and talking to community leaders.
This is a change from earlier in the summer, when officials only wanted to vaccinate people who had been infected and their close friends and family. But as the number of infections has gone up in the last month, state and local health officials have not been able to keep up, a person who knows about the efforts said.
On Tuesday, the White House chose Robert Fenton to be the national monkeypox response coordinator and Demetre Daskalakis to be his assistant. Thursday will be the first time the two will talk to the press about what they are doing to help.
An official in the administration said, “The President is always looking for ways we can do more to stop the spread of monkeypox.” “And by having Bob Fenton and Dr. Daskalakis at the helm as White House coordinators, we will ramp up our urgent, whole of government response even more.”
The federal government has said that it plans to send more than 700,000 doses to states, on top of the 300,000 doses that have already been sent. However, officials haven’t said much about how the extra doses will be sent.
“Once the data showed that this outbreak was different from others and spreading quickly, we stepped up our comprehensive response, speeding up timelines to make more than a million doses of vaccines available,” an official from the administration said.

Doctors and public health officials say that doses of the vaccine have been slow to arrive, and doctors are worried that there won’t be enough to meet demand, which is coming in part from people who are less likely to get sick, like health care workers and men in monogamous relationships.

Tyler Temeer, CEO of the San Francisco AIDS Foundation, said that so far the city only has about 12,000 doses out of the 35,000 doses that were asked for. He said that just over 1,000 doses have been sent to his clinic, which has a waiting list of 10,000 people.
A person needs to get two shots of the vaccine for it to work best.

In New York City, too, there is much more demand than there is supply. But demand has been low among Black men who have sex with other men, a key group where infections have been especially high, said Celine Gounder, an infectious disease expert in New York. She said that more needs to be done to reach the people who are most at risk. Many of these people don’t have health insurance, a primary care doctor, or are shamed for having sex with other men.
Gounder said, “What we’re seeing is that 30 to 40 percent of cases are in men of colour or trans women of colour, but the vast majority of people waiting in line to get vaccinated are white men.” This is true both in New York City, where I live, and in Atlanta, where his colleagues also work. “And that’s a problem because you’re not getting to the people who are most at risk.”
Some states may also have to wait longer to get their vaccine doses because the federal government has said it won’t ship a state’s full allocation of vaccines until they start sharing data on infection rates and demographics. Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials, said that some states say they can’t do this because of privacy laws.
Doctors say that people who get monkeypox will have to fill out hours of paperwork before they can get Tpoxx, a smallpox treatment that is thought to work on monkeypox patients. Gounder and other doctors said that this process has made some providers less likely to treat people with monkeypox.
The federal government has tried to make the process easier, but because the Food and Drug Administration hasn’t approved Tpoxx to treat monkeypox, officials want to know who is getting it so they can figure out how safe and effective it is, a person familiar with the process said.
Doctors and public officials say they want the White House to declare a public health emergency. This could free up money from Covid to be used for monkeypox, get rid of some administrative barriers to getting Tpoxx, and make it easier for states and the federal government to share information.
David Harvey, executive director of the National Coalition of STD Directors, said, “The declaration of a federal public health emergency will help solve some of the problems we have right now, but resources must follow.”
People close to the administration say that the White House and the Department of Health and Human Services have been pointing fingers at each other because of how the administration has responded.
The White House says it will let Health and Human Services Secretary Xavier Becerra decide if a public health emergency should be declared.
Many of the problems that doctors and health officials are having with how to respond to monkeypox are the same as those they had to deal with during the Covid pandemic: not enough testing, mixed messages, and not enough vaccines to meet demand. Even though monkeypox is a very different virus from Covid—it is thought to be spread mostly through skin-to-skin contact, not through the air—it has shown that the government still has some problems with how it handles new outbreaks.
Andy Slavitt, who led the White House response to Covid during Biden’s first year in office, said, “We’re not fundamentally set up in public health for crisis response.” “On top of that, our public health system is in a lot of trouble. These are things that need to be fixed by both Congress and the administration. There are a lot of big requests for this work, and changes need to be made.”

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