Infectious disease experts and public health advocates are warning that the Biden administration has been too slow in responding to the monkeypox outbreak and that the US is at risk of losing control of the disease.
The monkeypox response mirrors the worst parts of the early days of the coronavirus pandemic, they say, with severely restricted testing and a sluggish rollout of vaccines resulting in a virus that’s spreading undetected.
“What we are left with is in streamlining testing, making vaccines available, and streamlining access to the best therapeutics. All three areas have been bureaucratic and slow, and that means we have not contained this outbreak,” said David Harvey, executive director of the National Coalition of STD Directors (NCSD).
Unlike COVID-19, monkeypox is not a novel virus and strategies to contain the spread are well known. Biden administration officials said they are confident in their approach.
“We as a global community have known about this for decades. We know how it spreads. We have tests to help identify infected people. We have vaccines that are highly effective against it,” Ashish Jha, the White House coronavirus response coordinator, said during a recent briefing.
According to the Centers for Disease Control and Prevention (CDC), there are 460 cases in 30 states, Puerto Rico and DC, although experts say that number is almost certainly underestimated because many people who may be infected don’t yet have one Have access to extensive testing.
The government is stepping up its response by expanding testing capacity and expanding access to vaccination, though critics say efforts may be too late.
“We have been screaming for a month about how poor the diagnostic situation is for monkeypox. And that really was a clear mistake, avoidable, and it’s very clear that this government didn’t learn lessons from early COVID,” said James Krellenstein, co-founder of the HIV treatment advocacy group Prep4All.
Jon Andrus, associate professor of global health at George Washington University’s Milken Institute School of Public Health, said the US is lucky that monkeypox is not as contagious as COVID-19 or as deadly because the public health system is underfunded and overly dysfunctional be .
“I think we will continue to repeat those mistakes because that is our track record. That was our track record. We’ve had more than five or six waves of COVID, and we seem a little surprised each time,” Andrus said. “To stop the broadcast we must all read on the same page. We all have the same roadmap.”
The administration expanded testing to commercial labs in late June, meaning vendors will soon be able to order tests directly from the labs where they have established relationships and face fewer hurdles.
But it took more than a month for this move, which increased testing capacity from about 8,000 tests a week to 10,000 across the system.
Demand is also not evenly distributed across public health laboratory networks; it’s concentrated in urban areas like New York City, resulting in backlogs and frustrated patients waiting days for test results.
Biden administration health officials this week announced efforts to expand testing.
“I strongly encourage all healthcare providers to have a high clinical suspicion of monkeypox in their patients,” CDC Director Rochelle Walensky said during a call with reporters. “Patients with a suspicious rash should be tested.”
Testing for monkeypox is a relatively simple process that involves wiping a skin lesion. Unlike COVID-19, the CDC already had a previously developed test, but patients were restricted to a narrow set of specific criteria to qualify for the test.
“We already had tests available. We already had vaccines available. We really should have been a lot more aggressive with testing… and I think that speaks to some of the FDA’s bureaucracy [Food and Drug Administration] and CDC,” said Celine Gounder, infectious disease specialist and public health editor at Kaiser Health News.
“They could have brought the commercial labs on board earlier. Getting academic medical centers to do tests, hospital labs to develop their own PCR tests. I mean, it’s not very difficult,” Gounder said.
The White House is also working to expand its vaccination program and announced a plan to immediately ship tens of thousands of doses of Jynneos, the only FDA-approved vaccine specifically for monkeypox.
More than a million doses are made available throughout the year. The CDC is also expanding eligibility criteria so that people with confirmed monkeypox exposure and suspected exposure can be vaccinated, rather than just those who have a confirmed case.
But activists and experts say the administration has been slow to move and that the updated vaccination strategy is far from enough.
“We believe this outbreak is already out of control. So we didn’t contain it. Vaccines will not contain it at this time. Because we don’t have enough. Getting them into arms is an expensive and intense process,” NCSD’s Harvey said.
New York City and Washington, DC began offering the vaccines to men who have sex with other men or who may have been exposed to the virus. But both cities were running out of supplies less than a day after they launched their local immunization initiatives. DC Health had to suspend access approximately 10 minutes after the footage was made available.
There are about 56,000 doses of Jynneos in the Strategic National Stockpile that will be allocated immediately, officials said, and the administration plans to allocate 296,000 doses in the coming weeks.
The US has tens of millions of doses of the smallpox vaccine ACAM2000, but this shot has more dangerous and serious side effects.
According to a spokesman for Jynneos’ Denmark-based manufacturer Bavarian Nordic, 300,000 cans have already been delivered or will arrive in the next few days.
Another 1.1 million filled doses are still under FDA review, which should be completed in the next few weeks.
The government also owns up to 15 million cans in bulk, but they are still frozen and the administration has not told the company how those cans will be filled.
“American taxpayers spent money to buy these cans and make them in the right way for quick use in the event of an outbreak,” Prep4All’s Krellenstein said.
“Here we have an outbreak, and my friends are being literally put off vaccination because the Biden administration can’t figure out how to get a million doses from a freezer in Denmark to the United States.” Krellenstein added.