Infectious disease experts and public health advocates warn that the Biden administration has been too slow to respond to the monkeypox outbreak and that the US is at risk of losing control of the disease.
The monkeypox response reflects the worst parts of the early days of the coronavirus pandemic, they say, with severely limited testing and slow rollout of vaccines, resulting in a virus that spreads undetected.
“Where we are lagging behind is streamlining testing, providing vaccines, streamlining access to the best therapeutics. All three areas were bureaucratic and slow, and that means we haven’t got this outbreak under control,” said David Harvey, executive director of the National Coalition of STD Directors (NCSD).
Unlike COVID-19, monkeypox is not a new virus and strategies to reduce its spread are well known. Biden administration officials said they were confident in their approach.
“We as a global community have known about this for decades. We know how it spreads. We have tests that help identify infected people. We have vaccines that are very effective against it,” White House coronavirus response coordinator Ashish Jha 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 the District of Columbia, although experts say that number is almost certainly an undercount because many people who may be infected are still do not yet have access to extensive testing.
The administration is ramping up its response by expanding testing capacity and expanding access to vaccinations, though critics say the effort may be coming too late.
“We’ve already been shouting for a month about how bad the monkeypox diagnostic situation is. And it really was a clear mistake, preventable, and it’s very clear that this administration has not learned the lessons of early COVID,” said James Krellenstein, co-founder of the HIV treatment advocacy group Prep4All.
John Andrus, an assistant professor of global health at the George Washington Institute’s School of Public Health at the George Washington Institute, said the U.S. is fortunate that monkeypox is not as contagious as COVID-19, nor as deadly. because the public health system is underfunded and too fragmented.
“I think we’re going to keep repeating those mistakes because that’s our experience. This is our experience. We’ve had more than five or six waves of COVID, and it seems like every time we’re a little bit off the hook,” Andrus said. “Stopping the transmission requires that we all read from the same page. We all have the same road map.”
The administration expanded testing to commercial labs in late June, so providers will soon be able to order tests directly from labs they’ve established relationships with and jump through fewer hoops.
But it took more than a month for that move to happen, 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, leading to backlogs and frustrated patients waiting days for test results.
Biden administration health officials this week touted efforts to expand testing.
“I strongly encourage all health care providers to have a high clinical suspicion of monkeypox in their patients,” CDC Director Rochelle Walensky said on a call with reporters. “Patients with a suspicious rash should be tested.”
Testing for monkeypox is a relatively simple process that involves taking a swab from a skin lesion. Unlike with COVID-19, the CDC already had a pre-developed test, but patients were limited to a narrow set of specific criteria to qualify for testing.
“We already had tests available. We already had vaccines available. We should have really been much more aggressive with the testing… and I think that speaks to some of the bureaucracy and the FDA [Food and Drug Administration] and the CDC,” said Celine Gunder, an infectious disease specialist and managing editor for public health at Kaiser Health News.
“The inclusion of commercial laboratories could have been done earlier. Get academic medical centers to do tests, hospital labs to develop their own PCR tests. I mean, that’s not very hard to do,” 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 will be provided throughout the year. The CDC is also expanding eligibility criteria so that individuals with confirmed monkeypox exposures and suspected exposures can be vaccinated, not just those with a confirmed case.
But activists and experts say the administration has moved too slowly and that the updated vaccination strategy is not enough.
“We believe this outbreak is now out of control. So we haven’t withheld it. At this stage, vaccines will not contain it. Because we don’t have enough. Getting them gunned down is an expensive and time-intensive process,” NCSD’s Harvey said.
New York and Washington, D.C., have begun offering the vaccines to men who have sex with other men or may have been exposed to the virus. But both cities ran out of supplies less than a day after launching their local immunization initiatives. DC Health had to close access about 10 minutes after photos were provided.
There are about 56,000 doses of Jynneos in the strategic national stockpile that will be distributed immediately, officials said, and the administration plans to distribute 296,000 doses in the coming weeks.
The US has tens of millions of doses of the ACAM2000 smallpox vaccine, but this injection has more dangerous and severe side effects.
According to a spokesman for Denmark-based Jynneos manufacturer Bavarian Nordic, 300,000 doses have already been delivered or will arrive in the next few days.
An additional 1.1 million filled doses are still being reviewed by the FDA, which should be completed in the next few weeks.
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The government also has bulk materials totaling up to 15 million doses, but those are still frozen and the administration has not told the company how it wants those doses filled.
“American taxpayers are spending money to buy and manufacture these doses precisely so they can be used quickly in the event of an outbreak,” said Prep4All’s Krellenstein.
“We have an outbreak here and my friends are literally being denied vaccinations 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.
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