Monkeypox outbreak can still be stopped, U.S. officials declare

The country’s monkeypox outbreak can still be stopped, U.S. health officials said Thursday, July 28, despite rising case numbers and so-far limited vaccine supplies. The mayor of San Francisco, meanwhile,  announced a legal state of emergency Thursday over the growing number of monkeypox cases, allowing officials to mobilize personnel and resources and cut through red tape to get ahead of a public health crisis reminiscent of the AIDS epidemic that devastated the city.

The declaration, which takes effect Monday, was welcomed by gay advocates who have grown increasingly frustrated by what they called San Francisco’s lackluster response to a virus that so far has affected primarily men who have sex with men, although anyone can get infected.

The city has 261 cases, out of about 800 in California and 4,600 nationwide, according to the San Francisco Department of Public Health. A national shortage of vaccine has resulted in people waiting in line for hours for scarce doses, often to be turned away when the shots run out.

The Biden administration’s top health official pushed back against criticism about the pace of the response and worries that the U.S. has missed the window to contain the virus, which has been declared a global emergency.

“We believe we have done everything we can at the federal level to work with our state and local partners and communities affected to make sure we can stay ahead of this and end this outbreak,” Xavier Becerra, head of the Department of Health and Human Services, told reporters on a call.

But he added that local health officials “must do their part. … We don’t have the authority to tell them what to do.”

The pushback from federal leaders came as they announced distribution plans for 780,000 shots of the two-dose Jynneos vaccine. The doses will be allocated to states, cities and other localities based on their case numbers and the size of their populations that are considered high-risk for the disease.

Health departments in San Francisco; New York; Washington, D.C.; and elsewhere say they still don’t have enough shots to meet demand and have stopped scheduling appointments for second vaccine doses to stretch supplies.

In the face of limited supplies of vaccine and growing public concern, the Los Angeles County Board of Supervisors agreed today to lobby federal health officials to bolster local supplies of monkeypox vaccines and boost funding for testing and administration of the shots.

Local health authorities have repeatedly insisted that the odds of contracting monkeypox in the general population are extremely low. But growing case numbers, particularly among gay men, have been heightening public concern about a disease usually restricted to the African continent but now being detected globally.

As of Tuesday, there were 218 known cases in Los Angeles County. That’s up from 120 last week. The county has also confirmed local transmission of the virus, noting that some patients had no known history of recent travel.

The county has been slowly expanding eligibility for the JYNNEOS monkeypox vaccine, but supplies remain extremely limited.

In a motion that went before the Board of Supervisors Tuesday, Supervisors Hilda Solis and Janice Hahn noted that future vaccine supplies remain uncertain.

“With the current supply, it is estimated that only 5%-10% of the population that wants to be vaccinated will be reached,” according to the motion. “Given the vaccine can be administered both pre- and post-exposure and the continued spread of the monkeypox virus throughout Los Angeles County, additional vaccine supplies will be needed to expand vaccine eligibility to both prevent further spread and to provide an effective treatment to those who have been exposed.”

The motion also notes that some community health providers have reported that “reimbursement rates for administering monkeypox testing, vaccination and treatment are inconsistent and unsustainably low to support their efforts. In addition, providers remain concerned about their ability to serve the uninsured population without designated funding for these services.”

Under the motion, which was approved unanimously, the county will send a letter signed by all five supervisors to federal health authorities requesting additional supplies of the vaccine in the county, along with efforts at a national level to increase production of the vaccine and the establishment of “sustainable reimbursement levels … for monkeypox testing, vaccine administration and treatment.”

The letter will also call for the establishment of a funding source to reimburse clinics, hospitals and other health care facilities providing such services for uninsured residents.”

Becerra said the federal government has done its job and said the onus is now on local officials to use the tools available.

“We’ve made vaccines, tests and treatments well beyond the numbers that are currently needed available to all jurisdictions,” he said.

But one representative for specialty health clinics said Becerra’s comments showed a “lack of understanding for the full breadth of this crisis.”

“Clinics around the country are pleading with federal health officials for the information, supplies and staffing they need to successfully bring an end to this outbreak,” said David C. Harvey, executive director of the National Coalition of STD Directors, in a statement. The group is pressing for $100 million in emergency funding for local health departments and clinics.

There were more than 4,600 reported monkeypox cases in the U.S. as of late Wednesday, according to the CDC, and federal officials expect those numbers to rise.

More than 99% of reported cases are in men and the vast majority of those are among men who reported sexual contact with other men, though health officials have stressed that anyone can catch the virus.

The U.S. is now capable of testing 60,000 to 80,000 people per day, though Becerra said daily testing numbers are well below that.

The monkeypox virus mainly spreads through skin-on-skin contact, but it can also transmit through touching linens used by someone with the infection. People with monkeypox may experience fever, body aches, chills and fatigue. Many in the outbreak have developed sometimes-painful zit-like bumps.

The U.S. has ordered 5.5 million more vaccine doses for delivery by mid-2023 and has rights to raw ingredients that could make 11.1 million more doses. U.S. officials said a massive vaccination campaign could still be avoided if communities and individuals take measures to avoid spread.

In San Francisco, Tom Temprano had an appointment to get his second dose next week but was recently notified that it was canceled due to limited supplies. Temprano, who is the political director of San Francisco-based Equality California, said he’s frustrated that health authorities have taken so long to respond.

“Especially coming out of, still, two-and-a-half years into a pandemic, it’s just a very disappointing response for the first larger-scale public health crisis we’re facing coming out of that,” he said.

He also sees parallels to the slow government response to AIDS in the 1980s.

“I’ve heard from many folks … that this feels similar in the lack of real concern and urgency to a disease that is right now disproportionately impacting the LGBTQ+ community,” said Temprano, who is 36.

The CDC estimates about 1.5 million Americans currently meet suggested criteria for vaccination, primarily men who have sex with men.

But officials on Thursday declined to set a figure for how many vaccine doses would be needed to stop the outbreak. Nearly 340,000 vaccine doses have been distributed, but a CDC official acknowledged the federal government doesn’t know how many have been administered.

The additional 780,000 shots being sent to states this week were delayed by shipping and regulatory hurdles. They sat for weeks in storage in Denmark as U.S. regulators finished inspecting and certifying the facility where they were manufactured.

California state Sen. Scott Wiener, who belongs to the California Legislative LGBTQ Caucus, called the additional vaccines “significant.” But he added: “Of course, it’s not enough, and we know that we’re going to be getting millions more doses over the remainder of this year and into next year, which is not soon enough in terms of actually containing this outbreak.”

Georgia’s health department hasn’t had to postpone any second doses, but spokeswoman Nancy Nydam said: “Demand is still very high. Every time a health department or other provider opens appointments or slots at an event, they are taken up in a matter of minutes.”

The Associated Press and City News Service contributed to this report