Biden administration weighs declaring monkeypox a health emergency

While the new cases have been overwhelmingly in the gay and bisexual community, experts warn the virus is likely to spread to other groups. The first two U.S. cases of monkeypox in children were confirmed Friday, probably the result of sharing a household with an infected adult. But federal health authorities said there was no evidence yet of sustained transmission among broader population groups.

While some health officials say an emergency declaration is necessary to give the government authority to cut through red tape and collect data about the virus’s spread, others argued that the move is mostly symbolic and will not address vaccine shortages, treatment barriers or other challenges that have hindered the U.S. response, said three people who spoke on the condition of anonymity because they were not authorized to comment.

Officials also have raised questions about whether such a declaration is warranted for a virus yet to be linked to a single confirmed U.S. death. The strain of monkeypox implicated in this outbreak is tied to fever, lesions and severe pain that may last for weeks, in addition to complications in pregnant people, children and other vulnerable individuals.

Officials are hoping to make a decision on the emergency declaration this week, tied to a planned announcement that about 800,000 additional vaccine doses will be distributed following completion of a review by the Food and Drug Administration, two of the people said.

The decision also is complicated by domestic politics. Advocacy groups and health associations have called on the Biden administration to declare public health emergencies for abortion and gun violence, and the White House has said it is considering a broader emergency declaration for climate change, sparking debate about which issues to prioritize. The Biden administration has also continued to renew public health emergency declarations, which expire every 90 days, for opioids and the coronavirus.

Officials at the Department of Health and Human Services have privately acknowledged that it is unclear whether an emergency declaration is needed.

A declaration is “a tool that could be used to both align with WHO and raise additional awareness, as well as provide significant justification for HHS to use (though limited) tools that would aid in the response,” according to a memo sent to President Biden on Sunday, a copy of which was obtained by The Washington Post.

White House officials say that the decision rests with HHS Secretary Xavier Becerra and that they continue to be concerned about the slow pace of the response. Patients say they still face days-long delays in getting test results, physicians have complained about bureaucratic barriers when trying to prescribe treatment, and officials such as New York Mayor Eric Adams (D) have called for more vaccine doses as their existing supply is rapidly exhausted.

“Our focus is on getting HHS to move as quickly as possible … it’s about strengthening and accelerating the response, not just tacking on a different name,” said an official familiar with the response, saying Biden “is pushing HHS to get vaccine allocations out the door, and pushing FDA to get the vaccine cleared in the next few days, without cutting corners.”

Becerra told CNN on Monday that his department is still reviewing the merits of a declaration. “We want to get ahead of [monkeypox]. You don’t want it to become a part of life. But how many people have died compared to covid?” he said. “Zero … We declare public health emergencies based on the data and the science, not on our worries.”

Some outside experts contend a 90-day emergency declaration could be an important tool to focus the response.

“This could allow for all hands on deck to mobilize as big an effort as possible,” said Jennifer Kates, who leads global health policy for the Kaiser Family Foundation, a nonpartisan think tank. “To prevent this from becoming endemic — and hopefully not being too late.”

Kates said emergency declarations should be reserved for “truly unique events,” adding, “In the case of monkeypox, those criteria are being met. It’s crossing states, it’s spreading rapidly,…