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Public health experts, including within the Biden
administration, are increasingly concerned that the federal
government�s handling of the largest-ever U.S. monkeypox
outbreak is mirroring its cumbersome response to the coronavirus
pandemic 2� years ago, with potentially dire consequences.

As a result, they said, community transmission is occurring
largely undetected, and the critical window in which to control
the outbreak is closing quickly.

�It�s been unbelievably challenging,� said Lauren Sauer,
director of the Special Pathogens Research Network within a
government-funded consortium of medical centers focused on
pathogens training and education. �It felt like January 2020 all
over again.�

More than 150 monkeypox cases have been identified in the United
States since May 19, federal officials said this week, and more
than 3,300 cases have been detected in 42 countries around the
world.

The rapidly rising global case counts have prompted the World
Health Organization to convene an emergency committee on
Thursday to assess whether the monkeypox outbreak represents a
public health emergency of international concern � the agency�s
highest-level warning, which currently applies only to the
coronavirus and polio.

But as other nations have ramped up their efforts to track and
prevent the spread of infection, experts say the United States
has moved too slowly to expand access to monkeypox testing and
vaccinate people at highest risk. The government�s failure to
clearly and urgently communicate the symptoms and risks
associated with monkeypox, a disease spread by close contact
that can lead to fever, pain and a visible rash, has left gay
and bisexual men who are disproportionately contracting the
virus especially vulnerable, public health experts say.

The plodding U.S. response so far raises doubts about the
country�s preparedness for the next pandemic, some
administration officials say.

Communication about whom to test, when to test them and what
monkeypox symptoms look like has been dismal, said Sauer, a
public health expert at the University of Nebraska Medical
Center.

Frustrations are running particularly high because, unlike the
coronavirus, monkeypox has been studied for decades by global
and U.S. experts who know the tools, strategies and vaccine
protocols that can limit spread.

Biden administration officials on Wednesday said that they have
amply prepared for a monkeypox outbreak, touting the
government�s efforts to acquire more vaccine doses, warn the
public about the emerging outbreak, and begin distributing tests
to commercial labs across the country this week. They also
insisted their response reflected lessons learned from fighting
coronavirus, such as waiting to distribute the �right test that
works� to laboratories after federal officials distributed
flawed coronavirus tests in early 2020.

�All this work takes weeks to get it done right,� said Raj
Panjabi, who leads the White House�s global health security
efforts, reflecting on the �humility� that he said officials
have tried to apply to monkeypox after struggles in containing
the coronavirus and other outbreaks.

Monkeypox dilemma: How to warn gay men about risk without
fueling hate

Clinicians, patients and some administration officials have
faulted the Centers for Disease Control and Prevention for
testing criteria that they say are too narrow and have resulted
in long waits � sometimes multiple days � in identifying
positive cases. Under the current framework, physicians who want
a test for an individual suspected to have monkeypox must first
consult with a state epidemiologist. State public health
officials say that protocol helps identify people at highest
risk so doctors can recommend isolation and take other steps to
prevent community spread.

And just as in early 2020, when the coronavirus first menaced
the United States, federal officials at first limited monkeypox
testing to a network of several dozen public health laboratories
� and did not authorize thousands of commercial laboratories and
hospitals to perform their own testing, too.

Monkeypox testing is handled by 86 mostly state and local public
health labs, with capacity for more than 8,000 tests a week,
according to the CDC. But an official of a large city health
department who is working directly on monkeypox response said
that number is misleading, because the labs are not concentrated
around the major metropolitan areas where the bulk of infections
are detected.

Without better access to tests, which involves swabbing a
lesion, it is impossible for public health officials to know the
true prevalence of the disease.

Monkeypox has repeatedly emerged in Central and West Africa for
decades, but the current outbreak has been occurring in
countries that have not previously reported infections, raising
concern about how and why the disease appears to be gaining a
foothold in countries including Britain, Germany, Portugal and
Spain.

The response has also been hindered by U.S. physicians� lack of
familiarity with the rare disease. The CDC initially publicized
decades-old photos from more severe outbreaks in Africa, instead
of the more subtle rashes detected in the recent global
outbreak. The United States was far slower than Britain and
Canada to distribute updated education materials, only recently
sharing photos showing what the rashes look like on fair skin,
said David Harvey, executive director of the National Coalition
of STD Directors.

�One of the things that worries me right now is that we are
seeing cases pop up in many countries, and we are also seeing
numbers being reported in places that are much more aggressive
in their surveillance than what we�ve seen here,� said Jennifer
Nuzzo, an epidemiologist at Brown University�s School of Public
Health.

While monkeypox has been spreading mostly among men who have sex
with men, the disease is not specific to any one group. �If a
woman doesn�t have a particular known risk factor, and some
woman shows up in urgent care, what�s the likelihood that she is
going to get found?� Nuzzo said.

In most cases, monkeypox symptoms disappear on their own within
a few weeks. But for pregnant women, children and people with
weak immune systems, the disease can lead to medical
complications, including death, according to the WHO.

Two federal officials involved in the monkeypox response said
there are �significantly� more cases across the United States
that are being missed because testing for monkeypox had not been
expanded beyond the network of public health laboratories.

�If we don�t move aggressively now, monkeypox is going to be
that much harder to eradicate later � or it could even become
endemic� in the United States, said one of the administration
officials, who is among more than two dozen across the
Department of Health and Human Services and the White House
tasked with combating the outbreak and who spoke on the
condition of anonymity because they are not authorized to speak
to the press. Many of the same teams have been working on the
coronavirus response.

On Wednesday, administration officials said they were
authorizing five major commercial laboratories to test for
monkeypox starting in early July, a dramatic expansion of
capacity. That could allow labs to conduct tens of thousands of
more tests a week. Health-care providers will be able to send
specimens directly to the commercial labs for testing without
having to first consult with state health officials to determine
whether testing criteria are met. Activists say the move was
overdue.

About 10 monkeypox tests per day were being performed nationwide
in early June, even as other countries such as Britain were
performing far more, a senior administration official said
Wednesday. While laboratory testing ramped up last week, only
about 700 total tests had been conducted as of June 17, the
official said.

Before the CDC made its test widely available to commercial
labs, the agency needed to update testing protocols, establish
agreements with the five labs and ensure personnel had personal
protective equipment and vaccinations to protect against
infection, according to a senior public health official who
spoke under Biden administration ground rules that they not be
named.

One man who sought testing on June 13 in New York City for
potential monkeypox symptoms � flu-like illness and swollen
lymph nodes � was initially advised by a physician that he did
not have the disease and did not need a test, said Joseph
Osmundson, a virologist at New York University, who spent
several days trying to help the individual obtain a test. The
man had recently returned to New York from Portugal, where he
said he had casual sex with other men. Health officials have
advised clinicians to look out for travel-associated cases from
Europe, and in situations in which men have had sex with men.

But the man told The Post his efforts to obtain a test were
repeatedly rebuffed � even after he was found to have �abnormal
HPV-like lesions� that weren�t readily visible.

�The pain has been like someone stabbing me from inside � I
couldn�t sit, I couldn�t sleep,� said the man, who spoke on the
condition of anonymity to protect his privacy. He said he went
to four different providers, including a major New York City
hospital, before an urgent care clinic collected a specimen on
Monday. He said he finally received his results on Thursday
afternoon, 10 days after he first sought testing. The results:
positive.

Osmundson said he was aware of a dozen similar cases in which
people with possible monkeypox symptoms were being rebuffed.

�The CDC is very narrowly defining criteria for testing, and the
[New York] Department of Health is not going outside those
criteria. So if you don�t check off on every single one of the
boxes, based on CDC, you don�t get access to testing,� Osmundson
said.

Michael Lanza, a spokesman for the New York City Department of
Health and Mental Hygiene, confirmed that providers must contact
the agency to evaluate the case and determine whether testing is
necessary. He said officials have not denied testing requests
except in cases with no rash or no known risk factors.

James Krellenstein, co-founder of PrEP4ALL, an HIV-care
nonprofit that has pressed state and federal officials to expand
testing, said that �no one can confidently say if the outbreak
is under control or not.�

�I�m extremely, extremely frustrated,� Krellenstein said. �It�s
as if what happened in covid in February of 2020 never happened.
This is not the first time, and to see CDC, HHS [and other
officials] make the same errors over again is inexplicable,
considering how large the cost was in 2020.�

Public health experts also have criticized U.S. officials for
not proactively vaccinating high-risk individuals against the
virus, even as other nations have moved more aggressively to do
so. Health officials in Britain announced a strategy Tuesday to
offer vaccine to some gay and bisexual men at higher risk of
exposure, and New York City officials on Thursday opened a
vaccine clinic to those who may have been recently exposed.
While U.S. officials have stockpiled two vaccines that are
effective against monkeypox, there is a limited supply of the
vaccine that is specifically authorized to prevent monkeypox,
Jynneos.

U.S. officials �need to have very serious planning
conversations� about proactively vaccinating people at high risk
for disease, said Janet Hamilton, executive director of the
Council of State and Territorial Epidemiologists. She said
individuals who should be prioritized include men who have sex
with men, sex workers, lab personnel conducting monkeypox
testing, and health-care workers expected to provide direct care
for monkeypox patients.

Of the two vaccines that are effective against monkeypox,
Jynneos is in high global demand. The other vaccine, ACAM2000,
is older and was approved to prevent smallpox. While it is
effective against monkeypox, it can cause serious side effects
and cannot be used for people with severely weakened immune
systems or eczema, according to the CDC.

Senior public health officials said Wednesday they are
considering potential strategies for proactive vaccination.
Current CDC recommendations call for vaccinating those at high
risk after an exposure.

Inger Damon, the CDC�s top orthopoxvirus expert, said at a
briefing with reporters that federal officials have yet to
receive information from state and local health departments on
the number of Americans vaccinated against monkeypox.

Krellenstein, who joined a call with senior administration
officials on Tuesday to discuss the U.S. monkeypox strategy,
said the administration could not answer questions about vaccine
uptake.

�That�s very concerning, because we do need to be making sure
that this vaccine is going into arms,� Krellenstein said, adding
that the lack of clarity echoed the CDC�s data problems from the
coronavirus response.

Officials say they also are worried about possible supply chain
bottlenecks with the vaccine, a problem that emerged during the
coronavirus pandemic as countries competed for resources to
fight the virus, and hard-hit nations such as India moved to ban
exports of coronavirus vaccines.

Jynneos is produced by Bavarian Nordic in Denmark � and is the
only vaccine approved by the Food and Drug Administration to
prevent monkeypox. Some pandemic experts have warned that if the
outbreak worsens, European officials could institute an export
ban on Jynneos and limit shipments abroad.

The United States currently has more than 65,000 doses of
Jynneos, a two-shot vaccine, immediately available in its
Strategic National Stockpile, officials said. The federal
government has also requested that 300,000 additional government-
owned doses be soon shipped to the United States, and has
ordered another 500,000 doses to be delivered later this year.

Public health experts and activists are clamoring for more-
proactive vaccinations in high-risk communities, warning that
the outbreak could be amplified as the gay community celebrates
Pride Month and if clinicians miss opportunities to diagnose
probable cases of monkeypox.

�I had four close contacts that likely could have been avoided
if I�d gotten my early diagnosis,� said the New York City man
who was forced to visit four providers to get tested. He said he
decided on his own to isolate when his symptoms worsened,
because he worried about the virus spreading, undetected,
through the gay community. �Hopefully we can prevent that with
the vaccine,� he said.

Frances Stead Sellers contributed to this report.

Let the fags die. They don't learn, will not learn, refuse to
learn.

https://www.washingtonpost.com/health/2022/06/23/monkeypox- response-biden-administration/

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