Leading LGBTQ+ charities including GLAAD, and pharma company Gilead have teamed up to support responses to the monkeypox outbreak.
The coalition, which also includes the Human Rights Campaign, the National Black Justice Coalition, the National Center for Lesbian Rights, and the National Minority AIDS Council, was announced on 9 August.
Gilead, which makes PrEP pills Truvada and Descovy, has pledged up to $5 million in global grant funding to support a public education and vaccine hesitancy campaign, a public policy response and a global outbreak emergency fund.
The fund will issue grants of up to $50,000 to pre-existing Giliead grantee organisations that work in regions that have the highest active monkeypox outbreaks.
“Funds may be used to cover expenses such as community mobilisation activities specifically addressing MPV outbreak in communities disproportionately impacted by HIV, operating costs related to HIV testing and service interruptions and essential safety materials,” said GLAAD.
Charities such as GLAAD and HRC will focus on providing critical information about monkeypox to demographics and regions that are being significantly affected by the outbreaks, predominantly gay and bisexual man, and those living with HIV.
“As we saw with HIV, COVID-19, and now [monkeypox], disinformation continues to challenge the LGBTQ+ community,” GLAAD president and CEO Sarah Kate Ellis said.
“This new collaboration will enable creating and distributing content and resources to help our community know the facts and to understand prevention and treatment.
“When communities receive accurate, timely information, they are empowered to take appropriate action, leading to long-lasting, positive health outcomes.”
Giliead executive vice president of corporate affairs and general counsel Deborah Telman said the collaboration would ensure that the “immediate needs of impacted communities” were met, while steering groups away from disinformation which can lead to further spread of the disease.
In an interview with Reuters, spokesperson Rich Ferraro said that “with this partnership, we’ll be able to do more.”
There are currently a total of 31,800 confirmed monkeypox cases around the globe, according to regularly updated statistics from the Centers for Disease Control and Provention (CDC), with 31,425 of those coming from countries that have not historically reported monkeypox.
Because the disease has been found to disproportionately affect gay and bisexual men, there is a fear the outbreak could lead to homophobic stigma.
In America, far-right Republican Marjorie Taylor Greene has become notorious for spreading misinformation on the subject, saying that the disease is a “scam”.
“It’s not a threat to most of the population, and so it’s not a global pandemic, it’s really not, and people just have to laugh at it, mock it, and reject it. It’s another scam,” she said.
The CDC has said that research is still determining whether monkeypox can spread through “semen, vaginal fluids, urine, or faeces” and has only currently determined that it can spread through skin-to-skin contact, which can happen during “intimate contact.”
LGBTQI+ individuals are more likely than their counterparts to exhibit suicidal behavior. According to data reported by the Centers for Disease Control and Prevention, in 2019, nearly half of students identifying as gay, lesbian or bisexual reported seriously considered suicide. These students experienced a near fourfold increase in suicide attempts compared with heterosexual students. LGBTQI+ adults are also at greater risk of suicide. According to the Substance Use and Mental Health Services Administration’s (SAMHSA) 2020 National Survey on Drug Use and Health, 15.9 percent of LGB respondents ages 26 to 49 reported serious suicidal thoughts within the past year, and 2.1 percent reported a suicide attempt.
The experiences of stigmatization, rejection, trauma, victimization, microaggressions, homophobia and transphobia all contribute to this elevated risk. Conversely, support and connection between LGBTQI+ youth and their family or caregiver, peers, school and community, can promote better mental health, fewer negative outcomes and stronger resilience. The federal government, along with public and private sector partners, plays an important role toward building this affirming support and connection.
On July 16, SAMHSA led the nationwide transition to 988 as the easy-to-remember number to reach the 988 Suicide & Crisis Lifeline — an important step forward to strengthen and transform crisis care in our country.
Historically there have been notable gaps in accessing needed care for suicidal, mental health and substance use concerns with marginalized groups often facing additional barriers and inequitable outcomes.
SAMHSA is committed to enhancing access to crisis services for LGBTQI+ youth, including through the 988 Suicide and Crisis Lifeline, and has outlined a number of critical activities. These include enhanced training, service linkage to specialized care and creation and testing of direct chat portals and interactive voice response menu options.
In addition, research shows the training and expertise of the counselors who respond to crisis contacts matters. A recent survey of 12- to 25-year-old callers conducted by the Trevor Project revealed that nearly half indicated they called specifically because of LGBT-affirming counselors.
Recent federal appropriations direct $7.2 million to provide specialized services for LGBTQ youth within the 988 Lifeline. SAMHSA has been working closely with its partners to do so. Given both youth preferences for digital tools like text and chat and the particular needs of LGBTQI+ youth, such enhancements in access are critically important strategies to promote engagement.
The implementation of 988 and expanding access to affirming support for struggling LGBTQI+ youth is a critical first step in saving lives, decreasing stigma and linking those in need to compassionate and effective care. If you or someone you know may be struggling with suicidal thoughts, call or text 988 or chat at 988lifeline.org
For most of the six decades that monkeypox has been known to affect people, it was not known as a disease that spreads through sex. Now that has changed.
The current outbreak is by far the biggest involving the virus, and it’s been designated a global emergency. So far, officials say, all evidence indicates that the disease has spread mainly through networks of men who have sex with men.
“It clearly is spreading as an STI (sexually transmitted infection) at this point,” said Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security.
To protect the people at highest risk while trying to contain the spread, public health agencies are focusing their attention on those men — and attacking the virus based on how it’s behaving now.
On Wednesday, the head of the World Health Organization advised men at risk for monkeypox to consider reducing their sexual partners “for the moment.”
But this is a complicated outbreak that may shift in how it spreads and which population groups are most affected. There is also debate about whether monkeypox should be called a sexually transmitted disease, with some critics complaining that the term creates a stigma and could be used to vilify gay and bisexual men.
Monkeypox can spread in nonsexual ways too, and it’s not enough to use condoms or other typical measures for stopping STDs, Inglesby and other experts say.
Here’s what we know.
What makes something an STD?
A sexually transmitted disease is commonly defined as one that mainly spreads through sexual contact. But some STDs can be spread in other ways, too. HIV can spread through shared needles. Syphilis can spread through kissing. A common, parasite-caused sexual infection called trichomoniasis has been found to spread through the sharing of damp, moist objects like sponges or towels.
Monkeypox has not usually spread easily among people, and experts are still trying to understand exactly how it moves from person to person. In Africa, where small outbreaks have been common for years, people have been infected through bites from rodents or small animals.
But in May, cases began emerging in Europe, the United States and elsewhere that showed a clear pattern of infection through intimate contact with an infected person, like many other sexually transmitted diseases.
The public health workers who respond to outbreaks play a large role how they are framed. Much of the work on monkeypox has been done by professionals who operate sexual health clinics or specialize in STDs.
Indeed, the U.S. government’s response needs to be led by people with that expertise, said David C. Harvey, executive director of the National Coalition of STD Directors.
“The STD field has a wealth of knowledge and expertise in these areas developed over decades fighting various outbreaks and diseases affecting the very communities … we’re seeing monkeypox taking a toll on today,” Harvey said in a statement.
Who is getting monkeypox?
WHO officials said last week that 99% of all the monkeypox cases beyond Africa were in men and that of those, 98% involved men who have sex with men. Experts suspect that monkeypox outbreaks in Europe and North America were ignited by sex at two raves in Belgium and Spain.
The statistics are the same for cases reported in the United States, according to the Centers for Disease Control and Prevention. As in Europe, cases have emerged in other groups too, including at least 13 people who were female at birth and at least two children.
Last week, the New England Journal of Medicine published a study of hundreds of monkeypox infections in 16 countries. It found that the suspected means of transmission in 95% of the cases was sexual close contact, as reported by doctors. The researchers noted that it was impossible to confirm sexual transmission.
That idea seemed to be further supported by the finding that most of the men had lesions in the genital or anal areas or in the mouth — areas of sexual contact, the researchers said.
Why is there a debate about calling it an STD?
While there is broad agreement among health officials that monkeypox is being transmitted during sexual encounters, some experts debate whether it should be called an STD. They worry that the term unfairly stigmatizes and that it could undermine efforts to identify infections and tame the outbreak.
When a disease is defined as a sexually transmitted infection that mainly affects men who have sex with men, many people may begin to think of it as “a gay disease” that poses no risk to them, said Jason Farley, an epidemiologist at the Johns Hopkins School of Nursing.
That’s what happened in the early days of the AIDS epidemic in the 1980s, which contributed to the spread of HIV to other groups. Farley said.
“We learn nothing from our history,” said Farley, who is gay.
The WHO recommendation that at-risk men limit their sexual partners is sensible public health advice, he said. But it also amplifies “the message that this is a gay disease,” he said.
“This is the fine line between having a public health approach that focuses on the epidemiology of now, compared to the likelihood of the continued emergence of new cases in” the general community, he said.
“Monkeypox is not a sexually transmitted infection,” he said. “It is an infection that can be transmitted with sexual contact.”
What is known about transmission?
Some researchers have found evidence of the monkeypox virus in semen. A study in Spain found monkeypox virus DNA in the semen of some infected men, as well as in saliva and other body fluids. But the study didn’t answer whether the virus actually has spread through semen.
Sorting that out could affect the understanding of not only how men spread the infection, but also how long they might be contagious. Evidence of some other viruses — like Ebola and Zika — has been found in the semen of some men months after they were thought to be fully recovered.
Meanwhile, scientists believe the primary route of transmission during the current outbreak has been skin-to-skin contact during sexual encounters with someone who has symptoms. In that respect, it’s similar to herpes, some experts noted.
The virus also may spread through saliva and respiratory droplets during prolonged, face-to-face contact, such as during kissing and cuddling — a kind of spread that can occur outside of sex.
Researchers are exploring how often, and in what situations, that kind of spread might happen, said Christopher Mores, a professor of global health at George Washington University.
“We would do ourselves a disservice to try and exclude anything from the realm of possibility at this point,” he said.
Officials also say people can catch monkeypox from touching items that previously touched an infected person’s rash or body fluids, such as towels or bedsheets. That is thought to explain the infections of the U.S. children.
Why are these details important?
It’s important to understand exactly how monkeypox spreads in order to give people the information they need to protect themselves, health officials say.
That said, health officials believe those who are currently at the highest risk are gay or bisexual men who have sex with multiple partners. That understanding has shaped much of the work to contain the outbreak, including prioritization of the supply of vaccines and treatments.
The government has been shipping a monkeypox vaccine, but the supply is limited. So far it’s only been recommended as a post-exposure treatment or for people who have had multiple sex partners in the past two weeks in a place where monkeypox cases have been reported.
The vaccine is new, and officials are trying to gather data on exactly how well it works.
British health authorities said Friday the monkeypox outbreak across the country may be peaking and that the epidemic’s growth rate has slowed.
The U.K.’s Health Security Agency said in a statement there were “early signs that the outbreak is plateauing,” with 2,859 cases detected since May. No deaths have been reported. Last month, authorities estimated the outbreak was doubling in size about every two weeks, but the number of new infections has dropped in recent weeks.
“While the most recent data suggest the growth of the outbreak has slowed, we cannot be complacent,” said Dr. Meera Chand, Director of Clinical and Emerging Infections at the Health Security Agency. She said anyone who thought they might have monkeypox should skip meeting friends, social gatherings and avoid sexual contact.
The Health Security Agency said its most recent analysis of the outbreak “shows that monkeypox continues to be transmitted primarily in interconnected sexual networks of gay, bisexual, or men who have sex with other men.” More than 70% of the U.K.’s cases are in London.
British officials noted a small number of infections among women, but said there was not enough evidence to suggest there was sustained spread of monkeypox beyond gay and bisexual men; 99% of all cases in the U.K. are in men.
Scientists who analyzed monkeypox viruses in the U.K. noted a number of mutations compared to viruses circulating in Africa, but said there was no evidence those genetic changes made monkeypox any more transmissible.
The World Health Organization said this week that 92% of monkeypox cases beyond Africa were likely infected through sex and its Director-General recently appealed to vulnerable gay and bisexual men to consider reducing their sexual partners “for the moment.”
To date, more than 26,000 monkeypox cases have been reported in nearly 90 countries, with a 19% increase in the last week.
In June, British authorities expanded their vaccination strategy, offering vaccines not only to health workers treating monkeypox patients and high-risk contacts of patients, but to some men who are gay or bisexual and at high risk of catching the virus, including those with multiple sexual partners or who participate in group sex.
Last month, the U.K. downgraded its assessment of the monkeypox outbreak and dropped a recommendation for the contacts of monkeypox cases to isolate for three weeks unless they have symptoms. The change was prompted by data showing that only a small number of contacts are ultimately sickened by monkeypox and a lack of evidence that the disease spreads without close, intimate or sexual contact.
Monkeypox spreads when people have close, physical contact with an infected person’s lesions, their clothing or bedsheets. Most people recover without needing treatment, but the lesions can be extremely painful and more severe cases can result in complications including encephalitis and death.
The Australian government is to import 450,000 monkeypox vaccine doses to help tackle a rise in cases.
Health minister Mark Butler told reporters on Thursday (4 August) the government had negotiated at least 450,000 doses of the third-generation Bavarian-Nordic vaccine to be prioritised for specific at-risk groups including gay and bisexual men.
The government began negotiating vaccine distribution on 20 May, according to Butler, just one day after the first confirmed case in Australia.
At the current time of reporting, the US Centers for Disease Control and Prevention (CDC) estimates that at least 53 cases of the disease have been reported in Australia
While cases may seem low right now, Butler assured the public numbers had “increased quite quickly” around the world, with countries like the US currently seeing cases reach more than 6,000, and more than 4,000 in Spain.
While Australia has secured 450,000 doses, other countries are struggling to roll out the vaccine. The EU has purchased just 163,000 vaccines through its central Health Emergency Preparedness and Response Authority (HERA). France has purchased 250,000, with the UK having purchased just over 100,000.
Australia declared monkeypox a “communicable disease incident of national significance” on 28 July, just days after the World Health Organisation declared it a global health emergency.
Butler said that the first 100,000 doses are expected to reach Australia over the remaining months of 2022, with 22,000 arriving this and next week. The remaining 350,000 will be distributed in 2023.
He said the vaccine was “by far the most effective and user-friendly for patients with compromised immunity” and could also be administered in vulnerable groups such as pregnant women, children, and those with pre-existing conditions.
“I’m very pleased with the work the chief medical officer and the department have been able to do in a short period of time, particularly to secure the supply of vaccines in a highly contested global market,” he continued.
Patient receives a dose of the monkeypox vaccine at a pop-up vaccination clinic. (Mario Tama/Getty)He also warned against “stigma and discrimination” after several misinformed pundits had suggested monkeypox was a “gay disease” and is only sexually transmitted. The CDC reports researchers arestill determining whether the disease can transmit sexually and have not referred to it as an STI.
UK Health Security Agency (UKHSA) epidemiologist Mateo Prochazka toldPinkNews in May that the “discourse around this infection is going to become more prevalent and intersect with discourses that are homophobic”.
“Gay and bisexual men usually have larger numbers of sex partners and are more likely to have anonymous sexual partners as well,” he said, “and this can lead to direct contact that may not be seen in other sexual networks with the same frequency”.
“It might be that the pathogen has now entered those networks and is being spread that way. It does not mean that gay or bisexual men are doing anything inherently wrong, or that the virus has changed or that it’s sexually transmitted, it just means that this behaviour facilitates transmission in these networks.”
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Amid growing concerns over the potential threat of monkeypox, executives from Moderna said Wednesday they have initiated a research program to consider whether the company could create a monkeypox vaccine with mRNA technology. “We’re obviously very aware of the monkeypox concern and obviously very sensitive to recent announcements,” Moderna President Stephen Hoge said during an investor call.
“Our platform is pretty well established and our ability to rapidly scale has been demonstrated. If we were to go after a monkeypox clinical development program, it would be to very quickly progress toward an approvable set of endpoints in a clinical study,” he explained. As seen with the rollout for the COVID-19 vaccines, any new vaccine would still need to go through the regulatory authorization process, which can take weeks to months, even in special circumstances.
CDC Director Rochelle Walensky told reporters on a call Thursday that gay and bisexual men who are HIV positive or who are taking medicines, called PREP, to reduce their chance of contracting HIV face the greatest health risk from monkeypox.
“That’s the population we have been most focused on in terms of vaccination,” Walensky said.
The U.S. has secured 1.1 million doses of the two-dose vaccine Jynneos so far, according to the Health and Human Services Department. The federal government has delivered more than 600,000 doses of the vaccine since May, according to HHS.
As monkeypox continues to spread worldwide, health officials have recommended high-risk individuals get vaccinated as soon as possible—but research is limited on just how effectively the available vaccines prevent infection, Randy Dotinga writes for MedPage Today.
CDC has confirmed 6,326 cases of monkeypox across 48 U.S. states, the District of Columbia, and Puerto Rico. The states most impacted by the outbreak so far are New York with 1,617 cases, California with 826 cases, and Illinois with 533 cases.
To reduce the risk of viral transmission, health officials have recommended high-risk individuals be vaccinated against monkeypox. So far, the United States has purchased 7 million doses of Bavarian Nordic‘s Jynneos vaccine, the preferred vaccine against monkeypox, and the entire supply is expected to be available by mid-2023.
So far, the supply of vaccines has been limited, with many jurisdictions, including San Francisco and New York City, saying that they do not have enough to meet demand. Last week, FDA announced it had cleared an additional 786,000 vaccine doses for use.
How well does the monkeypox vaccine actually work?
While health officials continue to emphasize the value of vaccination, there is limited evidence to show that the monkeypox vaccine is effective at preventing infection from the virus. CDC has acknowledged that “no data are available yet on the effectiveness of these vaccines in the current outbreak.”
According to Jay Varma, director of the Cornell Center for Pandemic Prevention and Response, “It is absolutely critical that public health officials work on messaging this uncertainty to people about being vaccinated.”
So far, much of the data on the monkeypox vaccine is from a retrospective analysis published in 1988, which examined whether a smallpox vaccine could also prevent monkeypox. In the study, researchers followed household contacts of 209 people in Zaire who had been infected with monkeypox and found that those who had scars from prior smallpox vaccination were 85% less likely to be infected.
According to Ira Longini, a biostatistician at the University of Florida, the study’s conclusions are limited, since its statistical analysis has no reported confidence interval and did not adjust for other factors, such as age. In addition, the data was based solely on physical signs of vaccination.
The study “is the only shred of evidence we have (in regard to vaccine effectiveness), which is pretty weak,” he said. “In principle it should work, but we don’t know.”
Richard Kennedy, co-director of the Mayo Vaccine Research Group, agreed, saying that the Jynneos vaccine and an older smallpox vaccine ACAM2000 “have not been tested directly against smallpox or monkeypox” and that “[t]he immune responses they create are very close to first- or second-generation vaccines: A little weaker, but not much.”
However, Kennedy noted that the vaccines have been tested against monkeypox in several animal studies. “These data are also clear and consistent with very good protection against disease with animals showing very few or no symptoms of illness after challenge,” he said. “The animal data was strong enough that the FDA approved Jynneos to be licensed for prevention of monkeypox.”
How can people protect themselves against monkeypox?
In addition to vaccination, health officials have advised those who are most at risk, particularly men who have sex with men (MSM), to take steps to reduce their risk of infection, including adjusting their sexual behavior during the current outbreak.
For example, World Health Organization Director-General Tedros Adhanom Ghebreyesus last week recommended “reducing your number of sexual partners, reconsidering … sex with new partners, and exchanging contact details with any new partners to enable follow up if needed.”
Similarly, CDC offered advice for lowering the potential risk of infection during sex, including not kissing and avoiding sharing towels and other items.
“The prevention messaging should be that vaccinations will be an essential part of getting this outbreak under control, and we need everyone to get vaccinated as soon as possible,” said Michael Donnelly, a data scientist and LGBT health advocate. “But even if you’re vaccinated, you’re still at risk, and unprotected anal sex may be the highest risk.”
“Even after vaccination, you may want to consider reducing the number of your sex partners and using condoms or pursuing other safer sex approaches,” he added. (Dotinga, MedPage Today, 8/1)
Southern Decadence, advertised as the largest LGBTQ+ festival held annually in the Deep South, is scheduled for Labor Day weekend (Sept. 1-5) in New Orleans. It typically attracts 100,000 to 300,000 participants and is a major economic boon to the city in a season when tourism is otherwise sluggish. Health officials at the state and local level say Louisiana’s meager vaccine supply will leave the state vulnerable to a large monkeypox outbreak following such a massive event.
Southern Decadence could also further the virus spread in other parts of the country if visitors become infected while in New Orleans and carry monkeypox back to their hometowns, they said. “This will be a superspreader event without additional vaccine doses ahead of time to get as many people as possible [vaccinated],” said Jennifer Avegno, New Orleans health director and an emergency room physician, in an interview this week.
Joseph Ladapo — Florida’s surgeon general appointed by the state’s anti-LGBTQ Republican Gov. Ron DeSantis — is trying to make people distrust the monkeypox vaccine, stating that there is “little data” on it, which is misleading.
Ladapo’s position is hardly surprising considering that he spent years spreading COVID-19 disinformation and echoing DeSantis’ distrust in vaccines.
On Tuesday, DeSantis criticized the Democratic governors of California, Illinois, and New York for declaring states of emergency over monkeypox. The declarations give their governments greater ability to mobilize resources against the virus. (U.S. President Joe Biden declared a national state of emergency for monkeypox on Thursday.)
DeSantis said the governors were using the emergency declarations to stoke fear, control people, and “restrict your freedom.”
Ladapo backed up DeSantis’ words, stating, “It’s just kind of remarkable to see some of the headlines — the headlines that very clearly are trying to make you afraid of monkeypox or fill-in-the-blank. You know, because if you’re not afraid of this there will be something else after that and something else after that.”
“These people are determined to make you afraid and do whatever it is they want you to do. And, um, you know, I hope that more and more people choose not to do that,” he added.
Then after revealing that Florida had distributed 8,500 monkeypox vaccines, Lapado said, “You should know that there’s actually very little data on this vaccine.”
To understand why Lapado’s claim is misleading, a little background is necessary.
As of Tuesday, the U.S. Centers for Disease Control and Prevention (CDC) has reported 6,326 monkeypox cases within the United States. The Florida Department of Health shows 525 monkeypox cases statewide, The Florida Phoenix reported.
The Jynneos vaccine is made from a virus that is closely related to, but less harmful than, monkeypox viruses. It does not cause disease in humans and cannot reproduce in human cells.
A study of 400 individuals found that the Jynneos vaccine was as effective against monkeypox as the ACAM2000 smallpox vaccine, which the FDA approved in 2007. The safety of Jynneos was assessed in more than 7,800 individuals who received at least one dose of the vaccine, the FDA said. Previous studies have shown that smallpox vaccines are 85% likely to provide a high level of immunity against monkeypox for up to two years, according to the MIT Technology Review.
Ladapo’s authority on vaccines is highly questionable at best.
In July 2020, near the start of the COVID-19 pandemic, he appeared in a 43-minute viral video as part of a group called America’s Frontline Doctors. The group, which had no epidemiologists or immunologists qualified to speak on infectious diseases, promoted the anti-malaria medication hydroxychloroquine as a “cure” for COVID-19, even though no studies substantiated that claim. The video also said that face masks do not slow the virus’s spread and that COVID-19 is less deadly than the flu. Both claims are untrue.
The video also featured Dr. Stella Immanuel, a pediatrician and religious minister who gained notoriety in 2020 for her bizarre theories, including that “demonic seed” causes endometriosis and ovarian cysts. Immanuel explained on her church’s website that demons insert sperm into sleeping individuals when they have sex in their dreams.
The doctors’ recorded speech was organized by the Tea Party Patriots, a right-wing group backed by wealthy Republican donors. Lapado has written numerous op-eds repeating the video’s false claims.
The video received millions of views when then-President Donald Trump, his son Donald Trump Jr. and other right-wing media figures shared it on social media. Facebook, YouTube, and Twitter all removed the video for violating their policies on sharing COVID-19 misinformation.
In October 2020, Ladapo signed the Great Barrington Declaration, a statement that called for developing societal herd immunity to COVID-19 through natural infection. In response, 80 medical researchers signed an open letter published in The Lancet, a leading medical journal, calling the declaration’s theory “a dangerous fallacy unsupported by scientific evidence.”
Florida ranks third among U.S. states with the highest numbers of COVID-19 infections and related deaths. DeSantis has signed orders expanding exemptions for people who don’t want to get vaccinated against COVID-19 vaccines and to prevent schools and local governments from instating face mask mandates in Florida.
The Biden administration declaredmonkeypox a public health emergency on Thursday as cases topped 6,600 nationwide.
The declaration could facilitate access to emergency funds, allow health agencies to collect more data about cases and vaccinations, accelerate vaccine distribution and make it easier for doctors to prescribe treatment.
“We’re prepared to take our response to the next level in addressing this virus and we urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus,” Department of Health and Human Services Secretary Xavier Becerra said in a Thursday briefing about the emergency declaration.
A quarter of U.S. cases are in New York state, which declared a state of emergency last week. California and Illinois followed suit with emergency declarations Monday.
The World Health Organization declared monkeypox a public health emergency of international concern last month, a designation reserved for the most serious global disease outbreaks. It has previously been used for Covid-19, Zika, H1N1 flu, polio and Ebola. At least 26,200 monkeypox cases have been confirmed worldwide this year, according to the Centers for Disease Control and Prevention.
The WHO recently advised men who have sex with men to reduce their number of sexual partners and reconsider sex with new partners while the outbreak is ongoing.
The average U.S. monkeypox patient is around 35 years old, but people of all ages can be infected. The CDC has recorded five cases in children: two in California, two in Indiana and an infant who is not a U.S. resident who tested positive in Washington, D.C.
The California and Indiana health departments declined to provide details about their pediatric cases, but Jennifer Rice Epstein, the public affairs officer at the Long Beach Department of Health and Human Services, said the patient in her city was exposed via a close contact.
As of last week, white people represented 37% of U.S. monkeypox cases, followed by Hispanic or Latino people (31%), Black people (27%) and Asian people (4%), according to HHS.
U.S. officials still think the outbreak can be contained
HHS officials still hope to prevent monkeypox from becoming endemic in the U.S.
“We continue to marshal forward the tools that we need to make sure that we can take on monkeypox and keep it from spreading to the point of becoming endemic,” Becerra said Thursday.
“There should be no reason why we can’t stay ahead of this if we all work together,” he added.
That work relies primarily on testing, targeted vaccinations and treatment.
As of Thursday, the U.S. had distributed 600,000 of the 1.1 million available doses of the Jynneos vaccine, which is administered as a two-shot regimen. In total, the country has ordered 6.9 million doses. HHS said a shipment of 150,000 doses will arrive in the U.S. in September to then be distributed.
The shot can prevent monkeypox if given before or within four days of exposure. If given within 14 days after exposure, it can ease symptoms.
U.S. testing capacity has also increased, from 6,000 weekly tests in May to 80,000 now.
“Right now we’re really only testing at about 10% of the capacity we have. We are encouraging anyone who has a rash that could be monkeypox to present for testing,” CDC Director Rochelle Walensky said Thursday.
Around 14,000 people in the U.S. have received TPOXX, an antiviral drug that is authorized for use against smallpox but can also be used to treat monkeypox. The Strategic National Stockpile contains 1.7 million of the treatments, HHS said. But the drug’s use is for now limited to people with severe disease or a high risk of becoming severely ill. Physicians must also complete extensive paperwork to prescribe it for monkeypox.
Expanded access to TPOXX was among the many reasons that sexual health providers called on HHS to declare a public health emergency.
“It’s unconscionable not to further make changes to make TPOXX accessible to all that need it,” David Harvey, executive director of the National Coalition of STD Directors, said Tuesday on a news call.
Most U.S. monkeypox patients have reported a rash
The most common monkeypox symptoms include a rash — reported in 99% of U.S. cases so far — malaise, fever and swollen lymph nodes. Some patients have also reported chills, headache and muscle pain.
Some people with monkeypox develop just one or two lesions in their rash, while others can develop several thousand, according to the WHO.
A study published last month, which examined monkeypox cases in 16 countries from April to June, found that nearly 65% of people had fewer than 10 lesions. The lesions were most commonly found in the anus or genital area, followed by the torso, arms or legs. A smaller number of people saw lesions on their face, palms or soles of the feet.
Symptoms usually appeared within a week of exposure, the study found. Around 13% of people studied were hospitalized, mostly for pain management.
