Health minister says states ‘must work with us’ to fight monkeypox


“Ultimately, they are the ones who determine how health care will be delivered in their jurisdiction.”

People line up for monkeypox vaccinations at a sexual health clinic in the Harlem neighborhood of New York on July 7, 2022. Victor J. Blue/The New York Times

WASHINGTON – With monkeypox cases on the rise and vaccine doses running low, President Joe Biden’s health secretary suggested Thursday that states and local governments bear some of the blame for what critics have called a flawed response.

“We don’t control public health in the 50 states, territories and tribal jurisdictions,” said Xavier Becerra, the secretary of Health and Human Services, when asked by reporters if the virus could be eliminated. “We rely on our partnership in working with them. They have to work with us.”

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Still talking about the states, he added, “Ultimately, they are the ones who determine how health care is going to be implemented in their jurisdictions.”

Becerra’s comments came as San Francisco, which like New York has one of the highest rates of monkeypox cases in the United States, declared a public health emergency. Officials there said the move would allow the city to receive reimbursement from California and the federal government as it works to deal with the outbreak.

However, in Washington, DC, Becerra said his agency was still considering whether to declare a public health emergency. His suggestion that states and local governments must do more appeared to surprise state and local officials, who said in interviews that they were generally satisfied with the federal government’s actions, despite vaccine shortages.

“We feel the federal response has been strong and they’ve worked with us,” said Dr Marcus Plescia, chief medical officer of the Association of State and Territory Health Officials. “There’s just going to be a little lag between when we find out about these things and when we can really scale up the interventions that we have.”

Becerra may have been trying to deflect criticism from advocates for people with HIV and AIDS, who face a disproportionate risk of contracting monkeypox, and has been vocal about his displeasure with the response.

The Centers for Disease Control and Prevention reported Thursday that the United States has now confirmed more than 4,600 cases of monkeypox, which the World Health Organization has already declared a global health emergency. The number of cases in the US is among the highest in the world, and the figure is almost certainly an underestimate. Men who have sex with men account for 99% of confirmed cases so far.

On Wednesday, the Food and Drug Administration announced that it had approved nearly 800,000 additional doses of Jynneos, the monkeypox vaccine. On Friday, the administration will begin allowing states to order doses, using the same ordering system it has set up to handle coronavirus vaccines. Becerra said his agency has also purchased an additional 5.5 million doses of the vaccine and will provide more than 6.9 million doses by May.

James Krellenstein, founder of PrEP4All, an AIDS advocacy group, said it’s not fast enough. He criticized the FDA for not acting more quickly to increase supply and for delaying an inspection of the vaccine manufacturer’s production facility in Denmark.

But FDA Commissioner Dr. Robert Califf told reporters Thursday that his agency was acting “much faster than planned,” given that it had to not only inspect the factory but also make sure the vaccine was effective. “The only thing worse than not having a vaccine,” he said, “is having a vaccine that is widespread and not effective.”

Currently there is not enough vaccine. On Wednesday, New Jersey Gov. Phil Murphy, a Democrat, wrote a letter to Becerra and CDC Director Dr. Rochelle Walensky, complaining that New Jersey didn’t get its fair share. In the letter, obtained by The New York Times, Murphy noted New Jersey’s proximity to New York, which has more monkeypox cases than any other state.

He said his calculations show that because of that proximity and the number of same-sex households in New Jersey, his state would bear 3% of the national disease burden, but was allocated only 2.06% of the 131,000 doses so far available. “Therefore, we do not believe that New Jersey received a fair percentage of the available vaccine,” Murphy’s letter said.

Federal health officials say their distribution strategy depends on two factors: how many cases a state has and how many of its residents are at risk. The formula prioritizes areas with at-risk populations — including men who have sex with men, who have HIV or who are eligible for drugs that can reduce a person’s chance of contracting HIV, said Dr. Jennifer McQuiston, who is helping lead the response to monkeypox for the CDC.

Coming after more than two years of the coronavirus pandemic, the monkeypox outbreak, which began in May, presents another challenge for overburdened public health officials across the country. So far, Congress has not appropriated any money for the response — although Senate Democrats on Thursday proposed $21 billion in COVID-19 costs — and the public is tired of hearing about infectious diseases. The Biden administration estimated it would need an additional $7 billion to fight monkeypox.

And because of the country’s federalist system, in which public health is left up to the states, coordinating a national response has not been easy, said Theresa Spinner, spokeswoman for the National Association of County and City Health Officials.

“It doesn’t help us to have 57 plans when we have a national challenge,” she said, referring to the 50 states plus territories and major cities. Infectious diseases, she added, “don’t care about jurisdictional boundaries.”

Some states have reported that they are cooperating smoothly with the Biden administration so far. “We’re getting more vaccines from the federal government, and they’ve really responded,” said Dr. Clay Marsh, executive dean of health sciences at West Virginia University, who helped with the state’s response to COVID-19.

Patrick Allen, director of the Oregon Department of Health, said the state is already overwhelmed with the response to COVID-19 and is preparing for a continued surge in monkeypox cases.

“They’re all very thin,” he said. “It’s really obvious. The systems that are really taxed because of the coronavirus are the same systems that we have to rely on for monkeypox.”

Oregon, which has dozens of confirmed and suspected cases, has not yet experienced intense demand for vaccines, but needs more doses from the federal government, Allen said.

“We are implementing a delayed second dose strategy for vaccines, to make sure we can get as many first doses as possible to vulnerable communities and people who have been exposed,” he said. “We know that other doses will come, and we think that adds to the benefit.”

This article originally appeared in The New York Times.

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