Local health care experts and advocates are hoping for increased funding and attention to monkeypox with less bureaucratic red tape, after the Biden administration declared the outbreak a public health emergency on Thursday.
The declaration followed a similar one by the World Health Organization on July 23 and came as the number of monkeypox cases in the state grew by a more than a third over the previous week to 157.
“[The] declaration is an important signal not only to health departments across the country but the broader public that this is something to be taken seriously, and it gives them leverage to push other parts of the government to act,” said Dan Gates, president and CEO of AIDS Support Group of Cape Cod, which has been helping raise awareness about monkeypox and the availability of vaccines.
While vaccine supplies have been sufficient locally for those who are eligible, Gates said more vaccines were needed to provide shots to whoever wants one, and to continue the state’s robust response. Currently, only people living or working in Massachusetts can get a shot, and they must either have known contacts identified through means like contract tracing, have presumed contacts who have had a sexual partner in the last two weeks diagnosed with the virus, or have presumed contacts who had multiple sexual partners in the last two weeks in a jurisdiction with known monkeypox.
Gates said he’s heard of many people visiting Provincetown who are not from Massachusetts who wished they had the same kind of access locally, and who weren’t able to take advantage of Massachusetts’ response.
“We received many calls from people outside of MA asking how could they get vaccine access in their state, because their state didn’t have numerous pop up clinics like Massachusetts had,” he said. “That’s why something like this is important on a national level. It’s the communities that are disenfranchised or less connected to health care or geographically limited that makes vaccine access to important.”
Robert Fenton, White House National Monkeypox Response Coordinator, said at a press briefing on Thursday that the public health emergency declaration would allow the federal government to explore “additional strategies” to get vaccines and treatments to impacted communities and would expand data collection from jurisdictions to better track the outbreak.
As of last week, the government had designated 1.1 million doses of the vaccine, of which 600,000 have been distributed to partners around the country.
Beyond vaccines, federal officials detailed during the briefing that they had expanded testing capacity from 6,000 tests to 80,000 tests a week, and deployed some 14,000 treatments of an FDA-approved antiviral also known as TPOXX. Approximately 1.7 million of those treatments are available in the Strategic National Stockpile.
“But this virus is moving fast,” said Robert Fenton, who was appointed White House National Monkeypox Response Coordinator on Tuesday. “This is a unique outbreak, and that is spreading faster than previous outbreaks. That’s why the President asked me to explore everything we can do to combat monkeypox and protect communities at risk.”
Cases have continued to rise as the efforts to contain the virus have escalated. Nationally, federal officials said there were over 6,600 reported cases of monkeypox in the country — an increase from less than 5,000 the week prior. The Massachusetts Department of Public Health announced Thursday an additional 42 cases of monkeypox in adult males reported within the past seven days, bringing the total number of cases to 157. So far, 14 health care providers and locations are up and running to provide vaccinations, with 5,875 doses of JYNNEOS vaccine administered so far in the state.
The virus has hit the gay and bisexual male community with particular intensity. While not considered a sexually transmitted disease, the virus is currently spreading largely through intimate contact between men who have sex with men, though officials have noted that the virus can spread through close physical contact with anyone. The Massachusetts Department of Public Health said gay and bisexual men and other men who have sex with men continue to make up a significant proportion of the cases identified to date.
Sean Cahill, director of health policy research at The Fenway Institute, which is part of Fenway Health in Boston, said the declaration was important given the gravity of the crisis and the inadequacy of the federal response to date.
“We’re hopeful this declaration will lead to a dramatic scaling up of vaccine development in particular,” he said.
With 1.5 million gay and bisexual men living in the United States, 1.1 million doses of the two-dose vaccine was insufficient. Cahill said the government has promised to make an additional 150,000 doses available by September, and 5 million doses available by mid-2023, but that timeline was far too delayed.
“We’re hoping that with this public health emergency, they create a Manhattan project for vaccine development,” Cahill said. “We have a safe and effective vaccine, but we have to figure out how quickly they can manufacture it.”
An emergency use authorization for the vaccine as a single-dose therapy would also enable more states to have more comfort in how they distribute it. Currently New York City, D.C. and San Francisco, as well as the UK and Canada, have begun to distribute the vaccine as a single dose treatment.
Fenway Institute was also advocating for an emergency use authorization for new testing modalities, to facilitate the development of at-home tests. Though testing is faster and more broadly available now with the participation of several national labs, still there were incidents nationally where people couldn’t get tests or had to wait a week to get results, he said.
More work was also needed to speed up access to treatments. While the antiviral TPOXX is available, it is approved by the FDA for use with smallpox, and so patients accessing the drug for monkeypox have to be enrolled in clinical trials. While the federal government has eased some of the procedures to access it in recent weeks, some patients, particularly those with language barriers, are still having a hard time accessing it, said Cahill.
“At Fenway Health, and at academic medical centers, we have staff to run clinical trials for HIV prevention and COVID,” Cahill said. “We have experience filling out that paperwork. But your average health center may not have that experience.”
Dr. Andrew Jorgensen, chief medical officer for Outer Cape Health Services, said the public health declaration was a logical next step in the outbreak.
He hailed the efforts of local community health centers, local public health agencies and local governments to deliver vaccines to communities at highest risk.
“Because of that, we’ve likely prevented many cases of monkeypox,” he said. “I realize that’s not how it’s been everywhere, but it’s important as other communities focus on what more can be done to highlight how this effective collaboration between government and health care has worked here on Cape Cod.”
State Sen. Julian Cyr, who represents Cape Cod, Martha’s Vineyard, and Nantucket, noted the appointment of Dr. Demetre Daskalakis, the CDC’s Director of the Division of HIV/AIDS Prevention, as White House National Monkeypox Response Deputy Coordinator.
“His appointment as the deputy here, as someone who is a gay man and is known in the community as an effective advocate, that is noticed in this response,” Cyr said.