Public Health

We Don't Need a White House Monkeypox 'Coordinator.' We Just Need the Vaccines.

The feds botch another epidemic.


We're up to about 3,600 known cases of monkeypox in the United States, according to the Centers for Disease Control and Prevention (CDC). That's more than double the number of cases from just two weeks ago.

As the federal government struggles to distribute vaccines where they're needed, The Washington Post reports that the White House is thinking of declaring a public health emergency and naming a "White House coordinator" to oversee the response.

The public response should be: Please don't. Please just get the vaccines to local public health agencies and let them deal with it. Because right now, that's about half the problem that's causing monkeypox to spread.

Red tape from the Food and Drug Administration (FDA) and the CDC left more than a million monkeypox vaccine doses stuck in storage in Denmark, and then another roll of red tape made it incredibly difficult for doctors to prescribe an alternative monkeypox treatment because it's still in clinical trials.

As a result, local health agencies have had to carefully portion out vaccines to the highest-risk citizens—and they're still running out. In Los Angeles, the county Public Health Department will only administer to people who are infected, people who have had high-risk contact (typically sex) with somebody who is infected, and then gay or bisexual men or trans people who fit in one of the following categories:

  • They were diagnosed with gonorrhea or early syphilis within the past 12 months (this was previously limited to within 3 months and specific to rectal gonorrhea or early syphilis); or
  • they are on HIV pre-exposure prophylaxis; or
  • they attended or worked at a commercial sex venue or another venue where they had anonymous sex or sex with multiple partners within past 21 days.

And yes, you may be asked to provide documentation that you went to a sex party.

Full monkeypox vaccination requires two doses. But because of the shortage, Los Angeles is giving out as many first doses as it can and will worry about getting those second doses later. New York City is doing the same.

It should be clear from the above that local health agencies have a good sense of who is most at risk (almost entirely men who have sex with men) and how to prioritize vaccinations. What they need, clearly and obviously, is the vaccine. What they need from the White House is to break the logjams at the CDC, the FDA, and the Department of Health and Human Services.

The New York Times reported Sunday that the federal mismanagement of the vaccine stockpile has been even worse than we initially realized. As monkeypox continued its spread among gay and bisexual men in June and people were unable to get the vaccine, it turned out the U.S. already had 372,000 vaccine doses prepared and stored in Denmark that could have been shipped here. But officials didn't ask immediately even as the number of infections spread, and the drugs didn't start arriving in the U.S. until July. These were separate from the million doses that were locked up in a facility because the FDA hadn't inspected it yet.

According to the Times, the U.S. initially requested just 72,000 of the doses. Part of the explanation was that shipping all the doses to the U.S. would reduce their shelf life—if they weren't all needed, many would be lost.

Mind you, the only purpose of this medication is to treat smallpox and monkeypox. The decision to purchase and store all these vaccinations was in case of a bioterror attack of weaponized smallpox. That hasn't happened. The Times says that as of June 10, well after cases started appearing in the U.S., federal officials said we'd be receiving those 372,000 doses "over the next several weeks." But it turns out that the government had not yet requested that those doses be shipped over. The shipments didn't even begin until after New York City's Pride festival, and some local activists believed that the outbreak could have been stemmed had those doses had arrived earlier.

The CDC had an overly strict view of who should be vaccinated, despite the fact that the spread was already growing in Europe and despite the fact that we had all of these doses that served no other real purpose but to prevent the spread of monkeypox. The Times reports:

A spokeswoman for Health and Human Services [suggested] that more doses hadn't been needed earlier, noting that initially the CDC had only endorsed the vaccine for a limited group: known contacts of monkeypox patients.

Though New York City had by June 23 decided to offer the vaccine more broadly—to all men who had recently had sex with multiple or anonymous male sexual partners—the federal government did not endorse that move until June 28.

Those New York health officials were right.

Fortunately, monkeypox's spread has still remained pretty limited even as it has grown. The percentage of growth seems huge because we're dealing with a fairly low baseline. And though monkeypox is not technically a sexually transmitted disease—it is spread through contact with the rashes and lesions created by the virus as well as through saliva—this particular version of monkeypox has been pretty resistant so far to being spread through methods other than sexual contact.

The CDC announced Friday that two children had gotten monkeypox, the first child infections in the U.S. The infection appears to have been the result of household transmission, meaning the children were likely having regular contact with an adult who was infected and with objects—clothing, towels, bedding—that the adults had come into contact with.

But for now at least, those cases seems to be outliers; sexual activity between men remains overwhelmingly the primary method of spread. And yes, this has been pretty well communicated, as evidenced by the number of gay men trying to get vaccinations and the number of city health departments running out.

As long as the government is failing to get its act together, it's a good idea for at-risk groups to adjust their behavior. You don't want to end up like this fellow, described in The New York Times:

Sergio Rodriguez, 39, a transgender queer man who lives in the East Village, said he tried to get vaccinated before Pride Weekend, but was turned away. He hooked up with a few people, and about a week later, began to feel abdominal pain, swollen lymph nodes and body aches. Lesions then spread across his body, and some made it excruciating to urinate.

"I've actively been trying to do things to support myself because I knew that I would be at high risk," he said.

"It's really frustrating," he added, that the government "was not set up to adequately meet the demand."

No, they were not. So it would have been wise not to "hook up with a few people" in the period after he was turned down and before he finally was able to get a vaccination. Given the feds' ability to bungle just about any task, it's all the more important to take personal responsibility for avoiding high-risk behavior if it's in your power to do so.