On December 2, U.S. Department of Health and Human Services Secretary Xavier Becerra announced that the federal government intends to end the public health emergency declaration for monkeypox, now renamed mpox. The Biden administration does not expect to renew the declaration when it expires at the end of January.
The current global mpox outbreak was first identified in the United Kingdom in early May. As of December 7, the Centers for Disease Control and Prevention (CDC) has identified 29,711 cases of mpox in the United States and more than 82,000 cases worldwide, mostly in countries that have not historically reported the disease. A large majority of cases have been among gay, bisexual and other men who have sex with men, and sexual contact is the most commonly reported transmission route.
As previously reported, the Department of Health and Human Services (HHS) declared the then-growing mpox outbreak a public health emergency on August 4. This followed emergency declarations by the World Health Organization; states including California, Illinois and New York; and some cities with high case numbers.
Mpox incidence has since declined by more than 90% from its peak in July and August, according to White House national monkeypox response deputy coordinator Demetre Daskalakis, MD, MPH. Experts attribute the decrease to a combination of factors, including immunity in the initially infected group, rapid vaccine uptake and behavior changes, such as having fewer sex partners.
Updated #mpox epidemic curve from @CDCgov showing steady progress. Vaccinations with 1st and 2nd doses continue to decline. We need to keep emphasizing the importance of vaccine in maintaining protection to durably end this outbreak. Find vaccine at https://t.co/SLGExN0pL8 pic.twitter.com/gj7BfbCsXw
— DrDemetre (@dr_demetre) December 7, 2022
While the dramatic decline in mpox has been a rare bit of good news in the response to recent disease outbreaks, some public health experts and advocates fear the virus will not be eliminated, but rather could continue to circulate at low levels, especially among disadvantaged communities. By late summer, more than half of people with mpox were Black and Latino men who have sex with men, and the outbreak increasingly mirrors the same long-standing disparities evident in the U.S. HIV epidemic.
The emergency declaration enabled the federal government to devote more resources to the crisis, encouraged states to share more data with the CDC and spurred the implementation of a new dose-sparing vaccine strategy that allows a single dose to be split between five people using an intradermal administration method.
But advocates criticized the administration for its delays in procuring and distributing mpox vaccines and the antiviral medical TPOXX (tecovirimat). They also noted that increased funds did not materialize because Congress has failed to authorize money specifically for mpox and continued COVID-19 funding. This has left state and local public health departments and sexual health and HIV services struggling to add mpox to their existing workload without additional resources. To address this shortfall, the CDC and the Health Resources and Services Administration gave grantees the flexibility to repurpose funds earmarked for HIV and sexually transmitted infection services to support the mpox response.
Now, with cases at a low level nationwide, the federal government has decided to let the emergency declaration expire.
“From the outset of the mpox outbreak, the administration pulled every lever to stop the spread of this virus,” Becerra said in a statement. “Given the low number of cases today, HHS does not expect that it needs to renew the emergency declaration when it ends on January 31, 2023. But we won’t take our foot off the gas—we will continue to monitor the case trends closely and encourage all at-risk individuals to get a free vaccine. As we move into the next phase of this effort, the Biden-Harris Administration continues working closely with jurisdictions and partners to monitor trends, especially in communities that have been disproportionately affected.”
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