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July 18, 2022

Mapped: Where monkeypox is spreading in the US

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    As the United States experiences the "unprecedented" spread of monkeypox, health experts have criticized the country's response to the outbreak, saying that it is "nearly impossible" to access vaccines and treatments.

    Why the US response to monkeypox is drawing comparisons to Covid-19

    Monkeypox cases are on the rise in the US

    Currently, there are more than 11,000 cases of monkeypox worldwide. And in the United States, CDC has reported over 1800 confirmed cases across 43 states and the District of Columbia.

    So far, the states with the largest number of monkeypox cases are New York, California, and Illinois. Some areas have experienced sharp increases in cases over the last few weeks, with New York City seeing its case count triple over the past week.

    According to some health experts, the current monkeypox outbreak is reminiscent of the beginning of the HIV epidemic, which also first appeared in communities of men who have sex with men. However, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said there are "fundamental differences" between the two outbreaks.

    For example, Fauci said, although the current spread of monkeypox among humans outside of endemic countries is "unprecedented," the virus for monkeypox has already been identified, it is not as deadly as HIV, and there are several vaccines and treatments already available.

    "The challenge, now, is to obviously get a handle on the extent of this and the spread of this, and you do that by testing," he said. "The other challenge is to implement the countermeasures we already have. Like getting the vaccines to the people at risk and to make sure that we mobilize the vaccines we contracted to be made years ago."

    Access to treatments and vaccines remain limited, doctors say

    Currently, many physicians say access to treatments and vaccines against monkeypox remain limited, which has impacted their ability to treat patients and respond to the outbreak.

    According to Mary Foote, medical director for emergency preparedness and response in the New York City Department of Health and Mental Hygiene, it is "nearly impossible" for providers to get the monkeypox antiviral TPOXX for their patients, even though the city has more than enough supply.

    Currently, TPOXX is under a special CDC status because it has been approved only to treat smallpox, not monkeypox—making it more difficult for providers and patients to access. Providers must "go through more than 100 pages of paperwork each time they prescribe it, and between the forms and administrative requirements, a patient visit to initiate this medication can take between one and three hours," Roll Call writes.

    "We're worried that this could become a treatment only accessible by patients with privilege or who are very savvy at navigating a very complicated system," Foote said.

    Without increased access to TPOXX, many monkeypox patients will experience more severe symptoms. "A lot of people with this infection are really suffering, and some actually may be at risk for permanent damage and scarring," Foote said. "We've seen many people with symptoms that are so severe, that they are unable to go to the bathroom, urinate or eat without excruciating pain."

    In addition, supplies of the Jynneos vaccine, which is the preferred vaccine against monkeypox, have not kept up with growing demand. So far, more than 132,000 doses of the Jynneos vaccine have been distributed from the U.S. national stockpile, and more doses are expected to arrive from overseas in the next few weeks.

    "We are incredibly focused on making sure that vaccine doses get to the United States and get out to places like New York City," said Ashish Jha, the White House Covid-19 response coordinator. "Do we wish we had more doses? Of course. We had a stockpile, and what we need is more. We are getting more."

    Aside from increasing the supply of monkeypox vaccine, Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists, said the United States should also move away from its current post-exposure vaccine strategy and seek to contain the virus before it spreads to a wider population.

    "[T]here is no vaccine-preventable disease that exists that can be controlled solely post-exposure when there is no prior immunity," Hamilton said.

    "Everyone is susceptible at this point in time," she added. "There's no way we will ever be able to control this disease in a completely susceptible population without a pre-exposure vaccine strategy." (Cohen, Roll Call, 7/14; O'Reilly/Davis, Axios, 7/15; Langmaid/McPhillips, CNN, 7/14)

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