President Joe Biden appoints White House monkeypox coordinators, CDC issues monkeypox isolation guidelines, and more in this week's roundup of monkeypox news.

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

• President Biden on Tuesday appointed Robert Fenton as the White House monkeypox coordinator. Fenton, who helped lead the Federal Emergency Management Agency's Covid-19 vaccination effort, has managed the response to many public emergencies, including natural disasters, disease outbreaks, and humanitarian operations, the New York Times reports. In addition, President Biden named Demetre Daskalakis, who currently serves as the director of the division of HIV prevention at CDC, to be Fenton's deputy. According to the White House, the pair will coordinate "strategy and operations to combat the current monkeypox outbreak, including equitably increasing the availability of tests, vaccinations and treatments." (Stolberg/Baker, New York Times, 8/2; AP/Modern Healthcare, 8/2)

• After the World Health Organization last month declared monkeypox a public health emergency of international concern, several U.S. states and cities have followed suit with their own declarations. Last week, the city of San Francisco declared a "local public health emergency" with the hope of increasing "flexibility" to boost testing and vaccine distribution, said California state Sen. Scott Wiener (D), who called for the declaration. On Saturday, New York City declared a public health emergency over the monkeypox outbreak two days after New York state declared that monkeypox is an "imminent threat." According to a joint statement from New York City Mayor Eric Adams and city Health Commissioner Ashwin Vasan, "New York City is currently the epicenter of the outbreak." On Monday, California Gov. Gavin Newsom (D) declared a public health emergency that allows the administration to coordinate a "whole-of-government response to monkeypox, seek additional vaccines and lead outreach and education efforts on accessing vaccines and treatment." In addition, Illinois Gov. J. B. Pritzker (D) on Monday declared a state of emergency to "expand the resources and coordination efforts of state agencies in responding to, treating, and preventing the spread" of monkeypox. (Bastone/Shapero, Axios, 7/28; Habeshian, Axios, 8/1; Tanyos, CBS News, 7/30)

• FDA last week announced it had cleared around 800,000 additional doses of Bavarian Nordic's Jynneos—a smallpox vaccine that is also effective against the monkeypox virus—to help combat the growing monkeypox outbreak. But public health experts are voicing concern that the additional doses may not be enough to protect at-risk populations from the virus. Currently, there are only enough doses to vaccinate one-third of the roughly 1.6 million gay and bisexual men who are considered high-risk, the Washington Post reports. According to J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, the United States will likely need 3.2 million doses to adequately protect the at-risk population. However, he noted that the United States will not even have 2 million doses by the end of the year. "The United States must continue to ramp up vaccine supply and must move swiftly to implement a comprehensive distribution approach to significantly increase equitable access to vaccines," said Daniel McQuillen, president of the Infectious Diseases Society of America. (Cirruzzo/Dil, Axios, 8/2; Scribner, Axios, 7/30; Diamond, Washington Post, 7/30)

• Less than 10 years ago, the United States had roughly 20 million doses of Jynneos in its Strategic National Stockpile (SNS). But in mid-May, when the first U.S. monkeypox cases were reported, the SNS had just 2,400 usable doses of the vaccine, enough to fully vaccinate 1,200 people, the New York Times reports. The rest of the doses in the SNS had already expired. Since federal health officials did not consider smallpox or monkeypox a significant threat in the United States, they chose not to quickly replace the expired doses. Instead, they focused on developing a freeze-dried version of the vaccine that would increase its three-year shelf life. Over the last decade, the United States has purchased large quantities of the raw vaccine product, which is not FDA-approved and has not been filled into vials. Currently, the raw, unfinished vaccine is being stored in large plastic bags at the headquarters of Bavarian Nordic, the only drug maker that can produce Jynneos. Federal officials have shipped another FDA-approved smallpox vaccine, called ACAM2000, to local health officials for use against monkeypox. However, many experts are uncomfortable using ACAM2000 in a mass vaccination campaign because of its significant side effects. "If we really, really needed to, we do have the option of tapping into that stockpile and vaccinating a whole bunch of people with an effective vaccine, and I know that our state and local health authorities have thought about that, but it's not ideal. It's more of a desperate, last resort." said California state Sen. Wiener. (Goldstein, New York Times, 8/1; Ferrannini/Nexstar Media Wire, The Hill, 8/2)

• CDC on Monday issued a list of isolation and prevention practices for individuals infected with monkeypox. In the guidelines, the agency recommends those infected with the virus remain in isolation for the entire course of their illness, which could range from two to four weeks. Available data suggests that the virus may spread from symptom onset "until all symptoms have resolved, including full healing of the rash with formation of a fresh layer of skin," the agency said. While the most effective way to stop the spread of the virus is to remain fully isolated, if that is not possible, CDC recommends that infected individuals avoid close contact with people and animals, wear a well-fitting mask, cover all parts of a rash, avoid sharing clothing and utensils, and avoid public transportation. (Carbajal, Becker's Hospital Review, 8/2)