Health agencies are frantically preparing for the new MPox strain

State and federal health agencies are preparing to respond to a new strain of MPox — the virus formerly known as monkeypox — if it spreads to the United States.

This time, however, they are doing it with smaller means.

Both the MPOX public health emergency declaration and federal pandemic preparedness law were still in effect in 2022, the last time the United States faced a large MPOX outbreak. This gave the federal government and state health departments more resources and flexibility than they currently have to deal with an outbreak.

Last month, the World Health Organization declared a public health emergency of international concern, the highest alert under international health law, over the new strain of mpox. The strain, known as clade 1b, has been circulating rapidly in central Africa and has been detected in Sweden and Thailand.

The new strain is different from the 2022 global outbreak of the clade IIb strain of mpox, which U.S. officials treated with two doses of the JYNNEOS mpox vaccine. Like COVID-19 vaccines, the JYNNEOS mpox shot prevents severe infection, hospitalization and death from mpox, but does not completely prevent transmission, according to the Centers for Disease Control and Prevention.

Clade 1b is endemic in the Democratic Republic of the Congo, and this strain is more prevalent than any other epidemic strain. Clade 1b tends to cause a higher proportion of people with MPox to develop severe disease and die, compared with clade IIb, according to the CDC.

Although clade 1b has not yet been detected in the U.S., state and federal health officials are bracing for an outbreak that could be worse than 2022, based on lessons learned two years ago.

“It’s a very different game than 2022, in some ways better and in others still uncertain,” said Jen Kates, senior vice president and director of global health and HIV policy at KFF, noting that public health jurisdictions are already armed with vaccines and treatments for MPox, unlike in 2022.

Vaccine budgeting

The State Department says it is preparing for the emergence of clade 1b in the U.S. by December 2023 through increased monitoring of sewage and other surveillance systems. However, access to public health surveillance systems has decreased since the end of the COVID-19 public health emergency.

And the public health crisis of 2022 allowed the federal government to more easily free up resources to produce and distribute vaccines for free to high-risk groups.

The federal government ended its state of emergency in 2023, but vaccine maker JYNNEOS Bavarian Nordic privatized the vaccine earlier this year. States must now order it commercially. State health officials have said the budget is now a bigger concern because vaccines are being privatized.

Crystal La Tour Rambaud, program manager for the Pima County Health Department’s Vaccine Prevention Program in Tucson, Arizona, said costs for the MPox vaccine and the new RSV vaccine are rising.

“In just a few years, the workload has increased significantly without significantly changing the budget,” La Tour Rambaud said.

As a result, the Pima County Health Department is reevaluating who it offers free vaccinations to, and in some cases is only offering free shots to uninsured people. Insured people can get vaccinated at commercial pharmacies, she said.

Under the current structure, people with public or private insurance can access the mpox vaccine at no cost because the CDC’s Vaccine Advisory Panel has recommended it.

However, the only way uninsured adults can get vaccinated for free is by using federal funds available in their jurisdiction to purchase vaccines.

Raynard Washington, director of the Mecklenburg, North Carolina, Department of Public Health, said the department has been able to allocate some funds for sexually transmitted diseases and HIV to combat mpox, but it is still too limited.

The pandemic preparedness law was set to expire in September 2023, but Congress extended seven provisions of the law through a government funding bill from March through the end of 2024. That included rules to help activate personnel in the event of a public health emergency.

The CDC recommends that health departments report all cases of mpox to the CDC within 24 hours and promote vaccinations in their communities. In the event of a declared public health emergency, the government may waive some authority to improve disease reporting, such as sending funds to jurisdictions.

Even though there is no public health emergency currently in effect, Washington said Mecklenburg is “generally speaking, the system is probably better prepared than it is in 2022” because of the previous experience with mpox. Public health departments already have vaccines in place and people in the community who have been vaccinated.

The Mecklenburg Health Department is seeking reauthorization of the federal Pandemic Preparedness Act, as well as granting the CDC the necessary authority to collect data from both health care systems and laboratories to share that information with jurisdictions.

But since a new strain of MPox has emerged, they may have to change their response.

“We may be starting from ground zero again, depending on how this all plays out,” Washington said.