Dear President Biden,
Nearly 40,000 cases of monkeypox have been reported worldwide this year, affecting nearly 90 countries. These numbers are growing exponentially. Monkeypox can infect anyone, but the overwhelming majority of cases in the current outbreak are among gay and bisexual men and other men who have sex with men (MSM), among whom an estimated 28-51% are estimated to be people living with HIV.
In the United States, Black and Brown communities are reporting racial inequities in access to testing, vaccines and treatment. Countries with prior monkeypox outbreaks in Africa have no doses of vaccine at all and virtually no tests or treatment. Unless this outbreak is rapidly contained, monkeypox will also spread to other communities.
With appropriate ambition and urgency, the United States government must mount a global response commensurate with need, reversing the rise in cases and bringing the unprecedented outbreak under control. Such a response will require working not only to get tests, treatment and vaccines to people who are vulnerable in the United States, but working with international partners like the World Health Organization to ensure vaccines are available throughout the world where they are needed to prevent further spread.
You have taken some initial steps to elevate monkeypox as a priority within your administration, including through establishing a White House National Monkeypox Response team led by Robert Fenton and Demetre Daskalakis, declaring monkeypox a public health emergency, and expanding the scarce supply of the monkeypox vaccine Jynneos.,
But the current policy course will not be sufficient to stop monkeypox from spreading further to populations most vulnerable to severe outcomes, including people with HIV, immunocompromised people, prisoners, unhoused people and children.
To successfully confront monkeypox, the United States must heed lessons learned at great cost through experience with COVID-19, with policies supported by significant resources including new funding that your administration must request from Congress:
First, the United States must equitably share the available stockpile of Jynneos vaccine doses with the rest of the world.
The United States currently owns more vaccine substance than the rest of the world combined, in addition to more than one million finished doses and orders for several million more. For the immediate term, Jynneos vaccine doses will be in global scarcity. Equitable distribution of vaccines to countries experiencing outbreaks maximizes impact.
Second, you must utilize the Defense Production Act to marshal resources to ramp up and accelerate production of additional finished Jynneos vaccine doses.
Millions of doses worth of bulk vaccine substance sit dormant at a facility in Denmark, waiting to be filled and finished into vaccines for health care providers to administer. Through the Defense Production Act, the United States Government can surge staffing, ensure available supplies, and enlist additional qualified facilities to accelerate the fill-finish process, expediting availability.
Third, simultaneously, the United States must support expansion and diversification of vaccine production capacity globally.
We do not yet know the future challenges monkeypox will pose. Diversifying vaccine supply will protect against future shortages inherent under vaccine production monopolies. Through funding a network of globally distributed vaccine manufacturing and supporting technology transfer, the United States can prevent manufacturing problems, poorly timed contracts, and export restrictions from disrupting supply. The U.S. should require companies that benefit from public funding to share intellectual property, know-how, and technology with suppliers around the world.
The course of the monkeypox outbreak is not preordained and the decisions your administration takes in the coming weeks and months will be pivotal in charting it. The Africa CDC director accurately described the stakes for monkeypox last month: “The solutions need to be global in nature. If we’re not safe, the rest of the world is not safe.” It is vital that the U.S. government does not forget it.
African Services Committee
American Friends Service Committee
Coalition for Asian American Children and Families
Doctors for America
Justice is Global
Keeping Ballroom Community Alive Network
Maryknoll Office for Global Concerns
Treatment Action Group