Biden Names White House Coordinator for Monkeypox

WASHINGTON – President Joe Biden, under intense pressure from activists to step up his administration’s response to the monkeypox outbreak, named a veteran emergency response official on Tuesday to manage the U.S. government’s handling of the crisis after some of the nation’s largest states declared it a public health emergency.

Biden’s decision to run the response from the White House comes amid growing criticism from public health experts that his administration has been slow to recognize the seriousness of the outbreak, and was not prepared to address it adequately. The virus has spread much more quickly than officials anticipated, almost exclusively in the LGBTQ community, and the United States now has more cases than any other nation.

The president picked Robert Fenton, a regional administrator for the Federal Emergency Management Agency and twice its acting head, to serve as the White House monkeypox coordinator. Dr. Demetre Daskalakis, the director of the Division of HIV Prevention at the Centers for Disease Control and Prevention, will serve as his deputy.

Fenton, who oversees the American West for FEMA, has managed responses to natural disasters, disease outbreaks and humanitarian operations. Daskalakis led infectious disease management for New York City, including its response to COVID-19, before going to work at the CDC in December 2020.

The appointment of Daskalakis is notable because the vast majority of monkeypox cases in this country are among men who have sex with men, a population also at risk for HIV infection. A doctor and gay activist, he once set up an impromptu vaccination clinic at an after-hours sex club in New York to protect gay men against meningitis. After the CDC hired Daskalakis, the magazine Plus called him Biden’s “new weapon against HIV.”

The first U.S. cases of the current monkeypox outbreak emerged in May. The disease, characterized by fever, muscle aches, chills and lesions, is rarely fatal in countries like the United States, where it has not caused frequent outbreaks. But it can cause excruciating pain. One of the main criticisms of the administration’s response so far is that it failed to order enough vaccine, and to distribute it quickly, before many gay men were infected during Pride celebrations in June.

The New York Times reported on Monday that the United States had let 20 million doses of monkeypox vaccine expire, leaving the Strategic National Stockpile, the nation’s emergency reserve, with just 2,400 doses by the time the outbreak emerged. And while the federal government purchased vast quantities of raw vaccine product, it has yet to be filled into vials.

As a result, many people at high risk who want to get vaccinated have been unable to find a dose and may not be able to find one for months.

The appointments came a day after AIDS activists, gathered in Montreal for an international scientific conference, stormed the stage before Daskalakis spoke. They carried signs with pink triangles – once used by the Nazis to identify gay men, but now a symbol of queer liberation and power – declaring, “Biden You Failed the Monkeypox Response.”

James Krellenstein, the founder of the AIDS advocacy group PrEP4All and an organizer of the Montreal protest, said the appointments were long overdue. He described Daskalakis as an “excellent physician and epidemiologist” who “has the trust of so many in the gay and trans community.”

“Every single one of my friends who has gotten monkeypox now attempted to get vaccinated in late May or early June,” Krellenstein said, adding that he knew a dozen people who were infected. Because of the federal government’s missteps, he said, they were “unable to get vaccinated and unable to protect themselves, and they are sick and in excruciating, inhuman pain.”

Until now, the response has been coordinated largely by Dr. Raj Panjabi, the director for global health security and biodefense on the National Security Council, whose responsibilities include guarding against infectious disease threats. Dr. Ashish Jha, the White House coronavirus response coordinator, has also played a role, as have Dr. Jennifer McQuiston, a CDC official; Dawn O’Connell, the assistant secretary for preparedness and response at the Department of Health and Human Services; and Xavier Becerra, the health secretary.

Centering the response operation at the White House gives the administration more flexibility to coordinate efforts across a range of agencies that might be involved, including FEMA, the Health and Human Services Department and the Department of Homeland Security. It also creates a designated team that has no responsibilities other than to combat monkeypox – a move that makes sense, said Dr. Anthony Fauci, Biden’s chief medical adviser.

“Putting together someone who has extensive experience in implementation of public health programs, the way Bob Fenton did with the distribution of COVID vaccines, with someone like Demetre Daskalakis, who not only is an experienced infectious disease and public health physician, but who also has very strong, credible ties to the community, is a very important addition to the overall monkeypox response,” Fauci said in an interview.

An early-morning statement from the White House said the two men’s responsibilities would include “equitably increasing the availability of tests, vaccinations and treatments.”

Jennifer Nuzzo, a public health researcher and the director of the Pandemic Center at Brown University’s School of Public Health, praised the appointments, adding that the response thus far has been marked by a “lack of urgency.”

Health and human services officials say they have moved as expeditiously as possible. “Within days of the first case of #monkeypox in the U.S., HHS immediately focused on increasing vaccines, tests, treatments, and awareness,” the department wrote Tuesday in an unsigned statement on Twitter. “HHS continues to take action to protect and inform the public about the virus, including prevention methods, treatments, and more.”

Nuzzo warned that there was likely to be “spillover” from the gay population to other groups, and possibly deaths in the United States from monkeypox. Spain recently reported two deaths. At least four children in the United States have tested positive.

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The appointments of Fenton and Daskalakis came a day after Gov. Gavin Newsom of California declared a state of emergency to help address the monkeypox outbreak there. New York and Illinois have made similar declarations, as have the mayors of New York City and San Francisco.

The CDC has recorded nearly 6,000 cases of monkeypox since May, with almost half in those three large states. Tuesday’s action again raises the question of whether the Biden administration will declare a public health emergency, as the World Health Organization did late last month. Becerra is considering it.

Last week, with monkeypox cases on the rise and the vaccine still in scarce supply, Becerra announced an “enhanced strategy” to protect those at risk from the outbreak. It expanded those indicated for vaccination to “men who have sex with men who have recently had multiple sex partners in a venue where there was known to be monkeypox,” or in an area where monkeypox is spreading.

The White House said that 737,000 more vaccines were shipped out Monday, bringing the total number of distributed doses to 1.1 million.

This article originally appeared in The New York Times.