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The Department of Health and Human Services' declaration Thursday means the federal government can use additional resources in trying to combat the spread of monkeypox, of which there are more than 7,500 cases in the United States. But, what exactly is monkeypox, and who is most at risk of contracting it? And with vaccination rollouts moving slowly, is there a concern the country has not fully learned from mistakes made in the initial days of the COVID-19 pandemic?

This episode: White House correspondents Asma Khalid and Franco Ordoñez, and science correspondent Michaeleen Doucleff.

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Monkeypox Declared Public Health Emergency. Now What?

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Hey there. It's Asma with some exciting news. We are getting ready to take the show back on the road. And Houston, you all are up first. Please join Tamara Keith, Susan Davis, Ashley Lopez, Domenico Montanaro and me at Zilkha Hall on Thursday, September 15. You can find more information about tickets, including student ones, at And thanks to our partners at Houston Public Media. We hope to see you all there.

ANNA: Hi. This is Anna (ph), and I'm in my backyard with my husband here in Charlotte, N.C.


ANNA: We're celebrating our six-month wedding anniversary by welcoming six new baby chicks...


ANNA: ...Into our home. Say, hi, guys.


KHALID: Ah, I love that.

ORDOÑEZ: Hi, guys.

ANNA: This podcast was recorded at...

KHALID: 11:18 a.m. Eastern time on Monday, August 8, 2022.

ANNA: Things may have changed by the time you hear this, but I'll still be here making these little guys feel at home and trying to persuade our Labrador, Finley (ph), that these are friends, not food.

KHALID: (Laughter).

ANNA: OK. Here's the show.


ORDOÑEZ: (Laughter).


ORDOÑEZ: I lived five- six years in Charlotte. I did not know about this chick-living trend.

KHALID: (Laughter).

ORDOÑEZ: Chick roommates.

KHALID: Hey there. It's the NPR POLITICS PODCAST. I'm Asma Khalid. I cover the White House.

ORDOÑEZ: I'm Franco Ordoñez. I also cover the White House.

KHALID: And before we dive into today's show, I just wanted to recap some major political news from the weekend. On Sunday, the Senate passed the so-called Inflation Reduction Act. The bill now heads to the House, where it's expected to pass fairly quickly. And this piece of legislation, you know, is a big win for President Biden's agenda. On Friday's podcast, we actually took a deep dive into what the IRA could do. So if y'all have not heard that episode yet, just a quick plug to please check it out. And of course, we will be back in your feeds to update you all as this bill makes its way to President Biden's desk.

All right. Now on to today's show. Today, we are going to talk about monkeypox - what we know about the virus, how severe the problem is, how severe it could get and what the federal government's response has been so far. And to do that, we are joined by Michaeleen Doucleff from NPR's science team. Michaeleen, it is so good to have you on the show.

MICHAELEEN DOUCLEFF, BYLINE: Oh, thank you so much for having me.

KHALID: So I want to start with a fairly basic question to you, which is - what exactly is monkeypox?

DOUCLEFF: Yeah. So monkeypox is a virus, right? And it's actually related to smallpox, but it's less deadly than smallpox. You probably know smallpox is the virus that the world eradicated - got rid of. So since about the 1970s, monkeypox has been confined, really, to rural parts of Central and West Africa and was extremely rare. A person would catch the virus from an animal, often a rodent, and then pass it on to just a few people. So the outbreaks would be very, very small - like, just a few dozen cases at most. And that's because the virus didn't spread very well from person to person. Then, in 2017, things started changing. There was this large outbreak in Nigeria, and the virus started to spread more easily from person to person and also is spreading in cities and in young, healthy men. And actually, that outbreak never stopped in Nigeria. The virus continued to circulate. Eventually it spilled over into other countries, including the U.S., and eventually that outbreak in Nigeria turned into this massive outbreak we have today.

KHALID: OK. So help us understand a little bit more about the virus - how someone can contract it, what the symptoms are.

DOUCLEFF: Yeah. So in this outbreak right now, the vast majority of cases - we're talking about 95% or more - people are transmitting it through sexual contact, so that's close skin-to-skin contact during sex. Now, monkeypox may also transmit through semen during sex. Scientists aren't 100% sure yet, but there's growing evidence that that's probably the case. So besides this sexual route, monkeypox can also spread in two other ways - through face-to-face contact - so not touching somebody, but just talking to them for a long period of time - so talking about living with somebody, talking for hours to somebody. And then it can also spread by touching a surface that's contaminated with the virus. But I want to stress here and emphasize - because this is where there's been a lot of confusion - these two other routes, so not through sexual contact, are extremely rare and primarily happen when you're living with somebody that has monkeypox. So, for instance, some data from the WHO that just came out. The World Health Organization found that about 0.2% of the cases that we see right now have been through somebody catching monkeypox by touching a contaminated surface - so 0.2%. So you're not catching monkeypox on a bus or at a restaurant or even at a bar or music festival. This is really something you catch when you're really close to somebody.

KHALID: So, Michaeleen, who's most at risk?

DOUCLEFF: So the epidemiological data shows that in 98% in the U.S. - 98% or more of the cases are in gay men or queer people, including trans people, in their sexual networks. So this is primarily men who have sex with men and with multiple partners.

ORDOÑEZ: How severe can the symptoms be?

DOUCLEFF: Yeah. So this strain right now that's circulating is rarely lethal. There have been very few cases where a person has died in this outbreak. No deaths have occurred in the U.S. However, monkeypox can cause a pretty serious illness. You know, it can put you in the hospital. It can be extremely painful. People that are hospitalized are often hospitalized because it hurts so much. There are cases where people can't go to the bathroom, can't sit down or lay down for a couple of days. I mean, it can be a nasty illness. It can also cause blindness and disfiguration. But in other cases, you know, it's pretty mild. So there could be a very large spectrum here of symptoms and severity.

KHALID: So I want to shift gears and ask you both about the vaccination effort because there is a vaccine to combat this virus. And it's, you know, something we've heard, I think, the federal government, the White House speak to quite a bit, but it also feels like there is not sufficient supply of these vaccines yet. So help me connect those dots.

DOUCLEFF: So, yes, for sure. The supply is way, way too low right now. Health officials recommend that if you're in that high-risk population, you should get a vaccine. And yet a lot of people in this group want to get a vaccine, and they can't because the supply is so low, especially if you're not in major cities because, really, it's been the cities themselves that have been really pushing to get the vaccine out there. And there's been a lot of criticism about the administration, about the CDC on this front because - for instance, back in early June, the first week of June, Montreal in Canada started vaccinating high-risk people in that city. And that vaccination campaign slowed down their outbreak there.

ORDOÑEZ: Yeah, I mean, there's been a big, big push on Biden and the Biden administration to even invoke the Defense Production Act, which would allow, you know, the president to force private companies to prioritize orders for the government. And, you know, even Michaeleen talking about the cities, I mean, senators like Democratic Senator Kirsten Gillibrand, who is - represents New York, which is one of the hardest-hit states, has been pushing hard to do this. Karine Jean-Pierre - she's the White House press secretary - she was asked specifically on Friday whether they would use the Defense Production Act, and she wouldn't say whether they were going to do that or whether they were even considering it, but did note that the public health emergency did provide some production of the vaccine.

KHALID: And, Franco, to your point about a public health emergency, I actually want to talk a lot more about that. But first, let's take a quick break.

And we're back. And the most recent data that we have from the Centers for Disease Control and Prevention, as of this taping, indicates that there are about 7,500 confirmed cases of monkeypox in the U.S. right now. And, Franco, the White House has declared monkeypox a national public health emergency. You know, help us understand what exactly it means when the government declares something a public health emergency.

ORDOÑEZ: Yeah, it gives federal agencies power to direct more money toward the problem, toward developing vaccines and evaluating drugs. It will also help get access to more funding to hire more professionals to help manage the outbreak. And it also gives the CDC greater access to information from health care providers and from states which, you know, so far has been a problem, getting that information. The federal data has been really slow and unreliable, which is, you know, a big part of the problem because the reality is no one knows the full extent of the outbreak because of the lack of data and, you know, the delays in testing and vaccines.

KHALID: So, Michaeleen, you know, we were talking earlier about vaccines, and you mentioned that they're being limited to certain high-risk populations rather than a full-scale effort of, you know, vaccinating the entire population. Are the medical professionals that you've been speaking with thinking that this declaration is the right move right now? I mean, is it premature? Is there something else they were wanting to see from the administration?

DOUCLEFF: So by far, the scientists and doctors I talked to think that this is the right move and that probably this should have been done earlier. And here's why. You know, 7,500 cases doesn't sound like a lot, right? But this is a brand new disease in the U.S., and we have a unique opportunity here to stop and basically eliminate brand new, what is looking like, sexually transmitted disease. And that window of opportunity is closing, and it's closing quickly. And if we don't do that, if we don't stop this outbreak - which so far has not really slowed down at all, but has been speeding up - you know, our health care system will have to deal with a whole new disease. And that puts burden on us financially. That puts burden on us, you know, physically. I mean, we don't need another problem to deal with. And so I think this announcement, one, is shining a light on this issue, but also giving people the tools to really go after this thing and stop it before it becomes entrenched and endemic here.

KHALID: Michaeleen, I'm curious how the pace of this response compares - you know, in terms of the speed in declaring monkeypox a public health emergency - compared to when the government did that for COVID?

DOUCLEFF: You know, it's interesting. It's hard to compare the two - right? - because monkeypox spreads much slower than COVID, right? You can get this virus, like, three weeks after you're exposed. You know, the incubation period is a lot longer, and it doesn't spread to as many people, so it's hard to compare them. But I did read some analysis of this and that actually this is later in the outbreak given the number of known cases in the U.S. And so it's hard to compare, but this is definitely not more premature than the COVID emergency.

ORDOÑEZ: Just considering all of this, I mean, if people are waiting for a vaccine, I mean, what can they do in the meantime to protect themselves?

DOUCLEFF: You know, the first thing is to look at your risk. You know, are you in this high-risk population? And that's primarily men who have sex with men and multiple partners. If you are in that population, then you really want to be aware of what activities, especially sexual encounters, put you at risk for getting monkeypox. And I'm looking at right now a guide that's been put out by the Gay Sexuality and Social Policy Initiative, and it tells you a few things to consider. So one - consider taking a break from places where there is group sex. Another thing is to consider forming what's called a sex pod - so kind of like what people did with COVID, where you have a few people that you hang out with, who do the same thing, but with your sexual partners. And then also practice open and honest communication about this. So talk to your partners. You know, have you been exposed? Do you think you have it? Finally, you know, condoms will probably help cut down on transmission here. It won't be perfect because this is spread through skin-to-skin contact, but it will help. And then finally, they say, you know, if you are going to places where there's a lot of skin-to-skin contact, put on more clothes. You know, you really get this from rubbing against the lesions and possibly through semen, too, but wearing more clothes could protect you.

KHALID: Michaeleen, thank you for that information. We really appreciate you joining us on the podcast, and thank you for your reporting.

DOUCLEFF: Oh, thank you for having me.

KHALID: And we, and the NPR POLITICS PODCAST - we'll be back in your feeds again tomorrow, per usual. I'm Asma Khalid. I cover the White House.

ORDOÑEZ: And I'm Franco Ordoñez. I also cover the White House.

KHALID: And thank you all for listening to the NPR POLITICS PODCAST.


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