Monkeypox Is a Public Health Emergency in Some States. What Does It Mean?

Monkeypox is now considered a public health emergency in New York, California, and Illinois.

The declarations came a week after the World Health Organization declared monkeypox a “public health emergency of international concern”—an alarm it has rung only seven times since the creation of the term in 2005.

More than 6,000 cases have been reported in the United States, and that’s almost certainly an undercount. Globally, the count tops 25,000, according to the Centers for Disease Control and Prevention.

In the U.S., declaring an infectious disease outbreak a “public health emergency” often frees up funds for providers to offer important resources, like vaccinations, tests, and treatments. It also gives more leeway for sectors of the health system to coordinate their response to the outbreak.

The emergency can be declared at the local, state, and national levels.

Importantly, the designation requires localities to collect and report data about the outbreak. Improving data collection and reporting would help health experts and the public understand where and how the virus is circulating.

“The state of emergency creates a sense of awareness and a sense of urgency,” Georges Benjamin, MD, executive director at the American Public Health Association, told Verywell. “In this situation, it’s letting the community at large know that this is something we ought to be paying attention to, that the government is paying attention to it, and it speeds up the response in a much more organized manner.”

How Will a Public Health Emergency Declaration Change Monkeypox Response?

San Francisco was the first U.S. city to give the monkeypox outbreak emergency status. The legal action, which went into effect on August 1, allows the city to coordinate its response more effectively, secure more tests and vaccines, and receive reimbursement from the state.

“San Francisco showed during COVID that early action is essential for protecting public health,” San Francisco Mayor London Breed said in a statement. “We know that this virus impacts everyone equally, but we also know that those in our LGBTQ community are at greater risk right now. Many people in our LGBTQ community are scared and frustrated. This local emergency will allow us to continue to support our most at-risk, while also better preparing for what’s to come.”  

The San Francisco health department has reported more than 260 probable or confirmed cases of monkeypox, about a third of all California cases. The city initially requested 35,000 doses of the monkeypox vaccine. So far, it has only received 12,000 and expects 10,700 more in the near future, though it’s not clear when they will arrive.

On Friday, New York Governor Kathy Hochul declared the outbreak a “State Disaster Emergency.” The move expanded the group of people who may administer the monkeypox vaccine to include emergency medical services personnel, pharmacists, and midwives.

New York City soon followed the governor’s lead, declaring a public health emergency on Saturday. The city has recorded more than 1,500 cases so far, almost 25% of all monkeypox cases nationwide.

California and Illinois also declared the outbreak a state of emergency Monday. California is expanding access to vaccination by using relationships with clinics established during the COVID-19 pandemic and by allowing EMS personnel to dole out shots. The move will also improve public education and access to tecovirimat—the highly effective treatment for monkeypox has been limited so far during this outbreak.

Illinois governor Jay Pritzker emphasized the importance of delivering vaccines to the “most impacted communities.”

Declaring a public health emergency does not give a state or city priority access to the stockpile of vaccines, tests, or therapeutics from the federal government.

Still, Benjamin said the move brings public attention to the outbreak by indicating to residents that seeking vaccination and keeping an eye out for monkeypox symptoms is of the utmost importance. It also puts some pressure on the federal government to pursue a more concerted containment effort.  

“It does give them the ability to call upon the federal government and say, ‘Look we’re serious about this. Let’s make sure you get us our allocation of resources as quickly as you can,’” Benjamin said.

Improving Data Collection

In states with emergency orders, health providers are often required to share data on monkeypox vaccination and testing with the state health department. This could help health officials understand where vaccines and treatments have been distributed and who still needs the resources.

Based on the data collected by the CDC so far, it appears that the community of men who have sex with men is seeing the highest portion of monkeypox cases. But because states are not required to share data with the agency, the CDC has demographic data for only a fraction of monkeypox patients.

If the federal government creates an emergency declaration, localities will be required to report data to the CDC. This is bound to improve our understanding of where and how many cases are cropping up, and how many Americans are vaccinated, Benjamin said.

Will Monkeypox Become a National Public Health Emergency?

The Department of Health and Human Services may soon deem monkeypox to be a public health emergency. At the federal level, this emergency designation allows for some restrictions to be waived so that care can be provided more effectively. It gives flexibility to different agencies to tap into emergency funds.

During the COVID-19 pandemic, for instance, the FDA can authorize vaccines and treatments under an emergency use label, and certain branches of the U.S. armed services were deployed to support stressed hospital systems.

With improved public awareness of monkeypox and access to the key tools, health providers may be able to contain the outbreak, Benjamin said. But that success will come down to whether the White House will declare a federal public health emergency, and whether Congress will write a check to fund the effort.

“The public health community is juggling a bunch of balls and we just don’t have the resources to do it right now,” Benjamin said.