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Low Vaccination Rates Put United States At High Risk Of New Mpox Outbreaks

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U.S. Public health officials want high-risk individuals who haven't been vaccinated for mpox -- previously called monkeypox -- to do so before a potential resurgence of the virus happens like health experts fear it will. File Photo by Bill Greenblatt/UPILicense Photo

That surge could be worse than last year, federal modeling has found, but only about 23% of those at high risk for the virus have received vaccines, according to a report released Thursday by the U.S. Centers for Disease Control and Prevention.

Most communities have had too few people vaccinated to avoid a potential outbreak and have a "greater than 35%" risk of the virus resurging, the CDC said.

"It's not us saying get more people vaccinated because we think it's a good idea. We need to get more people vaccinated because we know there's a linear relationship between how many people are vaccinated and the chance of not having an outbreak," Dr. Demetre Daskalakis, deputy coordinator for the White House's mpox response, told CBS News.

Those at highest risk include gay and bisexual men, and people who have multiple sex partners.

People who survived previous mpox infections may have some protection already, according to the CDC. The risk of reinfection could grow for those individuals, however, over time and if the virus mutates, the report noted.

"This is the time to do that little health check, that tune-up before we get into summer to make sure that we have all our ducks in a row," Daskalakis said.

Now is a good time to get the Jynneos mpox vaccine while cases are down, he added.

"People with two doses should feel pretty confident that they're protected. But then always remember, if you have a lesion that's concerning, you should get tested because nothing is perfect," Daskalakis said.

Mpox cases are now reported at about one case a day throughout the United States. At their peak last August, there were 450 daily reported infections.

In its efforts to curb the virus, the CDC has created a new webpage that provides an mpox vaccine locator. To find a site near you, visit the MPOX vaccine locator.

"This is getting embedded into the fabric that we do to prevent sexually transmitted infections, like HIV. So it's moved back into a space that's more routine," Daskalakis said.

The study findings were published March 31 in the CDC's Morbidity and Mortality Weekly Report.

WHO Declares Monkeypox Outbreak A Global Emergency

The World Health Organization declared the monkeypox outbreak a public health emergency of international concern, the health body's highest level of alert.

The decision on Saturday from WHO chief Tedros Adhanom Ghebereyesus came as the organization's emergency committee was unable to reach consensus on whether the outbreak constituted such a global emergency.

"We have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little and which meets the criteria in the International Health Regulations," said Tedros.

The emergency committee was split with nine members against declaring the outbreak a global public health emergency of international concern and six in favor, Tedros said.

"Nine and six is very, very close. But at the same time there was no consensus," Tedros said. "Of course, since the role of the committee is to advise, I then had to act as a tie-breaker."

The latest figures show that more than 16,000 cases of monkeypox have been reported to the WHO during the outbreak, which has left health officials scrambling to secure vaccine doses. The European Commission has secured over 160,000 jabs for the disease, with EU Health Commissioner Stella Kyriakides saying this week that she was concerned about the increasing number of cases, which had risen by almost 50 percent in the EU in a week.

On Friday, the European Medicines Agency recommended that the smallpox vaccine Imvanex's license be extended to cover monkeypox. Bavarian Nordic's vaccine was granted approval to prevent smallpox in 2013, with the EMA's recommendation paving the way for more widespread rollout of the vaccine in the EU.

Monkeypox is endemic to several African countries and is transmitted between humans through close contact with an infected person. However, the current global outbreak has raised fears about the virus establishing itself outside the continent. "Monkeypox is spinning out of control & could become endemic outside of Africa," Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law, tweeted on Friday.

The monkeypox virus usually presents with a fever, rash and swollen lymph nodes. The current global outbreak is unusual as it's occurring in multiple countries without travel links to areas where the virus is endemic. Anyone can be infected with monkeypox but during the current outbreak, cases have been mostly identified in men who have sex with men, with infections being transmitted through close contact during sex.

The head of the WHO's health emergencies program, Mike Ryan, called for countries to take the monkeypox outbreak seriously, regardless of who it affects. He also warned that the declaration shouldn't be used as a way to implement coercive surveillance on groups most affected by the virus.

Tedros has made a set of recommendations for countries depending on how the outbreak is developing in their regions. The recommendations include intensifying surveillance and public health measures; speeding up research into the use of vaccines and treatments; and advice on international travel.

The report of the emergency committee that failed to reach consensus was also released on Saturday, revealing the key reasons for several experts being against the declaration of an international public health emergency. The reasons included the global risk assessment remaining unchanged; the greatest burden of the outbreak being in Europe and the Americas with early signs of a stabilization of cases in some places; most cases being in men who have sex with men; and the severity of the disease being low.

While many global health experts welcomed Tedros's decision to take the unusual step of declaring an emergency in the face of differing advice from the scientists advising him, the fact that the virus has spread in Africa for decades without significant attention also has been highlighted. "With monkeypox cases continuing to rise and spread to more countries, we now face a dual challenge: an endemic disease in Africa that has been neglected for decades, and a novel outbreak affecting marginalized communities," said Josie Golding, head of epidemics and epidemiology at Wellcome Trust. "Governments must take this more seriously and work together internationally to bring this outbreak under control."

Jimmy Whitworth, emeritus professor at the London School of Hygiene and Tropical Medicine, said he hoped that the increased attention on monkeypox "leads to more focus on control within Africa, the natural home of this virus, where the number of cases has been increasing for the past 20 years."

As with COVID-19 vaccines, African countries have found themselves at the back of the queue for monkeypox jabs, with the head of the WHO's Africa office, Matshidiso Moeti, previously warning that wealthy countries were snapping up limited supplies, while Africa was left behind.

Scientists Fear Bird Flu Surge As Billions Of Birds Start To Fly Home

Photo Illustration by Erin O'Flynn/The Daily Beast/Reuters, Path slopu/Wikimedia Commons, Mee2ch/Wikimedia Commons and CDC

The past year has already been a bad one for H5N1, the virus that causes bird flu. And it's about to get worse as wild birds complete their spring migrations in the northern hemisphere in the coming weeks, experts warned.

Where birds go, H5N1 goes too. All along bird-migration routes, which criss-cross North America, Europe and Asia, infection risk could increase. Not only for other birds—including domestic flocks of chickens, ducks and turkeys—but also for the growing number of mammal species that have caught bird flu. Foxes. Bears. Sea lions. Minks. Pigs. "Increased migration is definitely a concern," James Lawler, an infectious disease expert at the University of Nebraska Medical Center, told The Daily Beast.

The risk to people could spike, too. The 2022-2023 bird flu outbreak has already claimed at least one human victim, in China last year. At least five other people have caught the virus and survived.

This spring, more people could come into contact with infected animals. Epidemiologists are worried that people might start spreading bird flu to other people, too—raising the specter of a possible human bird flu pandemic.

But even as billions of birds take flight, authorities are at an impasse. The one strategy that might make an immediate dent in H5N1's spread—the mass-vaccination of domestic chickens, geese, ducks and turkeys—faces some profound logistical obstacles.

Last year saw a period of overlapping viral outbreaks—COVID, monkeypox, even polio—so you might not have noticed the bird flu outbreak that seems to have begun in mid-2021 but really accelerated in January 2022. First, an 80-year-old British man came down with the bird flu after exposure to wild ducks. Next, the U.S. Department of Agriculture detected H5N1 in domestic chicken flocks in the United States.

Infections spread far and wide during the 2022 bird migration season. A year later, 54 countries had detected H5N1 in wild birds or, in some cases, certain mammal species. In the United States alone, bird flu has been detected in 47 states, according to the U.S. Centers for Disease Control and Prevention. Almost 60 million wild and domestic birds have been affected in the U.S., the CDC reported.

In 2022 alone, the U.S. Poultry industry culled—that is, killed—no fewer than 50 million chickens, geese, ducks and turkeys in an effort to slow the virus's spread. Wondering why egg prices spiked last year? A sharp reduction in domestic chicken flocks is the main reason. In other words, blame bird flu.

Egg prices in the U.S. Have finally begun to fall as the industry recovers from the 2022 culls. The average price for a dozen eggs peaked at $5.20 late last year. It dropped fast in January and February to an average of around $2.40. But now the 2023 bird migration threatens more viral spread and potentially more bird deaths. The price of eggs is inching up again.

Pricey eggs aren't the biggest problem. While H5N1 can infect people who come into close contact with infected birds, it hasn't yet spread from person to person. Absent human spread, there's almost no chance of runaway bird-flu outbreaks in people. After all, most of us never come into contact with infected birds. "Some farmers and zoo workers may be at risk, but those interaction events are going to be limited," Tony Moody, a professor of Immunology at the Duke Human Vaccine Institute, told The Daily Beast.

But every H5N1 infection, in animals or people, is an opportunity for the virus to mutate. And it might not take a huge genetic leap for the H5N1 to become a truly human virus, and spread among family, friends and neighbors just like human influenza, COVID, monkeypox and a host of other viruses.

Maybe. "We just don't know enough to accurately predict" the risk of a major bird flu mutation, Lawler stressed.

A big outbreak of bird flu in pigs would be a red flag, Moody said. "They tend to be the ones implicated in generating new strains with a higher risk of human-to-human spread."

What's especially scary about H5N1 is that it's highly lethal. Where human flu kills less than 1 percent of infected people, and COVID kills around 3 percent, bird flu kills more than half of the people it infects. We have every incentive to prevent the virus from becoming a human virus.

But experts and officials disagree on how to do that. Widespread vaccination would help, of course. But while several human bird flu vaccines are in development, none are ready for human trials—to say nothing of being ready for approval by the U.S. Food and Drug Administration or regulators in other countries. Even under the most optimistic scenario, it'll be years before people can get a bird-flu jab.

There are already vaccines for birds, but they only prevent severe disease. They don't prevent the virus from spreading flock to flock. Better bird vaccines that do prevent transmission have been in development for a few years now. Last month, the Department of Agriculture announced it would test the first of these new vaccines. But it's not clear how long testing and authorization might take.

Nor is it clear exactly how the feds would administer the vaccine. It's impractical to innoculate wild birds, of course, but even farm flocks pose a challenge. There are 2 billion domestic chickens in the U.S. And hundreds of millions of geese, ducks and turkeys. No one has figured out the right strategy for dosing them.

Do authorities target domestic flocks closest to wild birds' migration routes? Do they try to dose domestic birds before possible exposure to the virus? Do they wait until after they detect the first infection in a particular flock? "From vaccine development, to production timelines, to dissemination to flocks, there are many factors that make implementing a vaccine strategy a challenge and it would take time to deliver an effective vaccine," a USDA spokesperson told The Daily Beast.

Even if the Department of Agriculture swiftly tests and approves a bird vaccine, it might not have any idea how to actually deploy the vaccine. Adding vaccine to the birds' feed "might work," Moody said. But it's going to take a lot of experimentation to figure it out.

All that is to say, we're probably not going to solve our bird flu problem this year. So as those billions of migratory birds take flight this spring, all we can do is hold our collective breath… and hope for the best.

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