The White House sees the light at the end of the monkey pox tunnel

By Daskalakis, was a visceral reminder of the depth of the challenge that lay ahead. A gay man and longtime public health official, he had spent decades working alongside these activists fighting diseases like HIV/AIDS and now, mpox, which primarily affect the LGBTQ community.

But he had also just agreed to take on a senior administration job that would put him in charge of managing the mpox crisis, and a new target for the frustration and anger that lay before him. August On the 2nd, the day after his appearance in Montreal, the administration officially announced Daskalakis as deputy coordinator of its response to mpox, the virus then known as monkeypox.

“It was like, I know I’m going to the White House!” Daskalakis said in a recent interview, recalling his thought process as he observed the scene.

If the episode illustrated the dangers of his new position, it also provided clues about how to approach it. Since taking over the federal mpox operation, Daskalakis and his boss, Robert Fenton, have coordinated closely with a wide array of activists and public health groups. Once the administration’s harshest critics, these groups have since become partners in a response aimed at increasing resources to LGBTQ communities and vaccinating those most at risk.

Since then, the national case count has dropped from an average of more than 450 a day to just five. Persistent vaccine shortages that fueled fears of another entrenched epidemic have largely eased. And the wave of anger that once threatened to turn the administration’s shaky response into a political debacle for President Joe Biden has simmered down.

“This was really a piece of crap from the Biden administration,” said Peter Staley, a prominent HIV/AIDS activist and board chairman of PrEP4All, one of the most outspoken critics of the early response. But, he added, “Demetre and Robert did an incredible job working with community groups to calm everyone down after the administration’s previous mistakes and say, ‘Give us a chance on this path forward.'” And he gave his fruits.”

Speaking on a recent weekday afternoon from the small office they’ve shared since arriving in Washington, Fenton and Daskalakis acknowledged they had few guarantees from the start that their efforts to restore confidence in the government’s response and quickly curb the bud would gain strength.

Fenton, a veteran of the Federal Emergency Management Agency, was selected to lead the response because of his logistical experience. But he had no background in public health and little in-depth experience in managing such an outbreak. She said her only request in taking the job was to be paired with someone who had a deep understanding of health and the LGBTQ communities. That role fell to Daskalakis, a well-known figure in those circles who had spent the past year leading the Centers for Disease Control and Prevention’s HIV/AIDS prevention division.

The two men had never met, but they suddenly found themselves with a response to the crisis hampered by a series of basic challenges: from expanding access to testing to increasing the supply of vaccines and improving awareness in the most vulnerable communities.

More than four months later, their efforts have been effective enough that Daskalakis and Fenton are now outlining a scaling back of the White House-led response, with the goal of returning much of the management to the CDC.

The transition would likely begin around the time the mpox public health emergency expires in late January, according to people familiar with the planning. Fenton and Daskalakis declined to comment on the details of their plans, but agreed that the emergency stage of the outbreak is almost over.

“The strategy has been set,” Fenton said. “We’re definitely headed in the right direction to make that transition.”

This was not the case in August.

Based on a list of priorities developed in their first days on the job, Fenton and Daskalakis sought to improve coordination among various health agencies involved in managing the outbreak, a complex bureaucratic task made even more complicated by the fact that some health officials they felt upset in the White House. had taken control of the response out of their hands, several people close to the matter said.

They also took it upon themselves to personally repair relationships with the LGBTQ and public health communities who had felt increasingly left out of government decision-making as the crisis worsened over the summer.

“In an event like this, there’s not a lot of confidence,” Fenton said. “You have to build the communication channels, you have to listen, you have to integrate these ideas into our strategies.”

After advocates raised concerns that people were not getting vaccinated because they were hesitant to certify in writing that they were a gay or transgender man with multiple partners, the CDC relaxed its requirements, allowing anyone who said they needed a vaccine in i got one An extensive pressure campaign to convince the World Health Organization change the name of the disease it also came at the behest of LGBTQ groups who argued that the disease’s original name was stigmatizing.

The White House also caught a couple of critical breaks: The group of men who have sex with men at higher risk were willing to change behaviors to avoid infection, according to a CDC study, slowing the spread of the virus while the government was scrambling to catch up. . . A controversial decision to split vaccine doses into fifths and use an intradermal injection method – depositing the vaccine in the skin rather than under it – also appears to have paid off. based on early studiesmultiplying the supply without sacrificing vaccine protection.

The progress has cheered the Biden mpox team. Once hesitant to promise that the administration could do much more than control the outbreak, Daskalakis is now confident that the circulation of mpox in the US can be stopped altogether.

“Our entry-level goal was to control and contain the outbreak, and our most aspirational goal was to eliminate household transmission,” he said. “I think we’re in a place where you see a more aspirational goal.”

Still, even as mpox cases reach new lows, the response team continues to struggle with persistent challenges. Biden’s personal directive to Fenton and Daskalakis to make equity a primary focus has yielded only average results.

CDC data show that blacks and Latinos account for the majority of mpox cases, including about two-thirds of those reported during the fall months, as infections generally declined. But so far they have only received a fraction of the vaccine doses.

“The social and racial disparities that have been persistent in this outbreak are truly disturbing,” said David Harvey, executive director of the National Coalition of STD Directors. “They reflect the biggest disparities in American society.”

Health experts fear the gaps could widen as attention to mpox wanes at the government and community level, and amid a wider struggle to convince at-risk people to get their second dose of the vaccine. Although more than 42 percent of the 1.7 million people at risk have had their first injection, less than a quarter have returned for a second, a delay that Daskalakis and Fenton say is now one of the their main concerns.

The mpox team recently changed their message to promote this second shot, presenting it as a preventative move against future outbreaks. Officials are confident they can stamp out the current outbreak, but acknowledge that the continued spread of mpox to other countries means the virus will inevitably return to the US in the future.

“It’s not just about getting to zero,” Fenton said of the vaccination drive. “It’s like maintaining that rate over time, especially as weather and behaviors change.”

This long-term work will soon be driven less and less from the White House. As management of the mpox response returns to the CDC, Fenton plans to return to his job at FEMA, under the administration’s proposed settlement, which has not yet been finalized.

Daskalakis would return to the CDC under this same proposal to continue managing the response from there. But it would also retain authority in the Department of Health and Human Services to coordinate efforts among the government’s various health agencies. Fenton declined to discuss his exit plans, saying no official decisions had been made. Daskalakis also declined to discuss his next role, but said he had a “sneaking suspicion that I will be closely aligned” with the ongoing mpox response.

Even then, the White House is expected to remain involved at some level in an oversight capacity, a sign that aides remain wary of fully entrusting the operation to a CDC that many blame for allowing the outbreak to initial gets out of control.

Restoring the administration’s credibility with LGBTQ and frontline health groups also remains a work in progress, advocates said. The government’s slow reaction and confused guidance during the first weeks of the outbreak are still missing from exacerbating the crisis. And while Fenton and Daskalakis are getting high marks in their campaign to restore trust, activists are watching closely how the administration continues to protect against future outbreaks.

“Hopefully the administration will get back into action when these spikes occur,” Staley said. “We will have to do our job [as activists] and monitor how they’re doing.”

Eugene Daniels contributed to this report.

Leave a Reply

Your email address will not be published. Required fields are marked *