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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Biden says everyone should be concerned about monkeypox. Naw.

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Hello, good morning. Do you have ~$1.2M and a plan to bid on “The Wizard of Oz” dress? Sorry to report that you’ll have to wait. 

Today’s edition: The FDA is defending its decision to review both vaccines for the youngest kids at the same time. Vulnerable House Democrats are pressing party leaders to extend Obamacare’s enhanced subsidies. But first …

No need to panic about monkeypox

Monkeypox isn’t the next coronavirus.

The spread of another viral infection across roughly a dozen countries may sound worrying after over two years of the coronavirus pandemic. Even President Biden raised alarms Sunday when he said monkeypox is “something that everybody should be concerned about.”

But federal health officials and experts say there’s no need for panic. The Centers for Disease Control and Prevention officials say they have “a strong scientific concern” that the virus may be spreading differently than seen before, but that the risk to the general population is low right now. And monkeypox has key differences from the fast-moving, more-transmissible coronavirus that make it easier to contain and treat.

  • “This is not covid,” said Jennifer McQuiston, the deputy director of the CDC’s Division of High Consequence Pathogens and Pathology. “I know that early in covid, we had not a lot of information, and things changed as we learned more. We do know a lot about monkeypox from many decades of studying it.”
Key differences

For one, monkeypox isn’t a new virus. The disease was first discovered in 1958 in monkeys kept for research, and the first human case was recorded a dozen years later in the Democratic Republic of Congo, according to the CDC.

Scientists have studied its patterns for decades. There are already vaccines and treatments that can be used against the virus. It’s a highly visible disease since it leads to a rash, making detection and contact tracing easier. 

And notably, it’s harder to infect another person. Lesions characteristic of the virus are a significant source of spread, such as sustained skin-to skin contact with a rash, sharing bedding or through prolonged close contact with someone who has lesions in their mouth.

  • “It's relatively straightforward to pick up covid because it's present in the air you breathe out if you're infected,” said Andy Pekosz, a virologist at the Johns Hopkins Bloomberg School of Public Health. “It takes a lot more to get infected with monkeypox.”
The backdrop

So why is monkeypox making the news? There’s been an unusual uptick in monkeypox cases across the globe. Many of the new cases — in places like the United Kingdom, Portugal and Germany — aren’t linked to travels to Central and West Africa, where the virus is usually found. That suggests the virus could be spreading through the community.

That’s left researchers across the globe racing to determine whether the virus has changed in some way or whether there’s a reason for the increased spread.

“There's a difference between being concerned and being alarmed,” said Anne Rimoin, an epidemiologist at UCLA who has studied monkeypox for 20 years. When a virus’s patterns of spread changes, it’s cause for investigation and concern, but that doesn’t mean it’s an all-out public health emergency, she explained. 

In the U.S.

So far, there has been one confirmed infection in Massachusetts. Federal health officials are presuming there are four other cases — two in Utah, one in New York and another in Florida. It’s likely there will be additional cases in the country, CDC officials said on a call with reporters yesterday. 

The public health agency is developing recommendations to help doctors determine which patients would be good candidates for the vaccines and treatments. 

Data suggests that the smallpox vaccine is 85 percent effective against monkeypox. The smallpox vaccine hasn’t been routinely administered to the general public in 50 years, but the United States has a supply of the newer shots. Experts also believe vaccination after exposure to the virus can help prevent the disease or decrease its severity. 

Biden said yesterday he didn’t believe a quarantine to prevent the spread of monkeypox would be necessary, our colleague Seung Min Kim reports, because there are sufficient vaccine doses available to combat flare-ups. His remarks came after Belgium imposed a 21-day isolation period for residents with monkeypox.

The nation’s vaccine stockpile includes … 

  • Over 100 million doses of the vaccine called ACAM2000, but the older generation shot has some potentially significant side effects.
  • More than 1,000 doses available of the vaccine JYNNEOS, and CDC officials expect that number to ramp up in the coming weeks as the company provides more doses.


FDA advisers to review Moderna, Pfizer-BioNTech vaccines for youngest children

The Food and Drug Administration’s advisory panel will meet June 15 to consider both Pfizer-BioNTech and Moderna’s requests for emergency use authorization of their coronavirus vaccines for the youngest children, The Post’s Carolyn Y. Johnson and Laurie McGinley report. 

The timeline:

  • If the FDA’s outside experts look favorably on the vaccines for America’s youngest kids, the agency could authorize the shots as soon as June 16.
  • Vaccine advisers to the CDC then would consider who should get the shots, followed by a final recommendation from the agency’s director, Rochelle Walensky.
  • Both company’s have said their vaccines would be available almost immediately afterward.

The meeting sets up a head-to-head comparison of efficacy and safety for Moderna's two-shot regimen and Pfizer-BioNTech's three-shot vaccine. But the review isn’t without controversy

Some parents have been pushing for the agency to quickly greenlight Moderna’s emergency use authorization and say the FDA should move ahead with a June 8 meeting to consider the first shot for children under age 5 as cases rise nationally.

But the agency defended its position to wait another week so its advisers could consider both Pfizer’s and Moderna’s shots at the same time. The agency said putting both vaccines before the committee “is the best approach to ensure the most informed recommendations from our external advisers,” and some doctors said it could help them better field questions from their parents.

Ann Chahroudi, pediatric infectious-disease physician at the Emory University School of Medicine:

Long covid patients report neurological symptoms more than a year after initial infection

A majority covid-19 long-haulers who weren’t hospitalized for their initial infection report experiencing persistent neurological symptoms like brain fog, headaches and dizziness 15 months after the disease’s onset, a new study from Northwestern Medicine found.  

Here’s what the researchers found: 

  • Reports of heart rate problems, blood pressure variations and gastrointestinal symptoms among long haulers increased in follow-up appointments, but loss of taste and smell decreased overall.
  • Most long covid patients reported improvements in their recovery, cognitive function, and fatigue, but quality of life measures remained lower than the average population of the United States.
  • Approximately 77 percent of patients observed in the study were vaccinated for the coronavirus, but researchers found the shot didn’t have a positive or detrimental impact on cognitive function or fatigue.

“Vaccination didn’t cure long covid symptoms, but didn’t worsen them either — which is a reason given by some long-haulers for not getting vaccinated,” said Igor J. Koralnik, chief of neuro-infectious diseases at Northwestern. 

More than 83 million coronavirus cases have been reported in the United States, according to The Washington Post’s tracker, which is surely an undercount. The Government Accountability Office recently said that as many as 23 million Americans might have developed long covid symptoms. 

On the Hill

Vulnerable Democrats press for party action to avert an Obamacare fiasco this fall

A group of more than two dozen vulnerable House Democrats is raising alarm bells about spikes in Affordable Care Act premiums, which voters will learn of shortly before they cast their ballots in the midterms elections. 

In a letter to Democratic leadership, the group — led by Rep. Lauren Underwood (D-Ill.) — asked for any reconciliation bill the party puts together to include provisions permanently extending enhanced subsidies that cut monthly costs for many individuals who buy plans on the Affordable Care Act’s insurance marketplaces.

Key context: President Biden beefed up the subsidies last year in Democrats’ covid-19 relief package, the American Rescue Plan. The move contributed to record enrollment in the Affordable Care Act’s insurance exchanges. But without extending the financial help, millions of Americans could see steep spikes in their monthly premiums each month. 

Yet in order for Democrats to pass a version of their long-stalled economic package, they’ll need sign off from Sen. Joe Manchin (D-W.Va.). And it’s unclear whether renewing the boosted tax credits could make it into such a reconciliation bill, a budget maneuver Democrats are using to bypass a Republican filibuster in the Senate.

Rep. Lauren Underwood (D-Ill.):

Larry Levitt, executive vice president for health policy at Kaiser Family Foundation:

Medical missives

  • On tap today: Sens. Maria Cantwell (D-Wash.) and Chuck Grassley (R-Iowa) are planning to introduce bipartisan legislation to crack down on pharmacy benefit managers, such as requiring PBMs to file reports to the Federal Trade Commission including on so-called spread pricing and granting whistleblower protections, according to a person familiar with the legislation.
  • After years of refusing to expand Medicaid in North Carolina, state Senate Republicans are expected to propose legislation as early as this week that would expand health-care coverage to hundreds of thousands of the state’s poorest residents, Axios reports.
  • A group opposing the Biden administration’s coronavirus vaccine mandate for federal workers is petitioning a federal appeals court to reconsider its decision allowing the White House to require the shot, per the Associated Press.

Sugar rush

Thanks for reading! See y'all tomorrow.