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Officials Express Optimism That Monkeypox Can Be Eliminated in the U.S.

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WASHINGTON — With monkey pox cases declining nationally, federal health officials on Thursday expressed optimism that the virus could be eliminated in the United States, though they warned Americans would remain at risk unless it was eradicated globally.

“Our goal is to eradicate; that’s what we’re working towards,” said Dr. Demetre Daskalakis, the deputy coordinator of the White House’s Monkeypox Response team, during a visit to a monkey vaccination clinic in Washington. He added: “The prediction is that we will get very close.”

dr. Daskalakis was joined by Xavier Becerra, President Biden’s health secretary, and response team coordinator Robert J. Fenton Jr., who echoed his optimism. The clinic visit was intended to showcase the efforts of the District of Columbia to close the racial divide in monkeypox vaccination — a key goal of the Biden administration.

“The president said from the start, ‘Get on top of it, then get ahead of it,'” Mr Becerra told reporters. “And we can’t say we’re really ahead of it if we leave certain communities behind.”

dr. Daskalakis, an infectious disease expert who previously headed the HIV prevention division at the Centers for Disease Control and Prevention, was brought to the monkeypox response team by Mr. Biden last month.

On Thursday, Dr. Daskalakis has no timeline for ending the outbreak in the United States, saying only he was looking into his “interim crystal ball”. But he said he expected cases to drop to a trickle over time and only sporadic infections would develop, allowing health officials to isolate and vaccinate the close contacts of those infected — and end the outbreak in the process.

That strategy, known as ring vaccinationwas used in the worldwide campaign to eradicate smallpox, which was declared eradicated in 1980.

But there is a big difference between monkeypox and smallpox: Smallpox only occurs in humans, while monkeypox also occurs in animals. The existence of an “animal reservoir” means there will always be the risk of spreading it to humans, said Dr. Michael T. Osterholm, an infectious disease expert at the University of Minnesota.

“Eradication is a very sacred word in public health; eradicating it means it’s gone for good, and the only virus we’ve done that with so far is smallpox,” said Dr. Osterholm.

He said a better word was “elimination,” and a better comparison would be measles. “We have had a large-scale measles elimination program in this country and have greatly reduced the incidence of measles, but the challenge remains the introduction of the virus by individuals around the world,” said Dr. Osterholm.

The first US cases of the current monkeypox outbreak emerged in May. The disease, which in the United States mainly affects men who have sex with men, is characterized by fever, muscle aches, chills and lesions. It is rarely fatal in wealthy countries like the United States, but it can cause excruciating pain. The current outbreak is unusually large; the last major outbreak of monkeypox in the United States occurred in 2003, when 47 confirmed and probable cases were reported in six states.

In the current outbreak, the United States is responsible for more than a third of the approximately 65,000 cases reported worldwide; from Thursday, the CDC had reported nearly 25,000 cases in the country. In the United States, an average of about 200 cases are still reported per day, although that figure is significantly lower than the peak of the outbreak in August.

The drop comes as a relief to officials in the Biden administration, who have been sharply criticized for their response in the early days of the outbreak. Critics, including many gay rights activists, said the government had failed to act aggressively to order and distribute vaccine doses before many gay men became infected during Pride celebrations in June.

One such activist, James Krellenstein, a founder of PrEP4All, an advocacy group, said Dr. Daskalakis were premature. He said a shortage of federal funds to research monkeypox, and a lack of answers to fundamental questions, made it too early to predict an end to the outbreak.

“This is the first time we’ve seen a truly major monkeypox outbreak with continued human-to-human transmission, and there are still many scientific unknowns,” said Mr. Krellenstein, referring to President George W. Bush. we don’t start here with a ‘mission accomplished’ landing on an aircraft carrier area.”

The vaccine shortage led to sharp racial inequalities that the government is now trying to address. dr. Wafaa El-Sadr, a professor of epidemiology and medicine at Columbia University’s Mailman School of Public Health, said she shared Dr. Daskalakis’ optimism that the outbreak could be brought under control, but only with intense efforts to reach disadvantaged populations. .

“The risk,” she said, “is that you have these populations that are hard to reach, often the poor and people of racial and ethnic minorities who are less aware have less access. They tend to fall behind sometimes, as we see, in vaccination.”