Government watchdog critical of federal mpox response

The Government Accountability Office (GAO) says in a new report that the Department of Health and Human Services's (HHS) response to the 2022 mpox outbreak was uncoordinated and lacked interagency cohesion.

For its report, the GAO visited 14 U.S. jurisdictions including Los Angeles, Miami Dade County, Atlanta, Chicago and New York City. The agency also interviewed nongovernmental stakeholders and reviewed the actions HHS took in response to previous GAO recommendations.

The audit was conducted from October 2022 to this month.

As the GAO noted, the mpox response was carried out through numerous agencies within HHS including the Administration for Strategic Preparedness and Response (ASPR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, the National Institutes of Health and the Health Resources and Services Administration.

While the declaration of a public health emergency accelerated the response, several jurisdiction officials said there did not seem to be a "central point of coordination until the White House team was stood up" in August, about three months after the first U.S. mpox case of the outbreak was detected.

"For example, officials from several jurisdictions talked about challenges working with CDC and ASPR, and said the two agencies regularly directed questions or requests from jurisdictions to the other agency," the GAO's report read.

"HHS could have responded to questions and requests from jurisdictions more quickly had there been increased coordination across all HHS agencies."

According to the report, HHS officials said ASPR acted as the central coordinator for some parts of the government's response to the mpox outbreak.

The GAO determined other missteps in the HHS response included not effectively communicating the elevated risk of infection to certain individuals, primarily men who have sex with men. An official from one of the jurisdictions told the GAO this sort of information could have helped in preventing infections.

Officials apparently acknowledged, however, that the response did improve after HHS incorporated community input. But other challenges in working with the federal government continued to crop up.

Supplies of the Jynneos smallpox vaccines used to combat the outbreak were stretched by administering intradermal shots a fifth of the size of a normal dose. While this improved availability, the necessary supplies to administer these shots were not provided as some health officials had come to expect due to the COVID-19 pandemic.

And reporting data back to the federal government was time-consuming, as officials described often having to upload case report data manually.

In response to its review, the GAO issued two recommendations.

First, it recommended that the HHS secretary "develop and implement a coordinated, department-wide after-action program that encourages collaboration between HHS’s component agencies, including integrating the existing public health emergency after-action programs of these component agencies."

Second, the office recommended that the secretary develop an after-action program that includes "stakeholders involved in each public health emergency response — such as other federal agencies, jurisdictions, and nongovernmental partners."

When reached for comment, an HHS spokesperson said the department "concurs with both recommendations and is working on implementation.”

Democratic Reps. Bennie Thompson (Miss.) and Ritchie Torres (N.Y.) and former Rep. Val Demings (D-Fla.) had requested the review from the GAO in August 2022, stating at the time that they were "concerned that the pace of the Federal response to monkeypox has enabled the virus to spread for two months and delays in distributing tests and vaccines have harmed efforts to contain the virus."

In response to the report, Torres announced he was introducing the Coordinated Agency Response Enhancement Act, which if enacted would require the HHS secretary to develop after-action programs that encourage interagency collaboration and to develop culturally sensitive, inclusive risk-assessment strategies.

"In the aftermath of the COVID-19 pandemic and Mpox outbreak, it’s time we radically change our federal approach to public health. Marginalized and at-risk communities cannot afford to bear the brunt of another public health emergency, desperately waiting for the government to get its act together," Torres said in a statement.

—Updated at 6:25 p.m.