GAO report: HHS mpox failures show persistent emergency response gaps

mpox on hands

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Even with the lessons learned from the recent COVID-19 pandemic, the US Department of Health and Human Services (HHS) failed to respond effectively or coordinate a national response to the 2022 mpox outbreak, with state leaders citing a lack of communication and uneven access to tests and vaccines, according to a new report from the US Government Accountability Office (GAO).

Moreover, HHS still lacks a "coordinated, department-wide after-action program to identify and resolve recurring emergency response challenges," the report read. 

The authors of the report warned that the failures seen in handling mpox, rarely deadly and only transmitted among a small proportion of the population, are a warning sign the HHS needs to continue to refine its approach to pandemic response. 

They also warn that unlike COVID-19, the federal government had medical countermeasures in place to immediately begin fighting mpox, including an effective vaccine. But it still took a critical 3 months of confusion surrounding distribution and delivery before the HHS ordered the right number of doses of the Jynneos vaccine, and it wasn't until August of 2022 that a White House response team was created to get the first shots in arms. 

Exhausted workplace after COVID

To complete the report, the GAO interviewed officials from the Department of Homeland Security, HHS, and 14 selected jurisdictions (six states, the District of Columbia, and seven localities). The jurisdictions saw a high number of mpox cases and included Los Angeles,San Francisco, Georgia, and New York City.

In a podcast on the GAO report, GAO's Mary Denigan-Macauley, who led work for the new report, says many of the problems in the mpox response were due to a deflated and exhausted public health workforce across the country.

"We were short of workforce to be able to control Mpox. If you remember correctly, this came at right during COVID — at the heels of COVID — and the workforce was absolutely exhausted," Denigan-Macauley said. 

We were short of workforce to be able to control Mpox.

She also emphasized poor communication between HHS officials and state leaders. In the report, the GAO writes, "HHS did not effectively communicate to the public the significantly increased risk of mpox for certain individuals during the initial stages of the outbreak, according to some jurisdictional officials we interviewed."

"Some officials said CDC's risk communication at the beginning of the mpox outbreak did not clearly identify the individuals who were most at-risk for mpox (men who have sex with men) and the most common mode of transmission (sexual contact)."

Denigan-Macauley said the HHS needs to listen to outside stakeholders as well as invest in public health infrastructure before something more deadly and widely transmissible than mpox is seen in the United States. 

"What happens if a bad guy were to introduce something for which we have no medical countermeasures and they introduce it in simultaneous and multiple places around the United States? It will be overwhelming. So we are looking for HHS to step up its game because it is a matter of saving lives," Denigan-Macauley said. 

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