The U.S. Centers for Disease Control and Prevention (CDC) said Friday it was aware of more than 700 cases of monkeypox globally, including 21 in the United States, with investigations now suggesting it is spreading inside the country. 

Sixteen of the first 17 cases were among people who identify as men who have sex with men, according to a new CDC report, and 14 were thought to be associated with travel. 

All patients are in recovery or have recovered, and no cases have been fatal. 

“There have also been some cases in the United States that we know are linked to known cases,” Jennifer McQuiston, deputy director of the CDC’s Division of High Consequence Pathogens and Pathology, told reporters on a call.  

“We also have at least one case in the United States that does not have a travel link or know how they acquired their infection.” 

Monkeypox is a rare disease that is related to but less severe than smallpox, causing a rash that spreads, fever, chills and aches, among other symptoms. 

Generally confined to western and central Africa, cases have been reported in Europe since May, and the number of countries affected has grown since. 

Canada also released new figures Friday, counting 77 confirmed cases — almost all of them detected in Quebec province, where vaccines have been delivered. 

Though its new spread may be linked to particular gay festivals in Europe, monkeypox is not thought to be a sexually transmitted disease, with the main risk factor being close skin-to-skin contact with someone who has monkeypox sores.  

A person is contagious until all the sores have scabbed and new skin is formed. 

‘More than enough vaccine’ 

Raj Panjabi, senior director for the White House’s global health security and biodefense division, added that 1,200 vaccines and 100 treatment courses had been delivered to U.S. states, where they were offered to close contacts of those infected. 

There are currently two authorized vaccines: ACAM2000 and JYNNEOS, which were originally developed against smallpox.  

Though smallpox has been eliminated, the United States retains the vaccines in a strategic national reserve in case it is deployed as a biological weapon.  

JYNNEOS is the more modern of the two vaccines, with fewer side effects. 

“We continue to have more than enough vaccine available,” Dawn O’Connell, assistant secretary for preparedness and response in the Department of Health and Human Services, told reporters.  

In late May, the CDC said it had 100 million doses of ACAM200 and 1,000 doses of JYNNEOS available, but O’Connell said Friday the figures had shifted, though she could not divulge precise numbers for strategic reasons. 

The CDC has also authorized two antivirals used to treat smallpox, TPOXX and Cidofovir, to be repurposed to treat monkeypox. 

“Anyone can get monkeypox, and we are carefully monitoring for monkeypox that may be spreading in any population, including those who are not identifying as men who have sex with men,” said McQuiston.  

That being said, the CDC is undertaking special outreach in the LGBT community, she added. 

A suspected case “should be anyone with a new characteristic rash,” or anyone who meets the criteria for high suspicion such as relevant travel, close contact, or being a man who has sex with men.  

 
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American children under age 5 could receive their first COVID-19 vaccines as early as June 21, the White House’s top COVID official said Thursday — if the two vaccines under review are approved by both U.S. government bodies responsible for such authorizations.

“We know that many, many parents are eager to vaccinate their youngest kids,” said White House Coronavirus Response Coordinator Dr. Ashish Jha. “And it’s important to do this right. And that’s what this process has been all about.”

Starting Friday, he said, the federal government will make 10 million doses available for order by states, pharmacies, community health centers and federal entities. Once the Food and Drug Administration approves the vaccine, those doses can be shipped, and once the Centers for Disease Control and Prevention gives its approval, children can start to get vaccinated. He predicted that if the process unfolds smoothly, children could begin receiving shots on June 21.

Currently, only children 5 or older are eligible for two-dose vaccines and for booster shots. If the vaccine is approved, the doses will be smaller than adult doses, Jha said, and the government has encouraged suppliers to make vaccinations available outside work and school hours, so parents can easily access them.

“We are prepared,” said White House press secretary Karine Jean-Pierre. “We’re working with states, local health departments, pediatricians, family doctors, other health providers and pharmacies to get ready, as we did with kids that are between 5 and 11. So we want to make sure that we get this done swiftly but also safely and … follow CDC recommendations.”

Last month, during the Quad leaders summit in Tokyo, the U.S. committed to providing COVID-19 boosters and pediatric doses to countries in greatest need, including in the Indo-Pacific. But it’s not clear whether the administration has firm plans to donate the vaccines for young children at this point.

“One of the things that the Quad partners are committed to is making sure that doses are safe and effective, and not trying to do anything to try and prejudge the approval process,” a senior administration official told VOA.

Moderna asked for authorization for pediatric vaccines in late April; Pfizer asked last month. The most recent survey from the Kaiser Family Foundation found that 18% of parents of under-5 children will get their children vaccinated quickly. But 38% say they will wait and observe how others take the vaccine. And another 38% say they will either “definitely not” pursue the vaccine or will do so only if required.

Johns Hopkins University, a leading tracker of the pandemic, notes that parental uptake of child vaccinations has been “stubbornly slow,” with less than 30% of children receiving the vaccine.

“The consistent message throughout the pandemic has been that the virus is mild for children,” said Rupali Limaye, deputy director of the International Vaccine Access Center.

The CDC emphasizes that the child-sized vaccine is safe and effective.

While severe cases among children are less prevalent than among adults, the CDC notes that since the pandemic began, COVID-19 has taken the lives of 479 American children under age 5.

Patsy Widakuswara contributed to this report.
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One of NASA’s robots on Mars chops its way through the record books. Plus, next-generation spacesuits, and a meteor shower ignites the sky over Brazil. VOA’s Arash Arabasadi brings us The Week in Space
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U.S. President Joe Biden met with major manufacturers of infant formula on Wednesday, and suggested their ranks should grow, as his administration presses ahead with efforts to boost imported supplies to help ease a nationwide shortage. 

“We need more new entrants in the infant formula market,” Biden said during a virtual meeting with executives from ByHeart, Bubs Australia, Reckitt Benckiser Group, Perrigo Company and Nestles Gerber. 

Multiple global suppliers are seeking U.S. approval to ship critical baby formula as Biden’s administration accelerates what it has dubbed “Operation Fly Formula” to help fill store shelves and calm frustrated parents. 

With about $4 billion in annual sales, the U.S. baby formula market has historically been dominated by domestic producers, with imports limited and subject to high tariffs. 

But U.S. parents have struggled to find baby formula in recent months after a February recall of some formulas by one of the nation’s main manufacturers, Abbott Laboratories, coupled with pandemic-related supply chain issues. 

The latest administration effort to solve the problem includes an announcement on Wednesday that United Airlines has agreed to transport U.K.-made Kendamil formula free of charge from Heathrow Airport in London to multiple airports across the United States over a three-week period. 

This first shipment, which includes Kendamil Classic and Kendamil Organic formula, will be available at Target stores across the country in the coming weeks. 

The administration also secured two flights totaling 380,000 pounds of baby formula from Bubs Australia that will be delivered to California and Pennsylvania on June 9 and June 11, respectively. 

Biden said on Wednesday he first learned of the severity of the U.S. baby formula shortage in early April. The White House said it had been working around the clock since February to address the problem. 

U.S. lawmakers have criticized the Food and Drug Administration (FDA) for not acting promptly to address the problems that caused the recall at Abbott’s Michigan plant, which is set to reopen June 4. 

The Biden administration has relaxed its import policy and invoked the Defense Production Act to help increase available U.S. supplies, which is still expected to take weeks. It has also said it could use federal resources to help transport supplies to retailers. 

Two million cans of formula have been sent from the U.K., and Australian manufacturers are also preparing to send in more product. 

Thorben Nilewski of Organic Family, which makes the popular Holle infant formulas, said in an email that the German company applied for the FDA’s temporary approval but has not yet received any feedback. 

Many U.S. parents rely on baby formula. Fewer than half the babies born in the United States were exclusively breast-fed through their first three months, according to the Centers for Disease Control and Prevention’s 2020 Breastfeeding Report Card. 
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As health authorities in Europe and elsewhere roll out vaccines and drugs to stamp out the biggest monkeypox outbreak beyond Africa, some doctors acknowledge an ugly reality: The resources to slow the disease’s spread have long been available, just not to the Africans who have dealt with it for decades.

Countries including Britain, Spain, Portugal, Italy, Switzerland, the United States, Israel and Australia have reported more than 500 monkeypox cases, many apparently tied to sexual activity at two recent raves in Europe. No deaths have been reported.

Authorities in numerous European countries and the U.S. are offering to immunize people and considering the use of antivirals. On Thursday, the World Health Organization will convene a special meeting to discuss monkeypox research priorities and related issues.

Meanwhile, the African continent has reported about three times as many cases this year.

There have been more than 1,400 monkeypox cases and 63 deaths in four countries where the disease is endemic — Cameroon, Central African Republic, Congo and Nigeria — according to the Africa Centers for Disease Control and Prevention. So far, sequencing has not yet shown any direct link to the outbreak outside Africa, health officials say.

Monkeypox is in the same family of viruses as smallpox, and smallpox vaccines are estimated to be about 85% effective against monkeypox, according to WHO.

Since identifying cases earlier this month, Britain has vaccinated more than 1,000 people at risk of contracting the virus and bought 20,000 more doses. European Union officials are in talks to buy more smallpox vaccine from Bavarian Nordic, the maker of the only such vaccine licensed in Europe.

U.S. government officials have released about 700 doses of vaccine to states where cases were reported.

Such measures aren’t routinely employed in Africa.

Dr. Adesola Yinka-Ogunleye, who leads Nigeria’s monkeypox working group, said there are currently no vaccines or antivirals being used against monkeypox in her country. People suspected of having monkeypox are isolated and treated conservatively, while their contacts are monitored, she said.

Generally, Africa has only had “small stockpiles” of smallpox vaccine to offer health workers when monkeypox outbreaks happen, said Ahmed Ogwell, acting director of the Africa CDC.

Limited vaccine supply and competing health priorities have meant that immunization against monkeypox hasn’t been widely pursued in Africa, said Dr. Jimmy Whitworth, a professor of international public health at the London School of Hygiene and Tropical Medicine.

“It’s a bit uncomfortable that we have a different attitude to the kinds of resources we deploy depending on where cases are,” he said. “It exposes a moral failing when those interventions aren’t available for the millions of people in Africa who need them.”

WHO has 31 million doses of smallpox vaccines, mostly kept in donor countries and intended as a rapid response to any re-emergence of the disease, which was declared eradicated in 1980.

Doses from the U.N. health agency’s stockpile have never been released for any monkeypox outbreaks in central or western Africa.

Dr. Mike Ryan, WHO’s emergencies chief, said the agency was considering allowing rich countries to use the smallpox vaccines to try to limit the spread of monkeypox. WHO manages similar mechanisms to help poor countries get vaccines for diseases like yellow fever and meningitis, but such efforts have not been previously used for countries that can otherwise afford shots.

Oyewale Tomori, a Nigerian virologist who sits on several WHO advisory boards, said releasing smallpox vaccines from the agency’s stockpile to stop monkeypox from becoming endemic in richer countries might be warranted, but he noted a discrepancy in WHO’s strategy.

“A similar approach should have been adopted a long time ago to deal with the situation in Africa,” he said. “This is another example of where some countries are more equal than others.”

Some doctors pointed out that stalled efforts to understand monkeypox were now complicating efforts to treat patients. Most people experience symptoms including fever, chills and fatigue. But those with more serious disease often develop a rash on their face or hands that spreads elsewhere.

Dr. Hugh Adler and colleagues recently published a paper suggesting the antiviral drug tecovirimat could help fight monkeypox. The drug, approved in the U.S. to treat smallpox, was used in seven people infected with monkeypox in the U.K. from 2018 to 2021, but more details are needed for regulatory approval.

“If we had thought about getting this data before, we wouldn’t be in this situation now where we have a potential treatment without enough evidence,” said Adler, a research fellow at the Liverpool School of Tropical Medicine.

Many diseases only attracted significant money after infecting people from rich countries, he noted.

For example, it was only after the catastrophic Ebola outbreak in West Africa in 2014-2016 — when several Americans were sickened by the disease among the more than 28,000 cases in Africa — that authorities finally sped up the research and protocols to license an Ebola vaccine, capping a decades-long effort.

At a press briefing on Wednesday, WHO’s Ryan said the agency was worried about the continued spread of monkeypox in rich countries and was evaluating how it could help stem the disease’s transmission there.

“I certainly didn’t hear that same level of concern over the last five or 10 years,” he said, referring to the repeated epidemics of monkeypox in Africa, when thousands of people in the continent’s central and western parts were sickened by the disease.

Jay Chudi, a development expert who lives in the Nigerian state of Enugu, which has reported monkeypox cases since 2017, hopes the increased attention might finally help address the problem. But he nevertheless lamented that it took infections in rich countries for it to seem possible.

“You would think the new cases are deadlier and more dangerous than what we have in Africa,” he said. “We are now seeing it can end once and for all, but because it is no longer just in Africa. It’s now everybody is worried.”
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The World Health Organization reported more than 250 attacks on health facilities and health personnel in Ukraine since it was invaded by Russian forces. One U.S. firm is helping fill the gap with mobile laboratories and clinics. For VOA, Genia Dulot has our story from Los Angeles.
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In the spring of 2020, as COVID-19 spread throughout the world in ways not fully understood, the United States faced a critical shortage of protective masks. 

Dozens of manufacturing startups attempted to meet the demand for what was then a confusing array of grades and types — N95, KN95, full-face respirators.  

Now, after a short respite from many COVID-19 precautions, the U.S. is weeks into a new surge in cases that may foreshadow a greater one this fall, and those same small companies that make masks are hurting.  

John Bielamowicz is a co-founder of United States Mask. The Fort Worth, Texas, company is among those struggling.  

Bielamowicz launched his mask-making mission after reading social media posts about medical professionals not having N95 masks in the pandemic’s terrifying early months. It was caregivers like them who had helped his family in 2016, when his son Matthew was born missing 80% of his diaphragm on the left side. 

Bielamowicz and his business partner ​David Baillargeon put their commercial real estate business on hold to start the mask company. 

“This was our way of paying it back … for the gift that they gave us for sending us home with our son,” Bielamowicz told VOA Mandarin in a virtual interview. “It was a debt that I never thought that I’d be able to pay back.” 

The partners began reading and experimenting in February 2020, and by late October of that year, their N95 masks carried a National Institute for Occupational Safety and Health certification. At its peak in early 2021, the company produced millions of N95 masks a month and employed close to 50 people. 

“For me and my family, this was a mission, and we were going to do it or fail trying,” Bielamowicz said. “And we didn’t fail. We did it.”  

Masks and jobs

The American Mask Manufacturers Association (AMMA) represents small companies that started making masks during the pandemic.  

“During the pandemic, we created just over 8,000 new manufacturing jobs. And this was at a time where most businesses were laying people off or furloughing people,” Lloyd Armbrust, president of the association, told VOA in a virtual interview.  

But attitudes toward mask wearing have varied widely across the U.S. since 2020, and on April 18, a federal judge in Florida voided the national mask mandate covering airplanes and other public transportation. This came a day before the Biden administration said it would no longer enforce a U.S. mask mandate.  

Armbrust American, Armbrust’s mask company in Pflugerville, Texas, staggered from the twin blows.  

“That day, we saw our online sales be cut at half or even more,” said Armbrust, who added that he and other mask-makers had already been competing with cheap masks from China before the one-two punch.  

China and masks 

According to research published last year by the Peterson Institute for International Economics, a Washington-based think tank, 72% of the masks and respirators imported by the U.S. in 2019 came from China. 

When the coronavirus that causes COVID-19 was first identified in humans in Wuhan, China, in late 2019, U.S. imports of protective masks from China plunged. 

When China resumed exporting government-subsidized masks in 2020, it attempted to create “a monopoly within the PPE (personal protective equipment) market,” the AMMA charged, and manufacturers such as Armbrust American found themselves in difficulty. 

“Our raw material costs me about $0.015 per mask,” Armbrust said. “And yet China can deliver it to the United States for less than $0.01. They say that they’re more efficient, but how is that possible when the cost of their finished products is cheaper than I buy the raw materials for? It’s just not possible. The answer is, the Chinese government is subsidizing it because they don’t want to lose this business.”  

In response to VOA Mandarin questions about China’s mask exports to the U.S., Liu Pengyu, the spokesman for the Chinese embassy in Washington, said, “I would like to point out that as a market economy, China has earnestly fulfilled its WTO (World Trade Organization) commitments and abides by multilateral economic and trade rules. Chinese merchandise is cheap and good because of the good supply chain, sufficient competition and economies of scale, not non-market behavior.” 

“I can be very competitive, but I can’t be competitive against the whole government. … In 2021, we laid off about 70% of our staff,” Armbrust said. 

Bielamowicz’s United States Mask laid off people as well. 

“It was the worst day of my career,” he said.   

An uncertain future 

Nationwide, the AMMA, which peaked with almost 30 members in 2021, now includes fewer than 10 enterprises still producing masks. 

Facing masks’ uncertain future, Armbrust American shifted to producing home air filters. 

Bielamowicz has been traveling to Washington to lobby the federal government. 

“We’re asking for free competition,” Bielamowicz said. “We know the free market works.” 

That said, Armbrust hopes the government can subsidize small companies that make masks, as it does farmers, to preserve production capability so that when the next pandemic hits, small producers can jump back into mask making. 

“If I could just have a base,” Armbrust said, “… where I could mothball these machines and … I could afford to pay the rent for the space instead of actually shutting it down and scrapping the machines, that would be another solution.”  
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