Public health officials are pressing the Biden administration to declare a public health emergency for monkeypox and say a lack of resources has forced clinics to ration vaccines and treatments and even motivated some patients to head to Canada for monkeypox vaccines.

The White House took actions Tuesday to step up its response, with President Joe Biden naming Robert Fenton, a regional administrator of the Federal Emergency Management Agency, as the national monkeypox response coordinator and Demetre Daskalakis, head of the Centers for Disease Control and Prevention’s Division of HIV/AIDS Prevention, as deputy coordinator. 

The White House said Fenton and Daskalakis would focus on equitably increasing the availability of tests, vaccinations and treatments. The U.S. has now secured 1.1 million Jynneos vaccine doses to prevent monkeypox and is distributing them to states based on population and case count.

Federal and state public health officials say the 5,800 monkeypox cases that the CDC says have been detected in the U.S. are probably an undercount because some people with the virus aren’t getting tested. 

State public health officials say more is needed from the federal government. They say declaring a national public health emergency could direct more money to states for a response as well as make it easier to acquire vaccines and treatments.

Health and Human Services Secretary Xavier Becerra told reporters last week that he is considering such a declaration, and several lawmakers have urged him to do so.

Tyler TerMeer, the CEO of the San Francisco AIDS Foundation, told reporters that 10,000 people are waiting for monkeypox vaccines at the foundation’s sexual health clinic. The virus primarily affects men who have sex with men. Sexual health clinics are on the front lines for treatment and vaccinations because the monkeypox lesions can first appear in the genital region.

“We need more vaccines, and we need them quickly,” TerMeer said.

California on Monday declared monkeypox a state public health emergency as the case count reached 827.

TerMeer said the process to order Tpoxx, the antiviral treatment that the administration is distributing, is “extraordinarily complex,” and that each physician spends more than three hours on paperwork, leading many clinics to decide they are too overwhelmed to administer it. TerMeer said his clinic has just received enough resources to begin prescribing the antiviral even though patients have been asking for it for weeks.

Zandt Bryan, a sexual health and prevention program manager with the Washington State Department of Health, said the largest sexually transmitted infection clinic in Seattle now functions primarily as a monkeypox clinic. The state has received vaccines and treatments from the federal government, but Bryan says the demand outstrips supply, causing many members of the LGBTQ community to go to Canada for shots.

“We’ve done the best we can with the information and resources we have. But more is needed from the administration, both when it comes to funding and guidance for the field,” Bryan said.