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Officials express optimism that monkeypox can be eliminated in the US.

WASHINGTON — With monkeypox cases on the decline nationally, federal health officials expressed optimism Thursday that the virus could be eliminated in the United States, though they warned that unless it is eliminated globally, Americans will remain at risk.

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

dr Daskalakis was joined by President Biden’s Health Secretary Xavier Becerra and Response Team Coordinator Robert J. Fenton Jr., who echoed his optimism. The clinic visit was intended to highlight the District of Columbia’s efforts to close the racial gap in monkeypox vaccination, a major goal of the Biden administration.

“The president said from the beginning: ‘Take care of this and then get ahead,'” Becerra told reporters. “And we can’t really say we’re ahead of the curve if we’re leaving certain communities behind.”

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

On Thursday, Dr. Daskalakis gave no timetable for ending the outbreak in the United States, saying only that she was looking at her “midterm crystal ball.” But she said she hoped that, over time, cases would decline and infections would emerge only sporadically, allowing health officials to isolate and vaccinate close contacts of infected people, and end the outbreak in the country. process.

That strategy, known as vaccination ringit was 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 occurs only in humans, while monkeypox also occurs in animals. The existence of an “animal reservoir” means there will always be a risk of spread 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; eradicate means it’s gone permanently, and the only virus we’ve done that with so far is smallpox,” Dr. Osterholm said.

He said that a better word would be “elimination,” and a better comparison would be measles. “We have had a major measles elimination program in this country and have greatly reduced the occurrence of measles, but the current challenge remains the introduction of the virus by people around the world,” Dr. Osterholm said. .

The first US cases of the current monkeypox outbreak emerged in May. The illness, which in the United States has occurred primarily in men who have sex with men, is characterized by fever, muscle aches, chills, and lesions. It is rarely fatal in rich 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 accounts for more than a third of the roughly 65,000 cases. reported worldwide; Beginning Thursday, the CDC had reported about 25,000 cases in the country. An average of around 200 cases per day are still being reported in the United States, although that number is significantly lower than the peak of the outbreak in August.

The decline is a relief to officials in the Biden administration, who came under heavy criticism for their response in the early days of the outbreak. Critics, including many gay rights activists, said the administration did not move aggressively to order vaccine doses and distribute them before many gay men became infected during Pride celebrations in June.

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

“This is the first time we’ve really seen a large outbreak of monkeypox with sustained person-to-person transmission, and there are still a lot of scientific unknowns,” Krellenstein said, adding, referring to President George W. Bush: “Let’s not get into the ‘mission accomplished’ landing in carrier territory here.

The vaccine shortage led to stark racial disparities that the administration 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’s optimism that the outbreak could be brought under control, but only with intense efforts to reach the underserved populations.

“The risk,” he said, “is that you have these hard-to-reach populations, often the poor and people of racial and ethnic minorities who are less aware, have less access. Sometimes they tend to lag behind, as we’re seeing, in terms of vaccination.”

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