Inside America’s monkeypox crisis — and the mistakes that made it worse

The nation’s top health officials believed they had finally hit upon a solution to quell weeks of public criticism about the stragglinggovernment response to the monkeypox outbreak spreading across the country this summer.

They would stretch the nation’s limited supply of the only FDA-approved vaccine for monkeypox by splitting doses to cover five times as many people — an admission, after repeated reassurances by top government officials, that the United States did not have enough shots for every at-risk American, after all.

But after Health and Human Services officials announced their proposal on Aug. 4, Paul Chaplin, chief executive of Bavarian Nordic, the vaccine’s manufacturer, called a senior U.S. health official and accused the Biden administration of breaching its contracts with his company by planning to use the doses in an unapproved manner. Even worse, said two people with knowledge of the episode, Chaplin threatened to cancel all future vaccine orders from the United States, throwing into doubt the administration’s entire monkeypox strategy.

“People are begging for monkeypox vaccines, and we’ve just pissed off the one manufacturer,” said one official who spoke on the condition of anonymity because they were not authorized to comment.

The behind-the-scenes clash with Bavarian Nordic, which has not previously been reported, was just the latest episode in a monkeypox response beset by turf wars, ongoing surprises and muddled messaging, with key partners frequently finding themselves out of sync as they race to catch up to a rapidly unfolding crisis.

For two months, the Biden administration has been chased by headlines about its failure to order enough vaccines, speed treatments and make tests available to head off an outbreak that has grown from one case in Massachusetts on May 17 to more than 13,500 this week, overwhelmingly among gay and bisexual men. And 100 days after the outbreak was first detected in Europe, no country has more cases than the United States — with public health experts warning the virus is on the verge of becoming permanently entrenched here.

“I think there’s a potential to get this back in the box, but it’s going to be very difficult at this point,” Scott Gottlieb, who led the Food and Drug Administration under President Donald Trump and has advised the Biden administration on itsresponse to public health outbreaks, said on CBS’s “Face the Nation” last week.

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