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A new Government Accountability Office report highlights significant flaws in the federal handling of the mpox outbreak, emphasizing the need for a more unified public health response system to tackle future health emergencies better.
A new report from the Government Accountability Office highlights significant areas for improvement in the U.S. Department of Health and Human Services’ response to the 2022 mpox (previously called monkeypox) outbreak, exposing a fragmented system lacking strategic coordination and effective communication. The deficiencies could lead to more severe outbreaks and a higher risk of global health crises. In response to these challenges, out U.S. Rep. Ritchie Torres, a New York Democrat, has introduced the Coordinated Agency Response Enhancement (CARE) Act, striving to overhaul federal public health emergency management.
The GAO report, released Thursday morning, criticized HHS for its poor internal communication, which hampered action and coordination during the outbreak. It highlighted the absence of a department-wide after-action program, essential for learning from past mistakes and preparing for future emergencies. Additionally, the GAO found that HHS struggled with engaging state and local governments, which faced significant challenges in accessing necessary vaccines, therapeutics, and diagnostic tests. Another major concern outlined was the inadequate outreach to underserved communities, exacerbated by a lack of language access, leaving these populations particularly vulnerable and poorly served during the public health crisis.
In light of these developments, Torres has proposed the CARE Act to establish a unified after-action program within HHS to foster better coordination among its agencies and to ensure that lessons from past emergencies are effectively integrated into future emergency preparedness and response plans. “As I have long suspected, today’s report makes abundantly clear that our government’s disease response apparatus is not properly equipped to successfully coordinate and improve its systems and processes over time,” Torres said in a press release announcing his bill. “In the aftermath of the COVID-19 pandemic and Mpox outbreak, it’s time we radically change our federal approach to public health.”
The CARE Act also mandates the development of a comprehensive, inclusive, and culturally sensitive risk communication strategy. This strategy would aim to clearly identify at-risk populations during public health emergencies and provide targeted, understandable, and accessible information to prevent the spread of diseases.
In a Thursday morning interview with The Advocate, Torres expressed deep concerns about the federal government’s preparedness, particularly that of HHS. Describing the report as an “indictment” of HHS’s readiness, Torres highlighted systemic failures that have had a disproportionately detrimental impact on the LGBTQ+ community.
“The federal government and HHS were catastrophically unprepared for the mpox outbreak,” Torres said.
According to the GAO report, HHS’s lack of a “coordinated department-wide after-action program” has severely hampered its ability to communicate and coordinate effectively during public health emergencies. This has created substantial barriers for local and state governments in accessing essential resources like vaccines, therapeutics, and diagnostic tests.
“For decades, the federal government has allowed its public health capabilities to atrophy from neglect, and the federal response to the [mpox] outbreak reveals that those capabilities remain atrophied,” the congressman said.
Torres, alongside fellow Democratic Rep. Bennie Thompson of Mississippi and former Florida Rep. Val Demings, initiated the GAO review to scrutinize the federal response to the mpox outbreak following the COVID-19 pandemic.
Reflecting on the impact on Americans, Torres remarked, “It’s communities like the LGBTQIA+ community that pay the greatest price for the failure of the federal government.” He stressed the necessity for rapid federal action to prevent new infectious diseases from escalating into full-blown epidemics or pandemics.
In early April, Bavarian Nordic, the manufacturer of the Jynneos vaccine, announced that the two-dose inoculation is now commercially available in the United States. A new study identified a distinct clade of the mpox virus in the Kamituga region of the Democratic Republic of the Congo, which features mutations that are a hallmark of efficient transmission between humans. This new clade, termed Ib, has been linked to rapid spread within the region, raising concerns about its potential to fuel another global outbreak.
In 2022, mpox spread mostly among gay, bisexual, and other men who have sex with men, as well as some transgender people, because of close contact during social events that coincided with Pride celebrations and other LGBTQ+ festivals. At the time, the White House initiated an mpox response team that coordinated the federal response.
The White House Office of Pandemic Preparedness and Response Policy, established by the PREVENT Pandemics Act of 2023, is tasked with leading and coordinating the federal government’s preparedness and response to biological threats that could precipitate significant public health crises. Among its responsibilities, OPPR is required to monitor diseases such as mpox, ensuring the U.S. is equipped to swiftly identify and respond to outbreaks and prevent them from escalating into more severe public health emergencies.
An HHS spokesperson told The Advocate that the department agrees with the findings.
“HHS concurs with both recommendations and is working on implementation,” the spokesperson said.
Kevin Griffis, the Center for Disease Control and Prevention director of communications, explained how the CDC tests for mpox in an email to The Advocate. He noted that a specific strain of the virus has a genetic change which might affect one type of test, but this strain should still be detected with the main test used across the United States. Griffis clarified that if test results are unusual—for instance if the primary test is positive but another is negative—it would lead to further investigation to see if the strain is Clade I. He emphasized that the CDC continues to test and review samples from diagnosed cases of mpox.
“No cases of Clad I mpox have been detected in the United States,” Griffis said.
Editor’s note: This story was updated to include a response from a spokesperson for the U.S. Department of Health and Human Services.
