On Wednesday, September 14, the Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing entitled, “Stopping the Spread of Monkeypox: Examining the Federal Response.” Four administration leaders testified at the hearing:

• Rochelle Walensky, MD, MPH, Director of the United States Centers for Disease Control and Prevention (CDC),
• Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases (NIAID),
• Robert Califf, MD, Commissioner of the United States Food and Drug Administration (FDA), and
• Dawn O’Connell, Assistant Secretary for Preparedness and Response, Administration for Strategic Preparedness and Response (ASPR).

In their opening statements, both Committee Chair Patty Murray (D-WA) and Ranking Member Richard Burr (R-NC) were critical of the administration’s monkeypox response. Chair Murray specifically raised concerns about challenges accessing monkeypox tests and vaccines not reaching the most vulnerable patients. She also emphasized the importance of building strong public health infrastructure, explaining that the country’s system has historically been underfunded and is still overwhelmed by the pandemic response. Senator Burr was particularly blunt in his assessment calling the public health agencies’ monkeypox response “a catastrophic failure” that repeated mistakes of the early days of the COVID-19 response.

Chair Murray and Ranking Member Burr were not the only senators to criticize the administration’s response to the monkeypox outbreak. Senator Bill Cassidy (R-LA) said stumbles by the administration had eroded the trust between public health agencies and the American people and needed to be rebuilt. Meanwhile, Senator Hickenlooper (D-CO) questioned the FDA’s decision to delay shipment of Jynneos vaccine until the agency could inspect the manufacturer facility, while Senator Tina Smith (D-MN) took issue with ASPR using a different vaccine ordering system for monkeypox than COVID-19, moves the senators argued slowed aspects of the response.

In his questioning, Senator Bob Casey (D-PA) highlighted the need to shift from large vaccination sites to local ones, and asked Dr. Walensky how the CDC is working with state and local partners to make sure everyone at risk has the opportunity to be vaccinated. Dr. Walensky concurred that vaccine distribution now needs to move to smaller-scale events in partnership with local community-based organizations and trusted messengers. In a follow-up, Senator Casey raised the historical under-investment in state and local health departments that has resulted in health departments being forced to shift funds away from regular, core public health activities to immediate response needs when emergencies arise and asked the witnesses how sustained public health funding would help the country be better prepared to respond to new threats. Assistant Secretary O’Connell acknowledged the burden of the extended COVID-19 response on the public health workforce and recommended policymakers invest in additional, long-term staffing and interoperable data systems. Dr. Walensky described core public health infrastructure as “key” and called for disease agnostic, long-term, sustainable funding to support workforce, laboratory infrastructure, and data needs.

Senator Chris Murphy (D-CT) raised the issue of data sharing with CDC, describing how in the absence of emergency authorities, the agency has to negotiate separately with each state to receive public health data. Dr. Walensky concurred that the agency’s lack of data authority outside of emergencies has hampered the CDC’s ability to get a full picture of the monkeypox response. Both Senator Murphy and Dr. Walensky referenced legislation endorsed by NACCHO, the Improving DATA in Public Health Act, that would create uniform standards for public health data sharing across federal, state, and local entities.

All the witnesses reiterated the Biden administration’s request for inclusion of $4.5 billion for the monkeypox response in the continuing resolution Congress will likely consider in the coming weeks. Although several Democratic senators offered support for the proposed funding, multiple Republicans, including Ranking Member Burr, were vocal in their opposition and strongly urged the agencies to instead look for ways to reprogram funds or request funding through the regular appropriations process.