🧵What @DrArwady says here needs to be shouted from the rooftops. A huge challenge local #PublicHealth departments have is they have virtually no flexibility in how they spend money they receive from the federal government (i.e., most of their funding). chicagotribune.com/news/breaking/…
Local health departments receive precious little sustained, year-over-year funding, and only periodically receive large, temporary funding for emergency situations like COVID. (By the way, they've received NOTHING yet to fight monkeypox.)
And even those emergency funds are broken down into smaller piles that must be spent in certain ways. This means that if you have leftover $ from COVID response, you can't spend it on monkeypox. Even $ you didn't spend on one aspect of COVID cannot be spent on another aspect.
And when the emergency is over, the $ disappears. While public health is supposed to be about prevention of all sorts of chronic, environmental, behavioral, and infectious conditions (most of which don't go away), as a country we forget about public health until the next crisis.
Dr. Arwady describes a much better approach: fund public health more consistently at a level where we can always be prepared for both the daily and emergency needs. Provide flexibility so the $ can be spent where the need is.
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FDA's new emergency use authorization (EUA) that allows for each vial of our primary #monkeypox/MPV vaccine (Jynneos) to be split into 5 doses is potentially a real game changer to get more vax in arms. But it's important to set some expectations here at the start.
For one thing, the new delivery method that FDA calls for requires different kind of needles. Those have to be ordered. Guess how many public health departments, especially big city health departments, are ordering these needles right now.
Many public health and health care workers will also need training in how to deliver vax intradermally (just under the first layer of skin instead of into a deeper layer of skin like we're used to)