National
Biden administration shifts monkeypox vaccine approach amid shortage
Health experts sees new guidance as mixed bag
The Biden administration, amid criticism it was slow to act on the monkeypox outbreak and still not meeting the demand for vaccines as the number of cases continues to grow, has announced a shift in guidance for implementation of the shot in an effort to enhance availability.
As the estimated number of monkeypox cases in the United States reaches 8,900, top health officials announced the new move on Tuesday as part of a decision by Secretary of Health & Human Services Xavier Becerra to issue a determination under Section 564 of the Federal Food, Drug and Cosmetic Act to justify emergency use authorization of vaccines. The announcement follows up on the Biden administration’s announcement last week declaring the monkeypox outbreak a public health emergency.
Becerra said in a conference call with reporters the 564 determination and change in approach to vaccines would “boost and strengthen” the Biden administration’s response to monkeypox, which has overwhelmingly affected gay and bisexual men, and “safely accelerates and multiplies our supply of effective vaccines by up to fivefold.”
“Today’s action also reaffirms HHS and this administration’s commitment to using all available resources and capabilities to end the monkeypox outbreak and provide the best possible care to those suffering from the virus,” Becerra added.
The new vaccine approach, which may may be considered minor to non-medical observers, would change injections of the JYNNEOS vaccine from the subcutaneous route (delivery of the vaccine under the fat layer underneath the skin) to the intradermal route (delivery of the vaccine into the layer of skin just underneath the top layer). In theory, that would allow for greater accessibility of monkeypox vaccines as it increases the number of doses from each vial of vaccine.
The change was made amid criticism the Biden administration failed to meet the demand for vaccines during the outbreak and geographic inequity as certain metropolitan areas of the country have more access to vaccines than other places.
As The New York Times reported last week, the Biden administration has faced criticism for not moving quickly enough in acquiring and distributing vaccines, including bulk stocks already owned by the U.S. government manufactured in Denmark by Bavaria Nordic now being given to other clients.
“The government is now distributing about 1.1 million doses, less than a third of the 3.5 million that health officials now estimate are needed to fight the outbreak,” the Times reported. “It does not expect the next delivery, of half a million doses, until October. Most of the other 5.5 million doses the United States has ordered are not scheduled to be delivered until next year, according to the federal health agency.”
Biden officials, nonetheless, touted the numbers of vaccines and tests in response to monkeypox as a positive, acknowledging the 1.1 million vaccines being made available as well as delivery of more than 620,000 of those doses, deployment more than 15,000 courses of the monkeypox treatment and increasing the country’s capacity to administer tests on a weekly basis to around 80,000. Meanwhile, officials also promoted the change in approach in vaccines as means to allow greater accessibility to the shots.
Rochelle Walensky, director of the Centers for Disease Control & Prevention, promoted during the conference call the use of intradermal injections and said they’re “often used for TB skin tests and have been used for other types of vaccines.”
Although Walensky conceded some health care providers “may not be as familiar with intradermal administration” as they are with subcutaneous injection, she said CDC would make additional guidance materials available, including a clinician alert message to the Association of State & Territorial Health Officials, outreach to key clinician partners and an education resource video. The change in guidance, Walensky said, is for vaccine implementation in adults, but children — where single digit monkeypox cases have been reported — would continue to receive vaccination in the traditional subcutaneous approach.
But health experts aren’t responding with overwhelming praise to the decision to change the guidance on vaccine implementation from subcutaneous injections to intradermal injections, expressing concerns the new approach may be insufficient.
Jennifer Kates, director of global health & HIV policy at the Kaiser Family Foundation, was among those saying the change in guidance on vaccine approach was a mixed bag and told the Blade more data is needed to evaluate the effectiveness.
“As we saw with COVID, using these authorities in the context of public health emergencies is an important strategy,” Kates said. “In this case, this step will significantly expand access to vaccines for those most at risk. However, there remain questions about the effectiveness of this approach — real world studies are needed — and challenges to translating vaccines into vaccinations.”
Peter Marks, director of the Center for Biologics Evaluation & Research (CBER) at the Food & Drug Administration, was asked during the conference call with reporters to respond to concerns the change in guidance was insufficient and downplayed the novelty of implementing the vaccines through the intradermal route as “not at all new.”
“In fact, the reason why the Bavaria part of this equation comes from the fact that in Germany, this vaccine was given intradermally originally, in an effort to replicate the original version of the smallpox vaccine,” Marks said. “It’s been given to thousands of people intradermally, so this isn’t the first time it’s been done.”
Walkensky said the intradermal vaccine approach has been implemented amid policies among localities to implement a one-dose approach to the JYNNEOS vaccine through the subcutaneous route. (The D.C. government is one of the jurisdictions that had enacted a one-dose approach amid a vaccine shortage.) There is not data, Walkensky said, to support that approach and “in fact, if anything, there are data saying that that is not protective enough.”
“So by using this alternative strategy of intradermal dosing, not only do we have more doses, but we actually allow people to get two doses in a way that shows immunologic response that’s superimposable from the subcutaneous dosing,” Walkensky said. “So we have more doses, and in fact, we have the ability to doubly vaccinate people so that they get the protection that they need.”
New York
Court orders Pride flag to return to Stonewall
Lambda Legal, Washington Litigation Group filed federal lawsuit
The Pride flag will once again fly over the Stonewall National Monument in New York following a court order requiring the National Park Service to raise it over the site.
The decision follows a lawsuit filed by Lambda Legal and the Washington Litigation Group in the U.S. District Court for the Southern District of New York, which challenged the removal as unconstitutional under the Administrative Procedure Act and argued that the government unlawfully targeted the LGBTQ community.
In February, the NPS removed the Pride flag from the Stonewall National Monument, the first national monument dedicated to LGBTQ rights and history in the U.S. The move followed a Jan. 21 memorandum issued by President Donald Trump-appointed NPS Director Jessica Bowron restricting which flags may be flown at national parks. The directive limited displays to official government flags, with narrow exceptions for those deemed to serve an “official purpose.”
Plaintiffs successfully argued that the Pride flag meets that standard, given Stonewall’s status as the birthplace of the modern LGBTQ rights movement. They also contended that the policy violated the APA by bypassing required public input and improperly applying agency rules.
The lawsuit named Interior Secretary Doug Burgum, Bowron, and Amy Sebring, superintendent of Manhattan sites for the NPS, as defendants. Plaintiffs included the Gilbert Baker Foundation, Village Preservation, Equality New York, and several individuals.
The court found that the memorandum — while allowing limited exceptions for historical context purposes — was applied unlawfully in this case. As part of the settlement, the NPS is required to rehang the Pride flag on the monument’s official flagpole within seven days, where it will remain permanently.
“The sudden, arbitrary, and capricious removal of the Pride flag from the Stonewall National Monument was yet another act by this administration to erase the LGBTQ+ community,” said Karen Loewy, co-counsel for plaintiffs and Lambda Legal’s Senior Counsel and Director of Constitutional Law Practice. “Today, the government has pledged to restore this important symbol back to where it belongs.”
“This is a complete victory for our clients and for the LGBTQ+ community,” said Alexander Kristofcak, lead counsel for plaintiffs and a lawyer with Washington Litigation Group. “The government has acknowledged what we argued from day one: the Pride flag belongs at Stonewall. The flag will be restored and it will fly officially and permanently. And we will remain vigilant to ensure that the government sticks to the deal.”
“Gilbert Baker created the Rainbow Pride flag as a symbol of hope and liberation,” said Charles Beal, president of the Gilbert Baker Foundation. “Today, that symbol is restored to the place where it belongs, standing watch over the birthplace of the modern LGBTQ+ rights movement.”
“The government tried to erase an important symbol of the LGBTQ+ community, and the community said no,” said Amanda Babine, executive director of Equality New York. “Today’s accomplishment proves that when we stand together and fight back, we win.”
“The removal of the Pride flag from Stonewall was an attempt to erase LGBTQ+ history and undermine the rule of law,” said Andrew Berman, executive director of Village Preservation. “This settlement restores both.”
With Loewy on the complaint are Douglas F. Curtis, Camilla B. Taylor, Omar Gonzalez-Pagan, Kenneth D. Upton Jr., Jennifer C. Pizer, and Nephetari Smith from Lambda Legal. With Kristofcak on the complaint are Mary L. Dohrmann, Sydney Foster, Kyle Freeny, James I. Pearce, and Nathaniel Zelinsky from Washington Litigation Group.
Federal Government
Trump budget targets ‘gender extremism’
Proposed spending package would target ‘leftist’ political ideologies
The White House submitted its 2027 budget request to Congress last month, outlining a push for the Federal Bureau of Investigation to “proactively” target what it describes as “extremism” related to gender — raising concerns about the potential for law enforcement to target LGBTQ people.
The Trump-Vance administration’s 2027 budget request, submitted to Congress on April 4, proposes a dramatic increase in national security and law enforcement spending, while reducing foreign aid and restructuring multiple domestic security programs. In total, the administration is requesting $2.16 trillion in discretionary budget authority (including mandatory resources), a 15.3 percent increase over the 2026 proposal.
Central to the proposal is the creation of a new “NSPM-7 Joint Mission Center,” a direct follow-up to the September 2025 National Security Presidential Memorandum 7 (NSPM-7). The directive instructs the Justice Department, the FBI, and other national security agencies to combat what the administration defines as “political violence in America,” effectively reshaping the Joint Terrorism Task Force network to focus on “leftist” political ideologies, according to reporting by independent journalist Ken Klippenstein.
The American Civil Liberties Union has characterized NSPM-7 as a way for President Donald Trump to intimidate his political enemies.
In a press release following the memorandum, Hina Shamsi, director of the ACLU’s National Security Project, said, “President Trump has launched yet another effort to investigate and intimidate his critics,” and had described the move as an “intimidation tactic against those standing up for human rights and civil liberties.”
The proposed mission center would include personnel from 10 federal agencies tasked with targeting “domestic terrorists” associated with a wide range of ideologies. Among them is what the administration labels “extremism” related to gender, alongside categories such as “anti-Americanism,” “anti-capitalism,” “anti-Christianity,” and “support for the overthrow of the U.S. government.” The document also cites “hostility toward those who hold traditional American views” on family, religion, and morality — language LGBTQ advocates have increasingly warned could be used to frame queer and transgender rights movements as ideological threats.
The mission center is one component of a proposed $166 million increase in the FBI’s counterterrorism budget.
In total, the FBI would receive $12.5 billion for salaries and expenses under the proposal, a $1.9 billion increase. Planned investments include unmanned aerial systems operations and counter-drone capabilities, counterterrorism efforts, and security preparations for the 2028 Summer Olympics in Los Angeles. The budget also cites 67,000 FBI arrests since Jan. 20, 2026, which it describes as a 197 percent increase from the prior year.
When Congress passed the USA PATRIOT Act in 2001, it also enacted 18 U.S.C. § 2331(5), which defines domestic terrorism as activities involving acts dangerous to human life that violate criminal laws and are intended to intimidate or coerce civilians or influence government policy through violence. That statutory definition has not changed.
However, federal agencies have historically categorized domestic terrorism threats into groups such as racially or ethnically motivated violent extremism, anti-government or anti-authority violent extremism, and other threats, including those tied to bias based on religion, gender, or sexual orientation.
The language in the budget suggests a shift in how those categories are interpreted and applied — particularly by explicitly linking “extremism” to gender and to perceived opposition to “traditional” views — without any corresponding change to federal law. Only Congress has the power to change the definition of domestic terrorism by passing legislation.
The budget document states:
“DT lone offenders will continue to pose significant detection and disruption challenges because of their capacity for independent radicalization to violence, ability to mobilize discretely, and access to firearms. Additionally, in recent years, heinous assassinations and other acts of political violence in the United States have dramatically increased. Commonly, this violent conduct relates to views associated with anti-Americanism, anti-capitalism, and anti-Christianity; support for the overthrow of the U.S. government; extremism on migration, race, and gender; and hostility toward those who hold traditional American views on family, religion, and morality.”
This language echoes earlier actions by the Trump-Vance administration targeting trans people.
On the first day of his second term, President Trump signed Executive Order 14168, titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.”
The order establishes a strict binary definition of sex and withdraws federal recognition of trans people.
“It is the policy of the United States to recognize two sexes, male and female,” the order states. “‘Sex’ shall refer to an individual’s immutable biological classification as either male or female. ‘Sex’ is not a synonym for and does not include the concept of ‘gender identity.’”
Appropriations committees in both chambers are expected to begin hearings in the coming weeks.
Puerto Rico
The ‘X’ returns to court
1st Circuit hears case over legal recognition of nonbinary Puerto Ricans
Eight months ago, I wrote about this issue at a time when it had not yet reached the judicial level it faces today. Back then, the conversation moved through administrative decisions, public debate, and political resistance. It was unresolved, but it had not yet reached this point.
That has now changed.
Lambda Legal appeared before the 1st U.S. Court of Appeals in Boston, urging the court to uphold a lower court ruling that requires the government of Puerto Rico to issue birth certificates that accurately reflect the identities of nonbinary individuals. The appeal follows a district court decision that found the denial of such recognition to be a violation of the U.S. Constitution.
This marks a turning point. The issue is no longer theoretical. A court has already determined that unequal treatment exists.
The argument presented by the plaintiffs is grounded in Puerto Rico’s own legal framework. Identity birth certificates are not static historical records. They are functional documents used in everyday life. They are required to access employment, education, and essential services. Their purpose is practical, not symbolic.
Within that framework, the exclusion of nonbinary individuals does not stem from a legal limitation. Puerto Rico already allows gender marker corrections on birth certificates for transgender individuals under the precedent established in Arroyo Gonzalez v. Rosselló Nevares. In addition, the current Civil Code recognizes the existence of identity documents that reflect a person’s lived identity beyond the original birth record.
The issue lies in how the law is applied.
Recognition is granted within specific categories, while those who do not identify within that binary structure remain excluded. That exclusion is now at the center of this case.
Lambda Legal’s position is straightforward. Requiring individuals to carry documents that do not reflect who they are forces them into misrepresentation in essential aspects of daily life. This creates practical barriers, exposes them to scrutiny, and places them in a constant state of vulnerability.
The plaintiffs, who were born in Puerto Rico, have made clear that access to accurate identification is not symbolic. It is a basic condition for moving through the world without contradiction imposed by the state.
The fact that this case is now being addressed in the federal court system adds another layer of significance. This is not a pending policy discussion or a legislative proposal. It is a constitutional question. The analysis is not about political preference, but about rights and equal protection under the law.
This case does not exist in isolation.
It unfolds within a broader context in which debates over identity and rights have increasingly been shaped by the growing influence of conservative perspectives in public policy, both in the United States and in Puerto Rico. At the local level, this influence has been reflected in legislative discussions where religious arguments have begun to intersect with decisions that should be grounded in constitutional principles. That intersection creates tension around the separation of church and state and has direct consequences for access to rights.
Recognizing this context is not an attack on faith or religious practice. It is an acknowledgment that when certain perspectives move into the realm of public authority, they can shape outcomes that affect specific communities.
From within Puerto Rico, this is not a distant debate. It is a lived reality. It is present in the difficulty of presenting identification that does not match one’s identity, and in the consequences that follow in workplaces, schools, and government spaces.
The progression of this case introduces the possibility of change within the applicable legal framework. Not because it resolves every tension surrounding the issue, but because it establishes a legal examination of a practice that has long operated under exclusion.
Eight months ago, the conversation centered on ongoing developments. Today, there is already a judicial finding that identifies a violation of rights. What remains is whether that finding will be upheld on appeal.
That process does not guarantee an immediate outcome, but it shifts the ground.
The debate is no longer theoretical.
It is now before the courts.
