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.”
Pennsylvania
Pa. House passes bill to codify marriage equality in state law
Governor supports gay state Rep. Malcolm Kenyatta’s measure
The Pennsylvania House of Representatives on Wednesday passed a bill that would codify marriage equality in state law.
House Bill 1800 passed by a 127-72 vote margin. Twenty-six Republicans voted for the measure.
The Republican-controlled Pennsylvania Senate will now consider the bill that state Rep. Malcolm Kenyatta (D-Philadelphia), who is the first openly gay person of color elected to the state’s General Assembly, introduced. Democratic Gov. Josh Shapiro supports the measure.
“Here in Pennsylvania, we believe in your freedom to marry who you love,” said Shapiro on Wednesday. “Today, the House has stepped up to protect that right.”
BREAKING: The Pennsylvania House just passed @RepKenyatta's bill to codify marriage equality into law in PA — and they did it with broad bipartisan support.
— Governor Josh Shapiro (@GovernorShapiro) March 25, 2026
Here in Pennsylvania, we believe in your freedom to marry who you love. Today, the House has stepped up to protect that…
Florida
DeSantis signs emergency bill that restores Fla. ADAP funding
Temporary funds to last through June 30
After the Florida Department of Health made huge cuts to the AIDS Drug Assistance Program in January, Republican Gov. Ron DeSantis has signed emergency legislation restoring HIV access to more than 12,000 Floridians.
Two months ago, as the Washington Blade reported, the Sunshine State cut the vast majority of those in ADAP by shifting the income levels required for eligibility — without following standard procedure when changing government policy outside of legislative or executive action.
The bill, signed by DeSantis on Tuesday, passed both chambers of the Florida Legislature unanimously and appropriates $30.9 million in emergency bridge funding through June 30, 2026. It restores Florida’s ADAP income eligibility to 400 percent of the Federal Poverty Level — the level it was prior to the January cuts. The legislation also requires the FDOH to submit detailed monthly financial reports to legislative leadership beginning April 1.
Under the old policy, eligibility would have been limited to those making no more than 130 percent of the federal poverty level, or $20,345 per year.
“For 10 weeks, 12,000 Floridians living with HIV did not know if they could fill their next prescription. Today, they can,” Esteban Wood, director of advocacy and legislative affairs at AIDS Healthcare Foundation, said in a statement.
The detailed reports now required to be sent to legislative leadership must include all federal revenues and expenditures, including manufacturer rebates; enrollment figures by county and insurance status; prescription utilization by drug class; and any projected funding shortfalls. This is the first time the Legislature has required this level of financial transparency from the program.
DeSantis signed the legislation one day after a Leon County Circuit Court judge denied AIDS Healthcare Foundation’s request for an injunction to block the significant changes the DeSantis administration is making to the program, which it claims faces a $120 million shortfall for calendar year 2026.
AIDS Healthcare Foundation, a national organization focused on protecting and expanding HIV healthcare access and prevention methods, filed a lawsuit over the change in eligibility, arguing the Florida Department of Health did not follow the laid out path for formally changing policy and was acting outside established procedures.
Typically, altering eligibility for a statewide program requires either legislative action or adherence to a multistep rule-making process, including: publishing a Notice of Proposed Rule; providing a statement of estimated regulatory costs; allowing public comment; holding hearings if requested; responding to challenges; and formally adopting the rule. According to AIDS Healthcare Foundation, none of these steps occurred.
The long-term structure of ADAP will be determined by the 2026–2027 fiscal year state budget, something that lawmakers have until June 30 to finish.
Federal Government
Markwayne Mullin confirmed as next DHS secretary
Okla. senator to succeed Kristi Noem
The U.S. Senate confirmed Markwayne Mullin as the next secretary of Homeland Security on Monday, as the agency continues to grapple with what lawmakers have described as a “never-ending” funding standoff, with Democrats attempting to withhold funding from one of the nation’s largest and most costly agencies.
Mullin — a Republican senator from Oklahoma, former mixed martial arts fighter, and plumbing business owner — was confirmed in a 54–45 vote. Two Democrats — U.S. Sens. John Fetterman (D-Pa.) and Martin Heinrich (D-N.M.) — sided with Republicans in supporting his confirmation.
The new agency head is expected to follow the policy direction set by President Donald Trump, emphasizing stricter immigration enforcement. This includes proposals to support immigration agents at polling sites and to cut funding to so-called “sanctuary cities.”
Mullin replaces Kristi Noem, who was fired earlier this month following a widely scrutinized 2-day congressional hearing on Capitol Hill.
During the hearing, Noem faced intense questioning over her response to several crises, including the fatal shooting of two American citizens in Minneapolis by U.S. Immigration and Customs Enforcement agents, a $220 million border security advertising campaign that featured her on horseback near Mount Rushmore amid one of the largest federal workforce reductions in U.S. history, and the federal response to major natural disasters such as the July 2025 Texas floods and Hurricane Helene in 2024.
Noem had previously drawn criticism for a series of policy decisions in South Dakota that broadly focused on restricting the rights of LGBTQ individuals. In 2023, she signed House Bill 1080, banning gender-affirming medical care for transgender minors. She also signed legislation and executive orders restricting trans athletes’ participation in women’s sports, as well as the state’s “Religious Freedom Restoration Act,” which critics argued enabled discrimination against LGBTQ individuals. Additionally, the state canceled contracts related to LGBTQ support services — including suicide prevention and health care navigation programs‚ and later agreed to a $300,000 settlement with trans advocacy group, The Transformation Project.
Despite her removal from DHS, Noem will remain in the Trump-Vance administration as a special envoy for the “Shield of the Americas,” an initiative aimed at promoting U.S. influence in the Western Hemisphere, including efforts to counter cartel networks, reduce Chinese influence, and manage migration.
The new head of DHS has served in Congress since 2013, in both houses of the federal legislature. While in the Senate and a member of the Health, Education, Labor, and Pensions (HELP) Committee, Mullin has been a vocal critic of policies aimed at expanding LGBTQ inclusion. He led a group of lawmakers in urging the Administration for Community Living to reverse a rule requiring states to prioritize Older Americans Act services based on sexual orientation and gender identity, arguing the policy could have unintended consequences.
Mullin also makes history as the first Native American — and a citizen of the Cherokee Nation — to lead the Department of Homeland Security. He was also among the 147 Republicans who voted to overturn the 2020 presidential election results despite no evidence of widespread fraud, and was present in the U.S. House of Representatives chamber on Jan. 6.
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