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.”
Vice President JD Vance and his wife, second lady Usha Vance, will visit Hungary next week.
An announcement the White House released on Thursday said the Vances will be in Budapest, the Hungarian capital, from April 7-8.
JD Vance “will hold bilateral meetings with” Hungarian Prime Minister Viktor Orbán. The announcement further indicates the vice president “will also deliver remarks on the rich partnership between the United States and Hungary.”
The Vances will travel to Hungary less than a week before the country’s parliamentary elections take place on April 12.
Orbán, who has been in office since 2010, and his Fidesz-KDNP coalition government have faced widespread criticism over its anti-LGBTQ crackdown.
The Associated Press notes polls indicate Orbán is trailing Péter Magyar and his center-right Tisza party.
President Donald Trump removed Attorney General Pam Bondi from her post Thursday, following growing criticism over how she and the Department of Justice handled a range of issues, including matters related to sex offender and Trump ally Jeffrey Epstein.
Trump announced Bondi’s removal on Truth Social, where he also said Todd Blanche will serve as acting head of the Justice Department.
“Pam Bondi is a great American patriot and a loyal friend, who faithfully served as my attorney general over the past year,” Trump wrote on the platform. “Pam did a tremendous job overseeing a massive crackdown on crime across our country, with murders plummeting to their lowest level since 1900.”
Trump was seen as recently as Wednesday with the now-former attorney general at a Supreme Court hearing on citizenship.
The decision contrasts with Trump’s previous public praise of Bondi, the 87th U.S. attorney general and former 37th attorney general of Florida, who served in that role from 2011-2019 before joining the Trump-Vance administration. He has frequently lauded her loyalty and said he speaks with her often. Bondi was also one of president’s defense lawyers during his first impeachment trial.
Privately, however, Trump had grown frustrated that Bondi was not “moving quickly enough” to prosecute critics and political adversaries he wanted to face criminal charges, according to multiple sources. The New York Times reported that her inability to charge former FBI Director James B. Comey and New York Attorney General Letitia James with any crimes is a large factor in the president’s choice to fire her from the government’s primary law enforcement agency.
The move comes as Trump has sought to minimize public turmoil within his administration, avoiding the perception of a revolving-door Cabinet that defined his first term.
Lee Zeldin, a former Republican congressman from New York who unsuccessfully ran for governor, has emerged as a leading contender to lead the Justice Department. He has been one of Trump’s most reliable allies.
“He’s our secret weapon,” Trump said of Zeldin in February during a White House event promoting the coal industry, adding, “He’s getting those approvals done in record-setting time.”
Bondi has also growing faced scrutiny from Congress.
The House Oversight Committee recently subpoenaed her to testify about the department’s handling of certain files, where she declined to answer key questions during a contentious House Judiciary Committee hearing in February.
The Tampa native has a long history of opposing LGBTQ rights through her roles in government. As Florida attorney general, she fought against the legalization of same-sex marriage, arguing it would cause “serious public harm,” pushing forward a legal battle that cost taxpayers nearly half a million dollars. She also asked the Florida Supreme Court to overturn a lower court ruling that found the state’s same-sex marriage ban unconstitutional.
More recently, Bondi established a “Title IX Special Investigations Team” within the Justice Department focused on restricting transgender women and girls from participating in women’s and girls’ sports teams and accessing facilities aligned with their gender identity. She also told Children’s Hospital of Philadelphia to turn over the medical records of anyone under 19 who received gender-affirming care.
Her removal follows Trump’s decision last month to oust another controversial female Cabinet figure, Kristi Noem.
The White House
VIDEO: Gay journalist detained for booing Trumps at ‘Chicago’ opening night
Eugene Ramirez booed first family at Kennedy Center
President Donald Trump and first lady Melania Trump attended the opening night of “Chicago” at the John F. Kennedy Center for the Performing Arts on Tuesday. They were greeted by a mix of cheers, applause, and some audible boos.
Among them was Eugene Ramirez, a gay Washington resident, who later shared his account of the night after being briefly detained by security for booing the president and giving a thumbs-down gesture — an expression of what many would call a textbook definition of constitutionally protected speech to criticize the government.
Ramirez attended the opening night performance with a group of friends, hoping to catch a final show before the center undergoes two years of major changes under Trump oversight. The musical, based on a 1926 play of the same name, has become synonymous with Broadway success.
With music by John Kander, lyrics by Fred Ebb, and a book by Ebb and Bob Fosse, “Chicago” has cemented itself as a cultural staple — known for its signature Fosse choreography, stripped-down staging, and sleek, campy aesthetic. The story follows Roxie Hart and Velma Kelly, women who murder their husbands but — with the help of the manipulative, charismatic, and narcissistic attorney Billy Flynn — walk away scot-free.
It remains the longest-running American musical in Broadway history, and its 2002 film adaptation famously won the Academy Award for Best Picture. On this night, however, the production also became the backdrop for a very modern moment of political protest.
“I accompanied five friends to opening night of ‘Chicago’, as a way to enjoy a final performance in the Kennedy Center as we know it,” Ramirez began to recount to the Washington Blade, describing the moment his group settled into their seats inside the ornate Opera House theater.
Just before the performance began, the twice impeached president and first lady appeared in the balcony box, drawing immediate attention from the audience below. Theatergoers stood, cheered, clapped, and waved, while Ramirez made a different choice.
While accounts of the crowd’s reaction have varied, Ramirez said his response was intentional, immediate, and within his rights. Moments after booing and giving a thumbs-down while recording on his iPhone, security intervened.
The video of Ramirez booing the Trump’s is here:
“Within moments, the director [of security] and another guard approached and escorted me to a side area where several other security guards were waiting,” he said. “I was detained until everyone was seated and the lights dimmed.”
As he was escorted away, Ramirez said his instincts as a journalist kicked in. A former lead anchor for Sinclair’s national evening news broadcast, he said the situation immediately felt off — or more aptly put — as if he could see the strings being pulled from someone attempting to control the narrative.
“Journalism is a vocation, not just a job. I immediately knew there wasn’t just an uncomfortable interaction with security,” he said. “The Kennedy Center is a federally funded cultural institution, and being questioned about speech related to the president in that setting felt like something the public should know about.”
Ramirez explained the difference between a standard visit by a public official and this performance: the president’s appearance wasn’t just ceremonial; it was very clearly a media moment.
“The White House press pool was there, and it was clear this was an effort to manage the president’s image in the media,” Ramirez continued. “The irony was not lost on me that this was happening on opening night of ‘Chicago’, a musical about manipulating the press to shape public perception.”
According to Ramirez, the explanation he received from Kennedy Center Director of Safety and Security Karles C. Jackson Sr., was brief, but illuminating.
“He said, ‘they don’t want booing,’ and even called out my thumbs-down gesture. He never clarified who ‘they’ were, but whether it was the administration or the Kennedy Center, the distinction felt meaningless,” he explained. “Mr. Jackson ultimately told me he was just trying to do his job, shook my hand, and allowed me to return to my seat once the lights dimmed and the overture started playing.”
Ramirez said he didn’t blame the guard individually, noting the broader context of the Kennedy Center’s uncertain future and the pressures staff were under.
“With the center closing in the coming months, some of these security guards being pressured to restrict our freedom of speech may only have a few weeks of work left.”
He believes the decision to remove him was driven less by disruption than optics, particularly given the presence of the press.
“It was very clearly about protection — whether protecting the president from visible dissent, or his image before the media present. There was no disruption as almost everyone was standing and reacting loudly to the arrival of the president and first lady, with cheers, applause, and hand gestures. The difference was that my reaction, unlike most, was negative.”
Drawing on his experience covering public officials, Ramirez said the incident felt more about controlling perception than security.
“Usually, law enforcement may monitor or intervene if there’s a disruption, but here there was no disruption at all. Simply expressing dissent in a public, cultural space drew the attention of security. It made it feel less like a matter of decorum and more like an effort to control the narrative around the president,” he said. “It’s about what happens when dissent is treated as disruption rather than a right.”
“The show hadn’t started. I threatened no one. Billy Flynn would have approved of the optics. The rest of us should be paying attention.”
Ramirez framed the incident as part of a broader constitutional concern, one that is plaguing the Trump-Vance administration as they continue to reject rules and normalcy set forth by other reserved presidents.
“Being singled out by security at a federally funded institution for expressing dissent shouldn’t be brushed off; it undermines the First Amendment,” he said, looking at it slightly distanced from it now. “Being of Cuban heritage, and a journalist, it’s a right I’m not willing to give up readily.”
“Publicly funded cultural institutions should allow visible dissent, even in politically charged moments,” he added. “Of course, I understand the need to manage disruptions during a performance, but that was not the case here.”
The themes of “Chicago”, a long-running satire about media manipulation and public perception, added another layer of irony to the experience, Ramirez explained.
“The satire truly leapt off the stage! A show about controlling the narrative, manipulating the press, and covering up truths by leaning on showmanship and distractions. The show is decades old, but could’ve been written today. We’re being razzle-dazzled daily and it’s getting harder to tell fact from fiction, no matter where you get your news.”
He, being gay, also acknowledged how hard it must have been for the performers on stage, assuming that at least some in the cast were also members of the LGBTQ community — and artists — two things Trump doesn’t always get along with.
“It was not lost on me that many of the actors on that stage, that the president and first lady presumably applauded, are members of the LGBTQ community which this administration has rolled back protections for under the guise of religious liberty and free speech, resulting in blatant discrimination.”
He pointed to a particular number that felt surreal given the circumstances.
“Its ‘Razzle Dazzle’ number celebrates keeping audiences off balance; at its climax, a massive American flag descends as the song celebrates blinding audiences to what is real. Watching that scene after being detained for a thumbs-down was surreal.”
Ramirez said the show’s closing lines were especially sharp given the presidential audience and what he just experienced.
“At the end of the show,
Velma says: ‘You know, a lot of people have lost faith in America.’
Roxie replies: ‘And for what America stands for.’
Velma: ‘But we are the living examples of what a wonderful country this is.’
Roxie: ‘So we’d just like to say thank you and God bless you.’
They had both just gotten away with murder!”
His closing lines, however, were a bit more pointed than “scintillating sinners” Roxie Hart and Velma Kelly’s were in the show.
“Democracy only works when citizens are allowed to boo,” he said. “Tuesday night at the Kennedy Center, ‘Chicago’ made that point better than I ever could.”
The Blade reached out to the Kennedy Center but did not receive a comment back.
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