Local health authorities and lawmakers have repeatedly called on the Biden administration to take more action in response to the monkeypox outbreak. Now, the White House appears to be pushing back by attempting to spread the blame to include state and local governments.

Health and Human Services (HHS) Secretary Xavier Becerra said during a Thursday press briefing on monkeypox that state and local governments “ultimately are the ones that determine how healthcare is administered in their jurisdictions.”

“We believe that we’ve done what helps our state and local health care partners stay ahead of this and we’ll continue to monitor because we cannot let this get out of control,” Becerra said on Thursday. “And we will do everything on our part to be a good partner to our state and local governments, who ultimately are the ones that determine how healthcare is administered in their jurisdictions.”

He further stated that the federal government does not control public health in “territories and in the tribal jurisdiction.”

“They need to work with us,” said Becerra.

These remarks come amid ongoing criticisms that vaccines, tests and treatments for monkeypox are still out of reach for many people as cases have spiked to over 5,000 nationwide. Since the start of the monkeypox outbreak, local and state leaders have called on the White House to provide further assistance.

In New York, where the epicenter of the U.S. monkeypox outbreak is located, Gov. Kathy Hochul (D) and New York City Mayor Eric Adams (D) have both called on the Biden administration to provide more vaccines and treatments.

When reached for comment, an HHS spokesperson said Becerra’s remarks were meant to convey that “in a public health crisis, all levels of government—federal, state, local, tribal—have important roles to play.”

“HHS and the federal government is doing all it can to provide response tools and support to the state and local officials and the health care workers who deliver care on the front lines, because without them, we won’t be able to stay ahead of the virus and end this outbreak,” the spokesperson said.

Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials (ASTHO), said he and his organization were “a little surprised” by what Becerra said. 

“I guess we were a little surprised just because this has been very collaborative and … it’s never seamless but it’s as close as it can get to seamless as far as interface between the feds and the states,” Plescia said.

Adriane Casalotti, chief of public and government affairs for the National Association of County and City Health Officials (NACCHO), reiterated the need for a strong collaborative effort against monkeypox and noted that local health departments are still reliant on other parts of the U.S. public health system to properly act against monkeypox.

“For example, other than about five cities, no local health departments are getting direct — most of our partners are not getting direct allocation of vaccines,” Casalotti said.

Noting the lack of supplemental funding for monkeypox, Casalotti said local health departments are “doing all of this work within the confines of the resources that they have and a local health department can’t individually petition Congress for resources.”

Becerra said Thursday that the administration has done what it can to help state and local partners stay ahead of the monkeypox outbreak, but Casalotti said the allocation of resources is currently “really uneven” and many local health departments lack the tools that they would ideally have during an outbreak like this one.

“So in all communities, there’s work that needs to be done. And that work has to be done with the same people who are still fighting the pandemic,” sai Casalotti. “The same people who are trying to pick up the pieces from the pandemic, including increased opioid rates and STI rates and lower vaccines in the childhood population.”

When asked about Biden potentially declaring a public health emergency over the outbreak, as many congressional Democrats have recently called on him to do, both Plescia and Casalotti said it would help in improving communication between state and local governments and the White House.

“Generally when there’s a national emergency, there are a lot of benefits to that for states. I mean, it tends to make resources more readily available. It tends to sort of speed up the processes you have to go through in order to get things done,” Plescia said.

Plescia said declaring a public health emergency would also help to resolve issues with states sharing data with the federal government, which Becerra also noted could be improved. Casalotti said her organization was generally supportive of a public health emergency declaration in order to free up resources.

Some local governments like those of San Francisco and New York state have already made their own declarations recognizing monkeypox as either an “imminent threat” or a public emergency within their own jurisdictions.

Despite the challenges that have been encountered in the monkeypox strategy, Plescia opined that the U.S. is still in “a much better situation than I would normally expect us to be with an outbreak like this.”

“In political circles and policy circles, we’re often talking about jurisdictional boundaries. A virus like this doesn’t care about those. And so wherever you live, you’re only as safe as the community next to yours. So we really all need to be working together in order to end this outbreak,” Casalotti said.