Board ratifies San Francisco health officerdeclaration of local emergency for monkeypox; DPH pledges expanded outreach and vaccine requests

San Francisco—The San Francisco Board of Supervisors on Aug. 8 unanimously ratified a local health emergency declared Aug. 1 by the cityand county health officer in response to a rapid increase in monkeypox cases.

The ratification, taken at a special meeting called by Board President Walton, gives the Department of Public Health (DPH) additional administrative tools to coordinate outreach, vaccine distribution, testing and treatment during the outbreak. Dr. Susan Philip, the cityand county health officer, told the board that as of 5 p.m. on Aug. 5 the department had confirmed 444 probable and confirmed cases in San Francisco and that more cases were expected.

"I issued this declaration to direct and harness resources, including efforts to obtain additional vaccine supply," Dr. Philip said, urging the board to ratify the declaration. DPH Director Dr. Grant Colfax described the departmentand its community partnersas working to confront stigma while prioritizing culturally competent information and services. "We are committed to ensuring that the stigma and discrimination ... is being confronted head on," Colfax said.

DPH described vaccine supply as a principal constraint. Dr. Philip said the city was allotted more than 10,000 additional doses from the state this week and that, to begin to meet projected need, the county estimates a supply goal of about 35,000 doses; to date DPH had received roughly 22,000 doses, she said. DPH said it will continue to request allocations from the state and distribute them to community clinics, health systems and other providers.

Supervisors pressed DPH on several operational issues during the public hearing, including contact tracing, vaccine access and distribution methods, protections for congregate settings and options for supporting people who must isolate.

- Contact tracing: Supervisors noted news reports and community concerns that DPH had reduced contact-tracing efforts. Dr. Philip said early in the outbreak investigators reached out to every reported case, and that DPH has contacted roughly 72 percent of identified cases as of Aug. 22. She said case investigators shifted emphasis away from eliciting partner names when those interviews repeatedly did not yield usable contact lists; instead, DPH pivoted to broader community outreach while prioritizing case investigation for people at highest risk for severe outcomes (people who are pregnant or could become pregnant) and for congregate-setting outbreaks.

- Vaccine access and delivery: Several supervisors asked whether appointments or vendor partnerships could reduce long lines at high-volume clinics. Dr. Philip said the emergency declaration gives the department authority to pursue vendor and contractual partnerships to simplify access and that the state plans to adapt its MyTurn appointment system for monkeypox later in the month; she also said health systems including Kaiser, UCSF and Sutter are vaccinating through their networks.

- Use of older smallpox vaccine: Supervisors asked whether the older replicate-capable smallpox vaccine (historically used in other contexts) could be deployed. Dr. Philip said the older vaccine can replicate and carries higher risks for people with uncontrolled immune suppression or certain household contacts; she said the federally recommended JYNNEOS vaccine lacks that replicating feature and is preferred given the local risk profile.

- Congregate settings and isolation supports: Supervisors raised concerns about possible cases in the county jail and in navigation centers and asked what support exists for isolation housing. Dr. Philip said test results in the jail were pending; DPH is coordinating with Jail Health and with shelter-health partners and has reserved vaccine supply for outbreak prevention in congregate settings. She also said the contracts used to provide isolation hotels during COVID were specific to that response and that comparable isolation capacity for monkeypox is limited at present.

Public commenters who called in or testified in person called for faster, more equitable access to vaccines and antiviral treatment (TPOXX), clearer multilingual outreach, expanded contact tracing and financial supports for people who must isolate. Several speakers supported making paid-leave protections available immediately rather than waiting for a separate implementation timeline; supervisors noted that San Francisco voters passed Proposition G in June (establishing paid public-health emergency leave) but that the measure does not take effect until Oct. 1.

The boardby roll call voteapproved the ratification without objection, with Supervisor Ronan excused. The ratification formalizes DPHauthority to require reporting from providers, prioritize distribution and seek additional resources from state and federal partners.

DPH signaled it will continue to request vaccine allocations, expand outreach to communities most affected and work with health-system partners and vendors to improve appointment systems and clinic throughput. Supervisors and community speakers urged additional measures including more robust contact tracing, access to antiviral treatment, multilingual communications and interim financial supports to enable safe isolation.