The Biden administration’s top health official got defensive on Thursday in response to questions about its response to monkeypox, suggesting localities and “communities at risk” weren’t doing enough on prevention efforts and asserting the federal government has “done our homework” in addressing the outbreak.

Secretary of Health & Human Services Xavier Becerra made the comments during a conference call with reporters intended to highlight the federal procurement of an additional 786,000 JYNNEOS vaccines from Bavarian Nordic, which are designed to protect against smallpox and monkeypox, amid concerns over a lack of supply causing localities to restrict access to the shots.

When reporters started asking questions about whether the U.S. government could eliminate monkeypox, or simply get ahead of it and whether the disease would become endemic in the United States, Becerra became defensive and downplayed concerns about vaccine availability.

“I almost want to turn that question back at you…and ask you how many vaccines do you think we need at this stage?” Becerra said. “Now there are 330 million Americans. We could try to vaccinate all 330 million but as we’ve seen with COVID, which is far deadlier. There’s not a person who’s died from monkeypox. We’ve lost over a million people from COVID. We still haven’t seen every American get vaccinated with a vaccine that has proven itself to be effective to keep people alive.”

Although challenges have persisted in getting Americans to take now widely available COVID vaccines, the problem with the monkeypox vaccine is supply not meeting demand. The D.C. government announced it would temporarily discontinue a two-shot strategy and offer one shot, which is below the recommended federal guidelines, unless a patient is considered high risk. D.C. Health officials have said the first dose is effective for six months and they anticipate having enough vaccine within that time frame to administer the second doses. Critics have said the Biden administration has not sufficiently ramped up efforts to make vaccines widely available for a disease that has been around since the 1950s.

Meanwhile, the number of cases of monkeypox in the United States, which have occurred almost entirely among men who have sex with men, has reached 3,591. The number of cases is now the highest anywhere in the world.

“So on monkeypox, there are so far less than 5,000 cases reported,” Becerra continued. “So we’ve already made available to jurisdictions throughout the country more than 330,000 vaccines and today we’re announcing that another 786,000 are available. How many more vaccines would you say we need today?”

That’s when Becerra appeared to shift blame over criticism to the government response to localities and “communities at risk,” suggesting they weren’t doing enough to prevent monkeypox. Although Becerra didn’t elaborate exactly on what he meant by prevention for monkeypox, nor “communities at risk,” he compared such efforts to social distancing and masks during the coronavirus pandemic.

“If the response is we’re not going to expect any type of prevention work by the communities at risk, by the state and local officials, then chances are we’re going to have to go to the really high numbers of vaccines,” Becerra said. “But if everyone does their work, and remember containing the virus requires a lot of preventative work — as you know we did masks, that’s why we did social distancing with COVID — we know what we need to do pretty well on monkeypox.”

Becerra went on to promote the federal government’s efforts on monkeypox as rising to the moment, continuing to say state and local officials were responsible for not getting vaccines to populations in need.

“And so to the question: Can we not only stay ahead of this virus, but end this outbreak? Absolutely,” Becerra said. “And we believe that we have done everything we can at the federal level to work with our state and local partners and communities affected to make sure we can stay ahead of this and end this outbreak, but everybody’s got to take the oar and row. Everybody’s got to do their part. We don’t control, as you can see from our lack of data that we’ve gotten from jurisdictions, what they’re doing with their vaccines. We don’t have the authority to tell them what to do. We need them to work with us. And so, I would say that if you’re asking students in the classroom who did their homework, I will raise my hand and say that at HHS, we’ve done our homework.”

Lindsay Dawson, associate director of HIV Policy and director of LGBTQ Health Policy at the Kaiser Family Foundation, told the Washington Blade in response to Becerra’s comments the secretary has a point about the role of localities, but said current problems are at least partly attributed to “barriers at the federal level.”

“Responding to infectious disease outbreaks, including monkeypox, often requires a joint federal and state or local response,” Dawson said. “It is certainly true that local governments have a significant role to play in curbing the current outbreak and that the different decisions they make will likely foreshadow their success to some degree. That said, many of the primary tools to address the monkeypox outbreak, particularly vaccination and treatment, remain limited to date due, at least in part, to barriers at the federal level. Limited access to these tools could challenge local communities in mounting a comprehensive response in the immediate term.”