“We still don’t have all the vaccine we’d like right now,” he said. When the supply crisis will subside is unknown. The federal government made another 131,000 doses available to states and other jurisdictions on Friday. But the scope of the outbreak remains unclear, in part because diagnostic testing has been slow and limited. Nearly 1,500 cases have been identified in the United States, mostly in men who have sex with men, and the number is likely to rise in the coming weeks, Dr. Walensky said. Globally, more than 11,000 cases have been identified in 65 countries, he added. “The window of opportunity to control it is closing fast,” said Anne Rimoin, an epidemiologist and monkeypox expert at the University of California, Los Angeles. “There are probably a lot more cases out there than we know about.” The Department of Health and Human Services ordered an additional 2.5 million doses of the vaccine, known as Jynneos, on Friday, but those doses are not scheduled to arrive until next year. The 2.5 million doses previously ordered should start arriving later this year, officials said. “It’s like saying we have a tank of water coming next week when the fire breaks out today,” said Greg Gonsalves, an epidemiologist at the Yale School of Public Health. Public health experts have criticized the US response to the outbreak as slow and ineffective, plagued by some of the same problems that plagued the early months of the Covid-19 pandemic. Initially, for example, testing for monkeypox was extremely limited, and each diagnosis had to be confirmed by the CDC, creating delays that might have allowed the virus to spread invisibly and unchecked. “We are now in a situation where it will be extremely difficult, with limited supplies of the vaccine and still some problems with testing, to get this under control,” said Dr. Gonsalves. The CDC has partnered with five commercial testing companies to expand the nation’s testing capacity, which now stands at 70,000 samples a week, up from 6,000 at the start of the outbreak.
What you need to know about monkeypox virus
Card 1 of 5 What is monkey pox? Monkeypox is a virus endemic to areas of Central and West Africa. It is similar to smallpox, but less severe. It was discovered in 1958 after outbreaks occurred in monkeys kept for research, according to the Centers for Disease Control and Prevention. What are the symptoms? Monkey pox creates a rash that starts with flat red welts that are raised and filled with pus. Infected people may also have fever and body aches. Symptoms usually appear in six to 13 days, but may take up to three weeks after exposure to appear and may last two to four weeks. Health officials say smallpox vaccines and other treatments can be used to control an outbreak. How contagious is it? The virus is spread mainly through body fluids, skin contact and respiratory droplets, although some experts suggest it can occasionally become airborne. It doesn’t usually lead to large outbreaks, although it has spread in unusual ways this year and to populations that weren’t susceptible in the past. What is the situation in the United States? Experts say the rapid spread of monkeypox across the country and the sluggish government response raise questions about the nation’s preparedness for pandemic threats. The tests won’t be readily available until later this month, and vaccines will be in short supply for months. Official cases, now in the hundreds, are likely a gross underestimate. “We have the capability for testing that we need, and we’ve made it easier to access,” Dr. Walensky said. But health officials should do more active surveillance for the disease, experts said. Officials should go out into the community and offer testing in places that serve men who have sex with men, as well as in gathering places, such as homeless shelters, where the virus can spread, Dr. Gonsalves said. The test for monkeypox involves swabbing one of the lesions that usually accompany the disease, making it difficult to extend the test to people who don’t have symptoms, Dr. Walensky said. “You have to have a breakdown to do a test,” he added. New tests are needed, including ones that can detect the virus in asymptomatic people, Dr. Rimoin said, as is active surveillance in animal populations, which can become reservoirs for the virus. The virus is unlikely to remain in the networks and communities in which it is currently spreading, he added, and expanding testing is especially important given the limited supply of vaccines. “The sooner you can detect cases, the better you can isolate them and prevent further transmission,” Dr Rimoin said. Jynneos, the only FDA-approved vaccine specifically for monkeypox, is given in two doses, 28 days apart. It is manufactured by Bavarian Nordic, a small company in Denmark, and its global supply is extremely limited. The United States has purchased nearly seven million doses in total, but has received just 372,000 of them, Dawn O’Connell, assistant secretary for preparedness and response at the Department of Health and Human Services, said Friday. So far, 156,000 doses have been distributed nationwide, he said. State health officials can request an alternative vaccine known as ACAM2000, which was developed to prevent smallpox and should also provide protection against monkeypox, experts say. But that vaccine is associated with serious side effects, and the federal government has only made it available to “a few states in relatively modest amounts,” Ms. O’Connell said. The Food and Drug Administration recently completed an inspection of Bavarian Nordic’s manufacturing facility in Denmark and is deciding whether to approve an additional 780,000 doses made there. “We are working diligently to complete our assessment of the required information, anticipating the hopeful release of these doses before the end of July,” said Dr. Peter Marks, the FDA’s top vaccine regulator. The United States is not considering turning to a one-shot strategy to expand existing supply, he added. “We are confident that we will have a supply of vaccine to be able to vaccinate with the second dose at or near the appropriate 28-day interval,” he said. States and jurisdictions experiencing high or increasing cases of monkeypox, as well as populations considered to be at high risk, will be prioritized for allocation of new vaccine doses, officials said. “We are working around the clock to increase supply and make sure we are reaching those most at risk,” Ms O’Connell said.
