“I just first heard about monkeypox like everyone else through the news, social media, the grapevine and how it was becoming something to worry about and how it was mostly affecting gay men or men who sex with men”. said Nicolo. It was enough to send him on a quest for more information on how to protect himself. “At the time, there were very few resources to find the vaccine,” he said. “I had a couple of friends reach out with links, and we clicked on them and it’s already completely like — they went away immediately. There was no access to anything,” he said. “We just watched the links and went on with our lives. And after Pride weekend I started having symptoms — and it was too late.”
Where do the vaccines go?
The US Centers for Disease Control and Prevention estimates that more than 1.5 million men who have sex with men are eligible for the monkeypox vaccine. Although monkeypox is not a sexually transmitted disease, it is spread through skin-to-skin contact, and in this outbreak, it has been spread primarily among men who have sex with men.
More than 132,000 doses of the Jynneos vaccine — a two-dose regimen manufactured by Bavarian Nordic — have been withdrawn from the national strategic stockpile and distributed nationwide, according to HHS data, but were not enough to cover the demand.
“We got an allotment of 200 vaccines, and the appointments for that ended in about an hour and a half,” said Dr. David Holland, chief clinical officer of the Fulton County, Georgia, Health Board.
The CDC says decisions about how to allocate the limited vaccine supply are based equally on the number of cases and the population at risk in a particular area.
The Jynneos vaccine is now available for people at high risk of exposure: those who have been identified as close contacts of someone diagnosed with monkeypox, those who have had sexual contact with a partner diagnosed with monkeypox in the past 14 days, and who have multiple sexual partners in the past 14 days in an area with an outbreak of monkeypox, according to the CDC.
As more vaccines become available, the agency will continue to evaluate its distribution strategy, a spokesman said.
The District of Columbia has received the most vaccines per capita, by far, and the city has far more confirmed cases per capita than any state.
But as of Wednesday, two states with confirmed cases — New Mexico and South Dakota — had yet to receive doses.
After DC, New York has received the most vaccine doses per capita: more than three times the US average. About three-quarters of the state’s supply went to New York.
In a letter Tuesday, New York City Mayor Eric Adams urged the Biden administration to increase vaccinations, calling his city the “epicenter” of the virus in the US.
The White House coordinator for dealing with Covid-19, Dr. Ashish Jha said on Wednesday that additional doses of monkeypox vaccine would arrive within weeks from a factory in Denmark.
“The thing is, we need to get more vaccines out there,” he said.
“We’re incredibly focused on making sure vaccine doses get to the United States and get them to places like New York. Do we wish we had more doses? Of course. We had a stockpile and what we need is more. We’re getting more.”
Dr. Carlos del Rio, executive associate dean at Emory University School of Medicine, says “the problem is we just don’t have enough vaccine. So we’re trying to respond.”
There are other issues to consider, he said.
“I think the challenge is that we have to make sure that the vaccine doesn’t just go to the people who are knowledgeable and can do it quickly. We don’t want the vaccine to just go to rich white people.”
Could a single dose strategy be helpful?
The full course of the Jynneos vaccine, as approved by the US Food and Drug Administration, requires two doses given four weeks apart. But some experts say one dose may be enough for now — and that delaying second doses may be one way to address the gap between supply and demand.
In his letter, Adams asked the administration to “consider alternative vaccine schedules, using a longer interval between the first and second doses, which would allow more of the readily available vaccine to be used for the first doses.”
Bavarian Nordic CEO Paul Chaplin told Science in early July that “There is a lot of data to support a single shot.”
Chaplin said the second dose could be given two years later and still achieve the same immune response as the standard schedule, so countries have plenty of time to get second shots if they decide to use single doses for now.
Health experts say providers are not expected to hold back on doses at this time.
“From what we’ve been told, it’s: Give the doses you have and in your subsequent administrations, there will be additional doses to cover the second doses,” said Claire Hannan, executive director of the Association of Immunization Managers.
Not a sustainable strategy
If the virus is not contained as soon as possible, health officials fear, it could spread beyond population groups now at high risk. Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists, says the US must move beyond a vaccine strategy that focuses on high-risk post-exposure because “there is no vaccine-preventable disease that can be controlled only after exposure when there is no prior immunity’. Monkeypox is endemic in parts of Africa, but is essentially a new disease in the US and no population immunity has developed. “Everybody is sensitive at this point in time,” Hamilton said. “There is no way we will ever be able to control this disease in a fully susceptible population without a pre-exposure vaccine strategy.”
Need for more and easier testing
In the meantime, people affected by the virus say they need other resources. The Biden administration has moved to expand testing, with the CDC announcing a partnership with five private companies to double the nation’s testing capacity. Some of these companies have already started offering trials. But that didn’t happen soon enough for some. Nicolo said that when he first went to his doctor with monkeypox symptoms, they took a sample to test — but he learned days later that it had been rejected, without testing. Two days after that visit, his symptoms worsened and he returned to the doctor. The second sample came back positive. Christian Redondo, a graduate student in Atlanta, noticed a sore and called the local health board, which said it did not run tests and referred him to his primary care doctor. His primary care doctor told him to go to the emergency room to get tested, but Redondo was able to contact a friend at his county health department, who said yes, in fact, he should go there for testing. . “Then, I was in the waiting room for, I don’t know, about four or five hours. It was a long time. And when I asked them about it, they told me they had to wait for permission from the CDC to even test me for monkeypox,” he said. Testing is necessary to prevent further outbreaks and to learn more about the full scope of the outbreak. “I think one of the challenges we’re facing is that we’re just not testing enough, so there’s probably a lot more cases than we’re currently recording,” Emory’s del Rio said.
