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Clinics across the country will begin offering monkeypox vaccinations to anyone who may have been exposed to the virus, federal health officials announced Tuesday.
Until now, vaccinations have only been offered to people with known exposure.
States will receive doses of a safer and newer monkeypox vaccine called Jynneos from the federal stockpile based on the number of cases and the proportion of the state’s population at risk for serious illness, officials said at a news conference.
State health officials may also request supplies of an older vaccine that was developed for smallpox and is believed to also protect against monkeypox.
The Ministry of Health will provide 56,000 doses of the Jynneos vaccine immediately and a further 240,000 doses in the coming weeks. Another 750,000 doses are expected to be available over the summer and a total of 1.6 million doses by the end of this year.
“This vaccine is currently subject to some supply restrictions and for this reason the government’s current vaccine strategy is prioritizing making it available to those who need it most,” said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention.
The older smallpox vaccine, called ACAM2000, has been linked to serious side effects, including death, in immunocompromised people, pregnant women and older adults.
The new vaccination plan was quickly criticized by experts who said the campaign was too small and too slow to make an impact. The longer it takes to contain the monkeypox outbreak, the greater the chance that the virus will take hold in the United States, particularly among men who have sex with men, researchers warned.
“Many of us are concerned that the window is closing so that we can eliminate monkeypox,” said Dr. Celine Gounder, infectious disease expert and public health editor at Kaiser Health News.
“Unless we start vaccinating faster and more widely, we’re going to have a very hard time containing this,” she said. Ideally, monkeypox testing and vaccines could have been offered at LGBTQ Pride events across the country to reach men who are at high risk of contracting the virus, added Dr. Gounder added.
Some experts said the plan is also unfair to vulnerable men who will not have access to the Jynneos vaccine, particularly those who have HIV and cannot safely take the older smallpox vaccine.
“It will not be enough to meet the demand,” said Elizabeth Finley, communications director for the National Coalition of STD Directors. “Also, a strategy based on contacts with a positive case fails without better testing capacity.”
It’s also not clear what counts as likely exposure, she added: “Do you have to know anyone who tested positive at the event or just say, ‘Oh I was at a rave and I want to make sure’ ?
Many clinicians are concerned about side effects and scarring from the older smallpox vaccine, as well as the misinformation and vaccine hesitation they may be fueling, Ms Finley said. “We had clinicians say there was no way they would give anyone ACAM2000,” she said.
The Jynneos vaccine, on the other hand, has never been used on this scale, and federal health officials said they were watching for unexpected side effects.
The government has so far shipped more than 9,000 doses of the Jynneos vaccine and 300 courses of antiviral treatments to 32 jurisdictions in the country, officials said on Tuesday.
The European Union adopts a similar plan, sending 5,300 of its 100,000 cans of Jynneos to Spain, which has the most cases, followed by Portugal, Germany and Belgium. Other Member States receive doses in July and August.
The number of cases of monkeypox has risen sharply in many European countries and in the United States.
As of June 28, there were 306 cases in 27 states and the District of Columbia, up from 156 cases a week earlier. The CDC has activated its emergency response center to better monitor and respond to the outbreak, said Dr. Walensky.
The reported numbers are likely to be underestimated, said Dr. Jay Varma, director of the Cornell Center for Pandemic Prevention and Response. “It is pretty clear to me and many others that the epidemic is far larger than our official case numbers suggest,” he said.
Given the increasing numbers, available doses may not be sufficient to meet demand. Washington’s health department offered 300 monkeypox vaccination appointments Monday; The slots filled up in less than 15 minutes.
New York City, which had identified 55 cases of monkeypox Tuesday, had 1,000 doses of the Jynneos vaccine on hand. The city’s health department began administering the vaccines at a single clinic in Chelsea, where the clientele is mostly wealthy white men who have sex with men.
The city offered the first cans Noon on June 23rd. Less than two hours later, officials announced that the clinic could no longer accept walk-in customers and had booked appointments until June 27th. The city was as of Tuesday still waiting so that more vaccine doses become available.
“It started and then stopped, and it started without anyone being prepared for it, and I’m not sure when it’s coming back,” said Keletso Makofane, a social media epidemiologist at the FXB Center for Health and Human Rights Harvard University.
“All this uncertainty is not helping us build the confidence we need,” said Dr. Makofane.
Several experts also criticized the location, saying it would have been fairer to offer the vaccines in clinics attended by black men with untreated HIV and limited access to health care.
