As the monkeypox outbreak grows in the United States, demand for the vaccine is outstripping the nation’s supply, said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, at a news conference Friday.
“We don’t have all the vaccines that we want at this moment,” she said.
It is not known when the supply crisis will ease. The federal government made an additional 131,000 cans available to states and other jurisdictions on Friday. However, the extent 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 increase in the coming weeks, Dr. Walensky. More than 11,000 cases have been identified in 65 countries worldwide, she added.
“Our 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.”
The Department of Health and Human Services on Friday ordered a further 2.5 million doses of the vaccine, known as Jynneos, but those doses are not expected to arrive until next year.
A previously ordered dose of 2.5 million doses should arrive later this year, officials said.
“It’s like saying a water tanker is coming next week when the fire starts today,” said Gregg Gonsalves, an epidemiologist at the Yale School of Public Health.
Public health experts have criticized the US response to the outbreak as slow and inefficient as it is beset by some of the same problems that plagued the first few months of the Covid-19 pandemic.
Initially, monkeypox testing, for example, was extremely limited and every diagnosis had to be confirmed by the CDC, causing delays that may have allowed the virus to spread unnoticed and unchecked.
“Now we are in a situation where, with limited vaccine supplies and still some issues with testing, it will be extremely difficult to get this under control,” said Dr. Gonsalves.
The CDC has partnered with five commercial testing companies to expand the country’s testing capacity, which is now at 70,000 samples per week, up from 6,000 when the outbreak began.
What you should know about Monkeypox virus
What is monkeypox? Monkeypox is a virus endemic to parts of central and west Africa. It is similar to smallpox but less severe. It was discovered in 1958 after outbreaks in monkeys kept for research, according to the Centers for Disease Control and Prevention.
“We have the testing capacity we need and we’ve made access easier,” said Dr. Walensky.
But health officials should monitor the disease more actively, experts said.
Officials should get out into the community and offer testing in places that serve men who have sex with men and in gathering settings like homeless shelters where the virus could spread, Dr. Gonsalves.
The monkeypox test involves swabbing one of the lesions typically associated with the disease, which makes it difficult to extend the test to people who don’t have symptoms, said Dr. Walensky. “You have to have a lesion to get a test,” she added.
New tests, including ones that can detect the virus in asymptomatic people, are needed, Dr. Rimoin, as well as active surveillance of animal populations that could become reservoirs for the virus.
The virus is unlikely to remain in the networks and communities where it is currently spreading, she added, and expanding testing is particularly important given the limited vaccine supply.
“The faster you can identify cases, the better you can isolate them and prevent onward transmission,” said Dr. rimoin
Jynneos, the only vaccine specifically approved by the FDA for monkeypox, is given in two doses 28 days apart. It’s made by Bavarian Nordic, a small company in Denmark, and their worldwide supply was extremely limited.
The United States has purchased nearly seven million doses in total but has only received 372,000 of them, Dawn O’Connell, the assistant secretary for preparedness and response at the Department of Health and Human Services, said on Friday. So far, 156,000 cans have been distributed across the country, she said.
State health officials may request an alternative vaccine called ACAM2000, which is designed to prevent smallpox and also protect against monkeypox, experts say. However, this vaccine comes with serious side effects, and the federal government has only made it available “in relatively modest amounts to a few states,” 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 cans manufactured there.
“We are working diligently to complete our assessment of the required information and anticipate the hopeful release of these doses before the end of July,” said Dr. Peter Marks, a lead vaccine regulator at the FDA
The United States is not considering moving to a one-dose strategy to expand existing supply, he added. “We are confident that we will have a stock of vaccine to vaccinate with the second dose at or near the appropriate 28-day interval,” he said.
States and jurisdictions that have high or increasing cases of monkeypox and populations considered to be at high risk will be given priority in allocating new vaccine doses, officials said.
“We are working around the clock to increase supply and ensure we reach those most at risk,” Ms O’Connell said.