Michael Austin Nicolo, a bartender in New York City, is one of more than a thousand people in the United States who have been diagnosed with the virus this year. He is also one of many others struggling to find an available vaccine.
“I just heard about monkeypox, like everyone else, through the news, social media, the rumor mill, and how it became something we have to worry about and how it predominantly affected gay men or men who have sex with men have.” Nicolo said.
It was enough to send him in search of more information on how to protect himself.
“At the time there were few resources to find the vaccine,” he said.
“I had two friends who reached out to them with links and we clicked on them and they’re already completely like – they were gone right away. There was no access to anything,” he said.
“We just kept the connections in mind and got on with our lives. And then, after Pride weekend, I started showing symptoms of it — and it was too late.”
Where vaccines are going
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, has spread primarily among men who have sex with men.
“We received an allocation of 200 vaccines and the appointments for them went in about an hour and a half,” said Dr. David Holland, Chief Clinical Officer for the Fulton County, Georgia Department of Health.
The CDC says decisions about allocating the limited vaccine supply are based equally on the number of cases and the population at risk in a given area.
As more vaccines become available, the agency will continue to evaluate the distribution strategy, a spokesman said.
The District of Columbia has received by far the most vaccines per capita, and the city has many more confirmed cases per capita than any state.
But as of Wednesday, two states with confirmed cases — New Mexico and South Dakota — still haven’t received doses.
After DC, New York has received the most vaccine doses per capita: more than three times the US average. About three-fourths of the state’s shipments went to New York City.
In a letter Tuesday, New York City Mayor Eric Adams called on the Biden administration to increase vaccine allocations, calling his city an “epicenter” of the virus in the United States.
White House Covid-19 Response Coordinator Dr. Ashish Jha said Wednesday additional doses of monkeypox vaccine will arrive from a facility in Denmark within weeks.
“The problem is that we need to get more vaccines on the market,” he said.
“We are incredibly focused on making sure vaccine doses get to the United States and places like New York City. Do we wish we had more cans? Naturally. We had a supply and what we need is more. We’re getting bigger.”
dr Carlos del Rio, Executive Associate Dean at Emory University School of Medicine, says: “The problem is that we just don’t have enough vaccine. So we’re trying to catch up.”
There are other issues to consider as well, he said.
“I think the challenge is that we have to make sure the vaccine isn’t just going to the people who are savvy and can get it quickly. We don’t want the vaccine to go only to white, wealthy people.”
Could a single-dose strategy help?
A full course of the Jynneos vaccine, as approved by the US Food and Drug Administration, requires two doses given four weeks apart. However, some experts say one dose might be enough for now – and that delaying the second dose could be a way to address the supply/demand mismatch.
In his letter, Adams urged the administration to “consider alternative vaccine schedules that use a longer interval between the first and second doses to allow more of the immediately available vaccine to be used for the first doses.”
Chaplin said the second dose could be given two years later and still achieve the same immune response as the standard schedule, giving countries a long time to give second shots if they decide to use single shots for now.
Health experts say providers are not currently expected to withhold doses.
“From what we’ve been told, it’s give the doses you have, and in your later assignments there will be additional doses that cover the second doses,” said Claire Hannan, executive director of the Association of Immunization Managers.
No sustainable strategy
Unless the virus is contained as soon as possible, health officials fear it could spread beyond populations that are now at high risk.
Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists, says the US needs to move beyond a vaccination strategy that focuses on high-risk post-exposure because “there is no vaccine-preventable disease that can only be controlled after exposure if no prior.” immunity exists.”
Monkeypox is endemic in parts of Africa, but it is essentially a new disease in the US and there is no built-up immunity in the population.
“Everyone is vulnerable at this point,” Hamilton said. “There is no way we can ever control this disease in a fully susceptible population without a pre-exposure vaccination strategy.”
Need for more and simpler tests
Meanwhile, people affected by the virus say they need other resources as well. The Biden administration has been scrambling to expand testing, and the CDC announced a collaboration with five private companies to double the country’s testing capacity. Some of these companies have already started offering testing. But for some it wasn’t soon enough.
Nicolo said when he first went to his doctor with monkeypox symptoms, they took a sample for testing – but he learned days later it had been thrown away untested.
Two days after that visit, his symptoms worsened and he returned to the doctor. The second sample tested positive.
Christian Redondo, a graduate student in Atlanta, noticed a sore and called his local health department, who said it wouldn’t test, and referred him to his GP.
His GP told him to go to the ER to get tested, but Redondo was able to contact a friend at his county health department who said yes, in fact, he would have to go there to get tested.
“Then I was in the waiting room, I don’t know, about four or five hours. It’s been a very long time. And when I asked them about it, they said they had to wait for permission from the CDC to even test me for monkeypox,” he said.
Tests are needed to prevent further cases and learn more about the full extent of the outbreak.
“I think one of the challenges we have is that we’re just not doing enough testing, so there are probably a lot more cases than we’re actually registering right now,” Emory’s Del Rio said.