Topline

Rollout of the monkeypox vaccine nationwide has been hamstrung by logistical, bureaucratic and technical errors, leaving many Americans frustrated and scrambling for scarce doses as experts and activists warn the government’s sluggish response may no longer be enough to contain the growing outbreak.

Key Facts

- Advertisement -

The Centers for Disease Control and Prevention expanded its vaccine push beyond people with confirmed exposures in June to include those most at risk of catching the disease, with most cities and states offering shots to men who have sex with men and transgender and non-conforming people who have sex with men (precise eligibility varies by location).

Vaccine supplies are severely limited—the US has ordered nearly 7 million doses but most will not arrive for months and present stock is not remotely close to meeting demand—and shots are distributed according to the number of monkeypox cases and vulnerable people states have, though the true scale of the outbreak is obscured owing to the slow rollout of testing,

The process of securing a coveted vaccination slot varies by location, ranging from being contacted directly by public health officials if exposed or at-risk, booking appointments in areas including New York City, Washington, DC, and Miami-Dade CountyFlorida, and walk-in shots in some cities like Chicago, San Francisco and Los Angeles,

Public health officials, including CDC head Dr. Rochelle Walensky, acknowledge the paucity of doses and the shortage has sparked long queuesfierce scrambles for appointments—in hotspots like New York City and Washington, DC bookings have filled up within minutes—clinics closing due to a lack of doses and huge waitlists for when supplies come in.

The issues have been magnified by technical problems and other obstacles often associated with online booking systems, particularly in New York City, where the rollout was stymied by the booking system glitching, freezing and allowing some people access to appointments early.

There are also concerns over who is receiving the shots and whether they are going to groups most at-risk of monkeypox amid reports of walk-in clinics opening up unannounced in affluent areas of New York City and the technical savvy and time needed to navigate online booking systems.

Big Number

1,814. That's how many confirmed cases of monkeypox there are in the US as of July 15, according to CDC data (the figure includes confirmed orthopoxvirus cases, the family monkeypox belongs to, which are presumed to be monkeypox). Experts warn that the limits on monkeypox testing mean this figure is likely much higher. The states with the most confirmed cases are: New York (489), California (266), Illinois (174), Florida (154), the District of Columbia (108), Georgia (93) and Texas (76).

Key Background

Though monkeypox has spread for decades in parts of Central and Western Africa, it has been largely ignored by the rest of the world until a number of cases were found in Europe and North America in May in people without a history of travel to the region. The virus does not spread easily between people and is primarily transmitted through close contact with an infected animal or person or objects like towels, clothes or bedding that have been contaminated by someone with an infection, though it can also spread through respiratory droplets made when people breathe, cough or sneeze. The overwhelming majority of global cases identified outside of Africa have been among men who identify as gay or bisexual and men who have sex with men, though the virus is not limited to that community. While monkeypox is not believed to spread sexually—experts are looking into the possibility after the virus was detected in the semen of some patients—the close physical contact inevitable during sex can facilitate transmission and experts have noted differences in symptoms from past descriptions of the disease.

News Peg

Activists and politicians have slammed the federal government's response to the monkeypox outbreak amid the slow rollout of testing and vaccines. North Carolina Senator Richard Burr (R) said the government had failed to learn from the Covid-19 pandemic and called for a new government office to deal with pandemic threats (experts do not consider monkeypox a pandemic yet). James Krellenstein, co-founder of PrEP4All, an HIV advocacy group, told NBC News the consequences of not having a robust vaccine supply chain is "severe," adding that "gay men are going to be paying for this with their health." Experts have also criticized the sluggish response, warning that the loss of the crucial time early on in the outbreak may allow the disease to gain a foothold in the US

What To Watch For

Prioritizing the first dose. The Jynneos vaccine, marketed as Imvanex in Europe and as Imvamune in Canada, is the only vaccine specifically approved by the FDA for use against monkeypox. It's meant to be given in two doses, 28 days apart. Given supply constraints and urgency of the growing outbreak, officials are debating the possibility of delaying the second dose to ensure as many people can get the first dose as quickly as possible. The strategy was employed by some countries during the early stages of the Covid-19 pandemic and is already being used by Canada and the UK for monkeypox. On Friday, New York City's health department said it will adopt a similar strategy to make best use of limited supplies. The CDC and Food and Drug Administration do not endorse such a strategy. The US is working to boost Jynneos supplies. The Department of Health and Human Services said on Friday it has distributed 156,000 vaccines already and an additional 131,000 doses will be available for states to order Monday. HHS said it expects to have around 7 million doses of Jynneos by mid 2023.

Surprising Fact

There are more than 1 million doses of Jynneos vaccine already purchased by the US sitting in Denmark. The shots, produced by Danish biotech Bavarian Nordic, have been awaiting an on-site inspection from the FDA to allow them to be shipped out. Officials last week said they had completed the inspection.

Tangent

There is another vaccine that could be used against monkeypox that is in plentiful supply in the government stockpiles: ACAM2000. The vaccine is an older type of shot developed for smallpox, a close relative of monkeypox, and believed to protect against monkeypox as well. It is associated with serious side effects, however, and its live-virus design makes it unsuitable for immunocompromised and pregnant people and people living with HIV. This is a particularly big problem for a public health campaign primarily targeting men who have sex with men, who are at greater risk of HIV.

Lesions, headaches, debilitating pain: Gay men with monkeypox share their stories (NBC News)

US Monkeypox Response Has Been Woefully Inadequate, Experts Say (Scientific American)

As Monkeypox Spreads, Here's Who Should Get A Vaccine—And How (Forbes)