(CNN) – The number of doses of monkeypox vaccine distributed in the United States has more than tripled since last week, according to the US Department of Health and Human Services, but supply is well below demand – and below the levels that experts say will be needed to control the outbreak.
Michael Austin Nicolo, a bartender in New York, is one of more than a thousand people in the United States who have been diagnosed with the virus this year. He is also among many others who have struggled to find an available vaccine.
“I just heard for the first time about monkey pox like everyone else, through the news, social media, the vine, and how it was becoming something we need to be concerned about and how it was mainly affecting the gay men or men who have sex with men,” says Nicolas.
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 contacted me with links, and we clicked on them, and they’re already completely like – they left immediately. There was no access to anything,” a- he said.
“We just kind of kept tabs on the ties and continued to live our lives. And then after Pride weekend, I started showing the symptoms – and it was too late.
Where do the vaccines go
The United States 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 was mainly spread among men who have sex with men.
More than 132,000 doses of the Jynneos vaccine – a two-dose regimen made by Bavarian Nordic – have been withdrawn from national strategic stock and distributed across the country, according to HHS Databut that was not enough to meet the demand.
“We received an allocation of 200 vaccines, and the appointments for that lasted about an hour and a half,” said Dr. David Holland, clinical director for the board of health in Fulton County, Georgia.
The CDC says decisions on how to allocate the limited vaccine supply are based equally on the number of cases and the population at risk in a specific area.
The Jynneos vaccine is available now for people at high risk of exposure: those who have been identified as close contacts of someone diagnosed with monkeypox, those who have had sex with a partner who has been diagnosed with monkeypox in the past 14 days, and those who have had multiple sexual partners in the past 14 days in an area where monkeypox is spreading, According to the CDC.
As more vaccines become available, the agency will continue to evaluate the distribution strategy, a spokesperson 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 a dose.
After DC, New York 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 on Tuesday, New York City Mayor Eric Adams urged the Biden administration to increase the vaccine allocation, calling his city the “epicenter” of the virus in the United States.
White House Covid-19 response coordinator Dr Ashish Jha said on Wednesday that additional doses of the monkeypox vaccine will arrive within weeks from a factory in Denmark.
“The problem is that we need to get more vaccines out,” he said.
“We are incredibly focused on making sure the vaccine doses get to the United States and get to places like New York. Do we wish we had more doses? Sure. We had a stock, and we need more. We get more.
Dr. Carlos del Rio, associate executive dean at Emory University School of Medicine, says, “The problem is that we just don’t have enough vaccines. So we are trying to catch up.
There are also other issues to consider, he said.
“I think the challenge is that we have to make sure the vaccine doesn’t just go to people who are knowledgeable and can get it quickly. We don’t want the vaccine to go only to rich whites. »
Could a single-dose strategy help?
A full course of the Jynneos vaccine, as approved by the United States Food and Drug Administration, requires two doses given four weeks apart. But some experts say one dose could be enough for now – and delaying second doses could be a way to bridge the gap between supply and demand.
In his letter, Adams called on the administration to “consider alternate vaccination schedules, using a longer interval between the first and second dose, which would allow for the use of more readily available vaccines for the first doses.”
Bavarian Nordic CEO Paul Chaplin said 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 get the same immune response as the standard schedule, so countries have plenty of time to provide second shots if they decide to use single shots. for the moment.
Health experts say providers aren’t supposed to withhold doses at this time.
“From what we’ve been told, it’s: give the doses you have, and in your subsequent allocations there will be additional doses that will 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 that are now at high risk.
Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists, says the United States must move beyond a vaccine strategy focused 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 it’s essentially a new disease in the United States, and there’s no built-up immunity in the population.
“Everyone is sensitive at this point,” Hamilton said. “There is no way to be able to control this disease in a completely susceptible population without a pre-exposure vaccination strategy.”
A need for more and easier tests
In the meantime, those affected by the virus say they also need other resources. The Biden administration has moved to expand testing, with the CDC announcing a collaboration with five private companies to double the country’s testing capacity. Some of these companies have already started offering tests. But that didn’t come soon enough for some.
Nicolo said when he first went to his doctor with symptoms of monkeypox, they took a sample to test – but he learned a few days later that he had been thrown away, untested.
Two days after this visit, his symptoms worsened and he returned to the doctor. The second sample tested positive.
Christian Redondo, a graduate student from Atlanta, noticed a sore and called his local health board, which said he was not testing and referred him to his primary care physician.
His primary care doctor told him to go to the emergency room to get tested, but Redondo was able to contact a friend from his county health department who said yes, in fact, he should go there for a test.
“Then I was in the waiting room for, I don’t know, like four or five hours. It was very long. 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.
Testing is 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’s probably a lot more cases than we’re seeing right now,” Emory’s del Rio said.