As Monkeypox Spreads, Here’s Who Should Get A Vaccine

Topline

Monkeypox vaccines will be offered to anyone in the U.S. who thinks they have been been exposed to the virus and groups most at risk of catching it, including men who have sex with men, measures officials hope will contain the growing outbreak as they work to bolster limited supplies.

People lined up for monkeypox vaccines in NYC.

Anadolu Agency via Getty Images

Key Facts

The new strategy recommends anyone with a confirmed or suspected exposure to monkeypox get vaccinated, expanding earlier rules limiting the shots to those with known exposures only.

This includes people who have had close physical contact with someone diagnosed with monkeypox, people who know their sexual partner was diagnosed and “men who have sex with men who have recently had multiple sex partners in a venue where there was known to be monkeypox or in an area where monkeypox is spreading,” the Department of Health and Human Services (HHS) said.

HHS said it will make 56,000 doses of the Jynneos monkeypox vaccine immediately available to states from the national stockpile and will provide an additional 240,000 doses in the coming weeks.

Jynneos, produced by Danish biotech Bavarian Nordic, is given in two doses delivered 28 days apart and is the safer of two vaccines used against monkeypox.

Supplies are limited and officials said states with the highest rates of monkeypox and that have more people vulnerable to severe disease will be prioritized, with Hawaii, Massachusetts, Utah, Illinois, New York, Rhode Island, California, Colorado and Florida and Washington, D.C., slated to be in the first tier of vaccine recipients, according to a draft of the plans seen by the Washington Post.

States may also request supplies of ACAM2000, an older vaccine developed for smallpox that is also believed to protect against monkeypox and is in much greater supply, though it is associated with serious side effects and its design makes it unsuitable for immunocompromised and pregnant people.

Key Background

Monkeypox is a well-understood entity that has flared up in parts of Central and Western Africa for decades. For decades, too, monkeypox has mostly been ignored by the global community who, before this year’s outbreak, rarely encountered the disease and these instances were almost always linked to travel. It does not spread easily and is primarily transmitted through close contact with an infected animal or person or contaminated objects like towels, clothes or bedding, though it can also spread via respiratory droplets produced when people breathe, cough, talk or sneeze. Monkeypox typically causes symptoms that include fever and a characteristic rash. The infection is usually relatively mild and will go away on its own within a month or so. It can kill and cause serious illness, however, and infection is particularly risky for children and pregnant people. The virus is a close relative of smallpox, unarguably one of the deadliest diseases to plague humanity and the only human disease to have ever been eradicated. This proximity means treatments and vaccines are available for monkeypox, even if not designed for it.

News Peg

In May, the near-simultaneous emergence of monkeypox in countries where it does not usually spread in Europe and North America alarmed experts and public health authorities. Some of these experts have long warned that the complete cessation of smallpox vaccination would leave the world vulnerable to monkeypox outbreaks and the way cases cropped up suggests it may have been quietly circulating for some time. Data from the Centers for Disease Control and Prevention show there have been 351 confirmed cases of monkeypox in the U.S. as of June 29, with large clusters in California (80), New York (72), Illinois (46) and Florida (35). The official count is likely to be a severe underestimate and could be painting an overly rosy picture of the disease’s spread. Experts warn that inadequate and underwhelming testing for the virus has left the nation ignorant as to the true extent of the outbreak. Globally, the CDC said there have been more than 5,000 cases confirmed across 51 different countries by laboratory testing during the 2022 outbreak. The bulk of these have been recorded in European countries like the U.K. (1,076), Germany (874), Spain (800), France (440), Portugal (391) and the Netherlands (257). A notable cluster has also been documented in Canada (276). Many more cases are suspected, but not confirmed, and official tallies likely underestimate the number of cases, particularly in areas with poor testing infrastructure. This data also does not capture the extent of the much longer monkeypox outbreak that has been ongoing in some African countries, notably Nigeria, from earlier this year and as an endemic disease for decades. Despite seeing more infections over a much longer time period, these countries have not received any monkeypox vaccines.

Big Number

1.6 million. That’s how many doses of the Jynneos vaccine the federal government will make available this year, HHS said, including the nearly 300,000 doses already released or expected in coming weeks. HHS said it expects an additional 750,000 doses will be made available over summer and another 500,000 throughout fall. As of late June, HHS said it had already distributed more than 9,000 doses of vaccine.

What To Watch For

Vaccine supplies and changing eligibility. There is not nearly enough of the Jynneos vaccine available in the federal stockpile for everyone who might want it. There have already been supply issues in areas that launched their own initiatives ahead of the national campaign. In Washington, D.C., and New York City, for example, vaccine supplies reportedly ran out less than a day after they kick started their immunization drives. The issue could intensify if eligibility guidelines expand or the outbreak grows. Officials have acknowledged the limited supply of vaccines and suggested the national strategy may change once supplies are on firmer footing. A stronger vaccine supply chain could mean a shift to vaccinating people before they have been exposed to monkeypox, CDC director Dr. Rochelle Walensky said at a press briefing.

Tangent

While the Jynneos vaccine may be in short supply, HHS officials told Forbes there is enough smallpox vaccine in federal stockpiles to immunize the entire U.S. population. The precise breakdown is not clear, but a significant portion consists of the ACAM vaccine. There is also a third shot, the Aventis Pasteur Smallpox Vaccine (APSV), which has similar setbacks to ACAM and has not been cleared for use. The nature of the ACAM vaccine poses some unique challenges if Jynneos supplies are insufficient. Aside from the noted risk of potentially serious side effects, the vaccine uses a related virus, vaccinia, to induce a sore or pock in the recipient, usually on the upper arm. On rare occasions, this can spread elsewhere on the body or even to other people and can leave a distinctive scar. The use of live virus limits who it can be given to, notably excluding people with compromised immune systems, those in close contact with such people and pregnant people. As monkeypox cases have been reported disproportionately among men who have sex with men, this poses a potentially significant problem, as rates of people living with HIV are higher in that community. An additional issue arises with how the ACAM shot is used. It relies on an old form of immunization featuring a distinct technique and special bifurcated needle, which most practicing clinicians are unlikely to have much, if any, experience using.

As Monkeypox Spreads, Here’s Who Should Get A Vaccine—And How