Tens of thousands of monkeypox vaccine doses to be distributed immediately in U.S.

As cases of monkeypox virus surge in the U.S., the Biden administration will start distributing the monkeypox vaccine across the country, focusing on people most at risk and communities with the highest numbers of cases, White House officials announced Tuesday.

The U.S. Department of Health and Human Services will send 56,000 doses of the Jynneos vaccine immediately to areas with high transmission. An additional 240,000 doses will be distributed over the next few weeks, with even more to come this summer and fall. Officials expect to make at least 1.6 million doses available by the end of the fall.

States with the highest numbers of cases include California, New York, Illinois and Florida, as well as Washington, D.C., according to the latest count from the Centers for Disease Control and Prevention.

"We are recommending that vaccines be provided to both people with known monkeypox exposures who are contacted by public health and also to those people who’ve been recently exposed to monkeypox,” the CDC’s director, Dr. Rochelle Walensky, said at a news briefing Tuesday.

The CDC is prioritizing initial access to the vaccine for people who have been in close contact, including sexual contact, with someone who has diagnosed with the virus. The agency will also provide vaccines to men who have sex with men who report having had multiple recent sex partners at a venue or party where the virus is known to have spread, or who have had sex with multiple partners in an area of the country with elevated spread.

The vast majority of confirmed monkeypox cases, both in the U.S. and in the global outbreak as a whole, have been among men who have sex with men.

While case numbers continue to rise in the U.S., the White House Covid-19 coordinator, Dr. Ashish Jha, seemed hopeful the U.S. could contain the outbreak and said it was important to remain vigilant.

“Monkeypox is not novel,” Jha said at the briefing. “We as a global community have known about it for decades. We know how it spreads. We have tests that help identify people who are infected. We have vaccines that are highly effective against it.”

The U.S. monkeypox outbreak was first detected in Massachusetts in May, after a person who had been traveling tested positive. Since then, the virus has been spreading around the country, with more than 306 cases in 28 states, according to the CDC. But because of limitations with testing for the virus, it’s likely the U.S. is significantly undercounting the numbers of infections, experts say.

“We’ve already lost control of this outbreak,” said David Harvey, the executive director of the National Coalition of STD Directors. “We think there’s many more cases, and we need to act now to get control of this outbreak.”

New York City and Washington, D.C., were among the first cities to begin vaccinating at-risk groups for monkeypox, including men who have sex with men reporting multiple partners or at least one anonymous partner within 14 days. With just 1,000 doses from the CDC to distribute at one clinic, New York, which began administering shots on June 23, quickly ran out.

It was a similar situation in Washington, where health officials announced Monday that they would also start vaccinating at-risk groups. The 300 available appointments were taken in less than an hour after the online booking system went live.

The Biden administration's vaccine strategy is welcome, but questions remain about how the doses will make it to "those most at-risk in an equitable way," NCSD's Harvey said in a statement after the briefing.

The two-dose Jynneos vaccine, which is approved by the Food and Drug Administration, not only prevents infection, but it can also be used to stop an infection after a person is exposed. Walensky said that people should get vaccinated within two weeks of exposure but that the vaccine works better the sooner it’s given. The doses are given 28 days apart.

An older vaccine that is FDA-approved for smallpox but also protects against monkeypox is also available, but it isn’t recommended because it can’t be given to anyone who is immunocompromised, or people with HIV.

The virus is marked by a rash that looks like pimples or blisters, along with symptoms like fever, headache, muscle aches, swollen lymph nodes and chills. Symptoms typically begin seven to 14 days after exposure, but they may start earlier or as late as 21 days after exposure.

In the current outbreak, the monkeypox virus is being spread primarily through intimate contact, including sex and prolonged face-to-face interactions, Dr. Jennifer McQuiston, the deputy director of the CDC’s High Consequence Pathogens and Pathology Division, said at the briefing.

Can monkeypox outbreak be stopped?

Epidemiologists who have studied monkeypox are concerned that the CDC’s numbers don’t reflect the true scope of the outbreak and that the U.S. may be reacting too slowly to stop case numbers from escalating.

“I am quite concerned that given how hard it still is for people to get tested and how difficult it may be for clinicians to recognize who is infected that our official tally of monkeypox cases is a significant undercount of the true number of infections,” said Jennifer Nuzzo, the director of the pandemic center and a professor of epidemiology at Brown University in Providence, Rhode Island. “We urgently need to increase access to testing, vaccines and therapeutic drugs.”

Walensky said Tuesday that public health and commercial labs can process up to 10,000 tests a week and that HHS plans even more. One challenge is that there is no rapid test yet similar to what is used to diagnose Covid.

Even with delays in testing, epidemiologist Anne W. Rimoin, the director of the UCLA Center for Global and Immigrant Health, said it’s not too late to bring the outbreak under control.

“We have the ability to bring this under control using the public health tools needed- including case identification, contact tracing and testing,” Rimoin said in an email. "We need rapid scale up of diagnostics that are widely available to be able to have good situational awareness of where we truly are in terms of case numbers.”

There are at least 4,700 confirmed cases of monkeypox in 49 countries, Walensky said. The World Health Organization said Saturday that monkeypox didn't yet constitute a global health emergency, but Director-General Tedros Adhanom Ghebreyesus said in a statement that there were serious concerns about the "scale and speed of the current outbreak."