Michael Austin Nicolo, a waiter in New York City, is one of more than a thousand people in the U.S. who have been diagnosed with the virus this year. He is also one of many more who have struggled to find a vaccine available.
“I just heard for the first time about smallpox from the monkey like everyone else, through the news, social media, the vineyard and how it was becoming something we have to worry about and how it was predominantly affecting gay men or men who have sex with men “. said Nicolo.
It was enough to send him looking for 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 got in touch with links, and we clicked on them, and they’re already completely as if they were gone immediately. There was no access to anything,” he said.
“We watched the links and continued to live our lives. And after the Pride weekend that’s when I started to show symptoms, and it was too late.”
Where do the vaccines go?
The U.S. 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 by skin-to-skin contact and, in this outbreak, has spread mainly among men who have sex with men.
More than 132,000 doses of the Jynneos vaccine, a two-dose regimen manufactured by Bavarian Nordic, have been removed from the national strategic reserve and distributed nationwide, according to HHS data, but it has not been enough. to meet demand.
“We received an allocation of 200 vaccines, and the appointments for that lasted about an hour and a half,” said Dr. David Holland, chief clinical director of the Fulton County Health Council, Georgia.
The CDC says decisions on how to allocate the limited supply of vaccines are based equally on the number of cases and the population at risk in a specific area.
The Jynneos vaccine is now available 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 couple diagnosed with monkeypox. for the past 14 days and those who have had multiple sexual partners in the past 14 days in an area with monkeypox spread, according to the CDC.
As more vaccines become available, the agency will continue to evaluate the distribution strategy, a spokesman said.
The District of Columbia has received the most vaccines per capita, by far, 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 – have yet to receive a dose.
After DC, New York has received more vaccine doses per capita – more than three times the U.S. average. About three-quarters of the state’s supply went to New York City.
In a letter Tuesday, New York Mayor Eric Adams urged the Biden administration to increase vaccine allocation, calling his city the “epicenter” of the virus in the U.S.
White House Covid-19 response coordinator Dr Ashish Jha said on Wednesday that additional doses of monkeypox vaccine would arrive in a few weeks from a plant in Denmark.
“The problem is we need to get more vaccines,” he said.
“We’re incredibly focused on making sure vaccine doses arrive in the United States and go to places like New York City. Would we like to have more doses? Of course. We had a reservation, and what we need is more. month”.
Dr. Carlos del Rio, executive associate dean of Emory University School of Medicine, says “the problem is 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 need to make sure that the vaccine doesn’t just go to smart people and that they can get it quickly. We don’t want the vaccine to only go to rich white people.”
Could a single dose strategy be helpful?
A full course of the Jynneos vaccine, approved by the U.S. Food and Drug Administration, requires two doses administered four weeks apart. But some experts say a dose might be enough for now, and that delaying second doses could be a way to address the discrepancy between supply and demand.
In his letter, Adams asked the administration to “consider alternative vaccine programs, using a longer interval between the first and second dose, which would allow more vaccine to be used immediately available for the first doses.”
Bavarian Nordic CEO Paul Chaplin told 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 achieve the same immune response as the standard program, so countries have plenty of time to offer second injections if they decide to use individual injections at the moment.
Health experts say providers are not expected to withhold doses right now.
“From what we’ve been told, it’s: give the doses you have and, in your subsequent assignments, there will be additional doses that will cover the second doses,” said Claire Hannan, executive director of the Association of Immunization Managers.
It is 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 overcome a high-risk post-exposure vaccine strategy because “there is no vaccine-preventable disease that can only be controlled. after the exhibition “. when there is no prior immunity “.
Smallpox is endemic in some parts of Africa, but it is essentially a new disease in the US and there is no accumulated immunity in the population.
“Everyone is susceptible right now,” Hamilton said. “There is no way we will ever be able to control this disease in a fully susceptible population without a pre-exposure vaccine strategy.”
Need more and easier testing
Meanwhile, people affected by the virus say they need other resources as well. The Biden administration has moved to expand testing, with the CDC announcing a partnership with five private companies to double the country’s testing capacity. Some of these companies have already started offering testing. But that didn’t happen soon enough for some.
Nicolo said the first time he went to his doctor with monkeypox symptoms, they took a sample to analyze, but found out days later that it had been ruled out, without testing.
Two days after that visit, his symptoms worsened and he returned to the doctor. The second sample tested positive.
Christian Redondo, an Atlanta graduate student, noticed a sore and called his local health board, which said he was not testing and referred him to his primary care physician.
Her primary care doctor told her to go to the emergency room for the test, but Redondo was able to contact a friend in her county health department who told her yes, in fact, she should go. -to take a test.
“Then I was in the waiting room for, I don’t know, about four or five hours. It was very long. And when I asked them about it they told me they had to wait for the CDC’s permission until all to prove to me the smallpox of the monkey, “he said.
Tests are needed to prevent more 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 currently recording,” Emory’s del Rio said.