As the monkeypox outbreak grows in the United States, demand for the vaccine is outpacing the nation’s supply, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said at a briefing Friday.
“We still don’t have all the vaccine we would like at this point,” she said.
It is not known when the supply crisis will ease. The federal government provided another 131,000 doses to states and other jurisdictions on Friday. But the scope of the epidemic remains unclear, in part because diagnostic tests are slow and limited.
Nearly 1,500 cases have been identified in the United States, mostly in men who have sex with men, and the number is likely to rise in the coming weeks, Dr. Walensky said. Globally, more than 11,000 cases have been identified in 65 countries, she added.
“Our opportunity to control it is rapidly closing,” said Anne Rimoane, an epidemiologist and monkeypox expert at the University of California, Los Angeles. “There are probably many more cases than we know about.”
The Department of Health and Human Services ordered an additional 2.5 million doses of the vaccine, known as Jynneos, on Friday, but those doses are not scheduled to arrive until next year.
The 2.5 million doses previously ordered should begin arriving later this year, officials said.
“It’s like saying we have a water tanker coming next week when the fire is happening today,” said Greg Gonsalves, an epidemiologist at the Yale School of Public Health.
Public health experts have criticized the US response to the outbreak as slow and ineffective, beset by some of the same problems that plagued the early months of the Covid-19 pandemic.
At first, for example, testing for monkeypox was extremely limited, and each diagnosis had to be confirmed by the CDC, creating delays that may have allowed the virus to spread unseen and unchecked.
“We are now in a situation where it will be extremely difficult, with limited vaccine supplies and still some testing issues, to get this under control,” Dr Gonsalves said.
The CDC teamed up with five commercial testing companies to expand national testing capacity, which now stands at 70,000 samples a week, up from 6,000 at the start of the outbreak.
What you need to know about the monkeypox virus
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What is monkeypox? Monkeypox is a virus endemic to parts of Central and West Africa. It is similar to smallpox, but milder. It was discovered in 1958 after an outbreak in monkeys kept for research, according to the Centers for Disease Control and Prevention.
What are the symptoms? Monkeypox produces a rash that starts as flat red spots that become raised and filled with pus. Infected people may also have fever and body aches. Symptoms usually appear after six to 13 days, but may take up to three weeks after exposure to appear and may last two to four weeks. Health officials say smallpox vaccines and other treatments can be used to control an outbreak.
How contagious is it? The virus is spread mainly through bodily fluids, skin contact and respiratory droplets, although some experts suggest it can sometimes be airborne. It does not normally lead to large outbreaks, although this year it has spread in unusual ways and among populations that were not vulnerable in the past.
What is the situation in the United States? Experts say the rapid spread of monkeypox in the country and the government’s sluggish response raise questions about the nation’s preparedness for pandemic threats. Tests won’t be readily available until later this month, and vaccines will be in short supply for months. The official number of cases, now in the hundreds, is likely a vast underestimate.
“We have the testing capacity we need, and we’ve made it easier to access,” Dr. Walenski said.
But health officials need to do more active surveillance for the disease, experts said.
Officials should go out into the community and offer testing in places that serve men who have sex with men, as well as in gathering places, such as homeless shelters, where the virus can spread, Dr. Gonsalves said.
The monkeypox test involves a swab from one of the lesions that typically accompany the disease, making it difficult to expand testing to people who don’t have symptoms, Dr. Walensky said. “You have to have a lesion to get a test,” she added.
New tests are needed, including ones that can detect the virus in asymptomatic people, Dr. Rimoane said, as well as active surveillance of animal populations that can become reservoirs for the virus.
The virus is unlikely to remain in the networks and communities where it is currently spreading, she added, and expanding testing is especially important given the limited supply of vaccines.
“The quicker you can identify cases, the better you can isolate them and prevent further transmission,” Dr Rimoane said.
Jynneos, the only FDA-approved vaccine specifically for monkeypox, is given in two doses, 28 days apart. It is produced by Bavarian Nordic, a small company in Denmark, and its global supply is extremely limited.
The United States has purchased a total of nearly seven million doses but has received only 372,000 of them, Dawn O’Connell, assistant secretary for preparedness and response at the Department of Health and Human Services, said Friday. So far, 156,000 doses have been distributed in the country, she said.
State health officials may request an alternative vaccine, known as ACAM2000, which was developed to prevent smallpox and should also provide protection against monkeypox, experts say. But that vaccine is associated with serious side effects and the federal government has only made it available to “a few states in relatively modest amounts,” Ms. O’Connell said.
The Food and Drug Administration recently completed an inspection of Bavarian Nordic’s manufacturing facilities in Denmark and is deciding whether to approve an additional 780,000 doses produced there.
“We are working diligently to complete our assessment of the necessary information, anticipating the encouraging release of these doses before the end of July,” said Dr. Peter Marks, FDA’s chief vaccine regulator.
The United States is not considering moving to a single-dose strategy to augment existing supplies, he added. “We are confident that we will have stocks of vaccine to be able to vaccinate with the second dose at or near the appropriate 28-day interval,” he said.
States and jurisdictions with high or increasing cases of monkeypox and populations considered to be at high risk will receive priority in distributing new vaccine doses, officials said.
“We are working around the clock to increase supplies and make sure we reach those most at risk,” Ms O’Connell said.
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