The Biden administration is attempting to smooth out the vaccination campaign intended to contain the nation’s expanding monkeypox outbreak after a rocky start.
To make the most of the U.S.’s limited supply of vaccines, the endeavor now relies on a novel and unproven method of splitting up previously full doses.
In spite of the fact that there are now more than 14,000 cases of monkeypox in the U.S., which is more than any other country in the world, many local health departments still claim that there are not enough vaccines available to protect everyone who is thought to be at a higher risk of getting the illness.
According to Dr. Mark Del Beccaro, Assistant Deputy Chief for Public Health – Seattle & King County, “We are absolutely in what we’re still calling ‘The Hunger Games’ phase of this – where there’s nowhere near enough dosages for the demand.”
Health officials now have to deal with still another challenge: how to squeeze five doses out of single-dose vials. These officials are already dealing with the anticipated logistical challenges of administering a vaccination campaign in a public health emergency.
Claire Hannan, president of the Association of Immunization Managers, believes it’s wonderful that we can vaccinate more individuals with the available supply. In spite of this, “making a change like that is kind of like turning the barge around in the midst of the water.”
With early immunization data revealing large racial discrepancies, the change raises questions about equality and presents issues with messaging and logistics, educating providers, and procuring the necessary equipment.
maximizing a finite supply
The JYNNEOS vaccine, a two-shot series made by Bavarian Nordic, is the main component of the U.S. government’s strategy to eradicate the illness.
However, a string of errors at the outset of the response resulted in a critical vaccine shortage in the United States. As a result, other nations were able to order vaccines ahead of the United States, and state and local distribution has been chaotic.
Around 700,000 vials of the monkeypox vaccine have already been delivered by the United States to various states and territories for distribution. The 1.7 million persons who are deemed to be at the greatest risk should get immunized, according to the Centers for Disease Control and Prevention.
The Food and Drug Administration approved a new dosing strategy last week due to a shortage of vaccines: the vaccine can now be administered using a “intradermal injection,” where the vaccine is injected into the skin rather than the customary method of injecting into the layer of fat beneath the skin.
In a video this week, Dr. Rochelle Walensky, director of the CDC, stated that “this measure serves to dramatically boost vaccination supplies.” “Vaccine providers can administer a total of up to five distinct doses of the JYNNEOS vaccine from an existing one-dose vial when administered intradermally.”
Federal officials are adamant that this reduced quantity of vaccine shouldn’t be regarded as a “partial dose” because it still has the same immunologic effect as the vaccine given using the original approach.
Although it has been successful for immunizing against other diseases, there is little evidence to support this technique.
The idea is based on the fact that the skin contains a large number of immune cells. Dr. John Brooks, a medical epidemiologist from the CDC, stated in the video that when a vaccination is administered into this tissue, you can create a powerful immune response using a smaller dose of vaccine, referencing a 2015 study on the vaccine. Brooks also emphasized that other vaccines, such as those for the flu and rabies, have been studied using this technique.
Do five doses per vial? No, hurry.
The idea to get five doses out of what was originally one dose has another practical issue:
Del Beccaro of Seattle & King County claims that “it’s just mechanically challenging to execute.” “I think the federal announcement of five doses per vial was extremely optimistic, and what we’re actually seeing is three to four doses per vial,” said the researcher.
The same worries have been expressed to Hannan, president of the Association of Immunization Managers.
Although we’re not really seeing it consistently at the moment, she adds, “Hopefully we will start to see more of the vials giving five doses.”
And yet, as it divides up the vaccination supplies and sends those out to health departments, it appears that the federal government is assuming five doses each vial, adds Del Beccaro.
Health authorities will soon need to prepare for an influx of patients returning for their second doses 28 days later. Up until now, the majority of the U.S. vaccine effort has concentrated on reaching those who are unvaccinated and at heightened risk of acquiring monkeypox.
This might add up to around 4,000 people in the Seattle area during the final week of August. Del Beccaro notes that although it is impossible to foresee how the federal supply may alter, it appears that they will not be receiving enough vaccine to do second shots while still giving first vaccinations at a high rate.
According to Janna Kerins, medical director at the Chicago Department of Public Health, the changeover also necessitates new equipment and training. It has taken some time to ensure that people have the supplies because it requires using a different syringe and needle, she explains.
On addition, healthcare professionals need technical expertise in how to inject a dose under the skin. Although there isn’t much information accessible, she adds, “we also need to educate [providers and the populations they serve] on the data that supports this transformation.”
Feelings of mistrust and disrespect
A strong sense of injustice among people in the communities most at risk for the disease is being fueled by the new dosing method.
According to CDC director Rochelle Walensky, “men who reported recent sexual encounter with other men” continue to make up the vast majority of cases found in the United States.
Although the data is insufficient, it does highlight another trend: a disproportionately high proportion of Black and LatinX members of the LGBT and queer community are developing monkeypox, and they have also experienced difficulty accessing immunizations.
Despite only receiving 24% of the monkeypox immunizations, the health department of North Carolina reported on August 10 that 70% of the state’s cases were found in Black men.
Men of color in Chicago are also showing immunization gaps. Only 15% of vaccines have been distributed to the Latino population in Chicago, despite the fact that Latino men make up 30% of the city’s cases. To better match vaccine doses with people who are [at risk of] developing illnesses, she says, “we have some work to do.”
According to national data, LGBT Black and Brown populations have high incidence of monkeypox: 33% of cases are among Hispanics, and 28% are among Black people.
The lack of access for these groups is a problem everywhere, according to Joseph Osmundson, a microbiologist at NYU and an LGBT community organizer in New York, even though no national data on vaccinations have been provided. The new dosage approach might contribute to that.
The data should be comparable both in New York and abroad, according to Osmundson. For individuals who receive the vaccine later—who are more likely to be working class and more likely to be Black and Brown, who have not yet had the privilege or opportunity to access vaccine—this [dose approach] uses a different dosing regimen.
According to Kenyon Farrow of the advocacy group Prep4All, inequities in vaccine access have bred mistrust and suspicion in communities of color.
Farrow asserts that more work needs to be done by public health officials to explain why this new approach is not always inferior. He claims that an online feeling, particularly among homosexual men of color, is that “The initial full doses were all given to White gay males. So now we’re expected to think that a fifth of that dose will work just as effectively for us.”
According to federal health officials, efforts are being made to close these gaps.
A pilot effort to provide vaccines to Pride festivals and gatherings where they may reach the homosexual, bisexual, and queer groups most at risk for catching the virus was unveiled by the White House monkeypox response team on Thursday.
Dr. Demetre Daskalakis, deputy coordinator of the national monkeypox response, said during a briefing with federal health officials on Thursday that “many of the events we’re focusing on are events that focus on populations who are overrepresented in this outbreak,” including Black and Latino people.
The key is to put biological therapies and message in locations where they can be accessed by the public. We also need to make sure we’re talking to the appropriate individuals and going to the right places.