Don’t expect America’s shortage of monkeypox vaccine to ease anytime soon. On Saturday, the Washington Post reported that there is currently only enough supply of the two-dose Jynneos monkeypox vaccine to fully vaccinate about a third of the gay and bisexual men in the U.S. who are considered highest risk for the virus. And more Jynneos doses aren’t expected to arrive in the U.S. until at least October, which experts fear may give the virus all the time it needs to become permanently established in the country. One federal official involved with the monkeypox response told the Post that the country may hit a “vaccine cliff” in a matter of weeks.
The nationwide outbreak continues to grow, with the number of confirmed U.S. monkeypox cases now roughly doubling every seven to eight days. Public-health authorities have already begun to ration the Jynneos vaccine by withholding second doses in some of the country’s hardest hit communities. While both the vaccine manufacturer and the Food and Drug Administration recommend two doses at least four weeks apart, there’s some evidence that one dose may still provide meaningful protection, but one-shot efficacy hasn’t been studied in real-world scenarios yet.
Monkeypox is a relative of the smallpox virus, which can cause lesions, agonizing pain, fever, and swollen glands. It most typically spreads through prolonged skin-to-skin contact, though it can also be transmitted via bodily fluids, and in rare cases, via bed linens and clothing. There have been no confirmed deaths linked to monkeypox in the U.S. Though anyone can be infected with the monkeypox, nearly everyone affected thus far in the outbreaks in U.S. and Europe have been men who have sex with men. As of Friday, more than 5,000 monkeypox cases have been confirmed in the U.S., but there may be many more cases that have gone undetected.
One of the places rationing Jynneos doses is New York City, which has become the epicenter of the national outbreak with about a quarter of all confirmed U.S. cases thus far. San Francisco, Colorado, and Washington, D.C., are now also prioritizing first doses, as is the U.K. The FDA has said it is investigating whether one dose of the Jynneos vaccine offers sufficient protection.
Biden administration officials said last week that the government was releasing nearly 800,000 additional doses — which had been held up in Denmark due to questionable U.S. regulatory delays — on top of the 300,000 doses that have already been shipped to state and local authorities thus far. In accordance with the two-dose guidance, that 1.1 million doses would only be enough for 550,000 people, well short of the at least 1.6 million people in the U.S. whom the Centers for Disease Control has estimated to be at highest risk and is prioritizing with the vaccination campaign. The next shipment of 500,000 doses to the U.S. from Bavarian Nordic, which manufactures the Jynneos vaccine, won’t arrive until the end of October, the company told the Post.
The Biden administration has also said that it has acquired enough raw materials for an additional 11 million doses, should they be needed.
Amid the vaccine shortage, some experts have been pushing for the U.S. to begin encouraging at-risk people who can’t get the Jynneos vaccine to instead get ACAM2000, a smallpox vaccine that the U.S. already has a large stockpile of, but which public-health officials have been reluctant to recommend for monkeypox since it comes with a higher risk of side effects. There is also an antiviral drug, TPOXX, which has shown promise in treating monkeypox infections, but largely thanks to government red tape, it remains very difficult to obtain.
On Friday, New York governor Kathy Hochul declared a state disaster emergency over New York City’s monkeypox outbreak, paving the way for more federal aid. On Saturday, the city itself declared the outbreak a public-health emergency. But there are limits to what any state or local government can do without access to more doses of the vaccine. New York City has been making vaccination appointments available as soon as it has been able to secure new shipments of doses from the federal government, and the slots have been snatched up almost immediately after being posted online.