In addition, there is little experience with the vaccine known in the USA as Jynneos, which is used against this disease. It was only approved by the U.S. Food and Drug Administration in 2019, primarily to prevent smallpox in case the virus — which was sidelined by a previous vaccine but kept in two labs — is ever used as a biological weapon became. Jynneos has undergone human safety studies but has never been tested for its effectiveness against monkeypox in humans; these estimates are based on animal studies. It was never commercially available in the US but was instead kept in the National Strategic Stockpile as a safer alternative to this older smallpox vaccine, which can cause dangerous reactions in people with compromised immune systems. It has only been released to health officials in the rare cases where an infected traveler accidentally carried the virus to the United States.
As a result, “we don’t have an estimate of vaccine efficacy given the routes of transmission we’re dealing with, which are very different from the routes of transmission we see traditionally,” says Rimoin.
Now, of course, Jynneos is being given everywhere, but it’s too early to draw any conclusions about how much immunity these shots generate. The vaccination campaign has been uneven: Initially, there was such great demand in major coastal cities that men queued for hours, online appointment dashboards filled in minutes, and clinics held back the second dose to secure immunity to extend supplies. In response, the White House proposed a dose-sharing strategy that increased availability, but at the expense of a different injection technique that some healthcare workers were unfamiliar with. Now clinics in cities devastated by the first wave, like New York, are regularly posting thousands of new appointments and can give second doses.
In some areas there may even be oversupply. “Our demand has decreased significantly,” says Philip Huang, physician and director of the Dallas County, Texas Department of Health and Human Services. “We have free appointments every day. We give second doses.”
Health departments based their appointment offers and vaccine allocation requests on their sense of how many men who have sex with men live in their communities, so these open appointments suggest anyone who is eligible for protection may not be getting it. They may not know they are at risk, they fear the stigma of stepping up, or they may not know the vaccine is available because overworked public health departments don’t have the time or staff to craft accurate messages to hard-to-reach groups . “We are still in an active public health emergency, pandemic response, and our Department of Health staff are wearysays Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.
And in a White House briefing this morning, federal health officials acknowledged that those departments don’t have enough money to craft their campaigns, and in some cases are shifting money from HIV and STD programs to pay immunization staff and advance education. “Our local jurisdictions have not received resources specifically for monkeypox,” CDC Director Rochelle Walensky said. “It speaks to the need for additional funds.”