Biden administration to widen access to monkeypox vaccine

The Biden Administration announced Tuesday that it will broaden availability of monkeypox vaccine as it attempts to contain a growing outbreak of the disease.

In addition to offering vaccine to people who have had known exposure to the virus, federal health officials said they will make vaccine available to men who have sex with men who have had multiple recent partners in venues where it is known monkeypox virus was spreading or in a geographic area where monkeypox is transmitting.

When vaccine supplies are more robust, the response may shift to a pre-exposure approach, Rochelle Walensky, director of the Centers for Disease Control and Prevention suggested.

“As soon as we have more vaccines available, we will of course continue to expand from a post-exposure prophylaxis strategy ideally to a pre-exposure prophylaxis strategy,” Walensky said during a media briefing organized by the White House. “I do think it would be wise to address that expansion at a time when we have more vaccine so we can really follow where the outbreak is densest.”

Jennifer McQuiston, deputy director of the CDC’s division of high consequence pathogens and pathology, explained the change in the vaccine availability protocol as effectively redefining who qualifies as a contact of a monkeypox case.

“We’ve always wanted to recommend vaccine to known contacts of monkeypox cases. But in a setting where you may not be able to actively or expediently identify all contacts, we’re considering as contacts people who may have had the type of exposure recently that would put them at high risk for monkeypox,” she said. “Whether they participated at a party or a venue where monkeypox was known to spread, but we can’t trace them, we recommend they come in for a vaccine.

The current outbreak, first detected in mid-May, has now spread to at least 49 countries, with more than 4,700 monkeypox cases reported so far. In the United States, 306 cases have been detected in 27 states and the District of Columbia.

Initially the U.S. response followed a ring vaccination model, where public health officials interviewed people with monkeypox to find out whom they had had high-risk contact with, then reached out to those individuals to offer them access to vaccine. Several other jurisdictions, including the Canadian provinces of Quebec and Ontario, as well as the United Kingdom, have been offering vaccine more broadly in a bid to stop spread of the virus, making vaccine available to men who have sex with men or men who have sex with multiple and-or anonymous sexual partners.

Monkeypox is a milder relative of the smallpox virus, a scourge that was declared eradicated in 1980 by the World Health Organization after a multi-year global campaign. Smallpox remains the only human virus to have been driven out of existence.

The virus, which is contracted mainly through contact with infectious lesions, initially causes fever and fatigue. But after a few days, lesions develop. They can spread widely across the body, including on the palms of the hands and soles of the feet. But in this outbreak, many cases report lesions primarily in the anogenital area.

Because of the genetic similarities of the two viruses, drugs and vaccines that were developed for smallpox are effective against monkeypox. The United States has supplies of two monkeypox vaccines, Jynneos, which is made by Bavarian Nordic, and ACAM2000, an older vaccine that can cause significant side effects and cannot be given to people who are immunosuppressed, have chronic heart failure, have eczema or are pregnant or breastfeeding.

David Boucher, director for infectious diseases preparedness and response in the Department of Health and Human Services, said the country currently has 56,000 doses of the Jynneos vaccine — enough to vaccinate 28,000 people. In the coming weeks, the country will receive another 240,000 doses from Bavarian Nordic. 

The vaccine can be given in the two weeks after exposure to prevent or mitigate disease. The vaccine is given in two doses, 28 days apart.

HHS expects more than 750,000 additional Jynneos doses to be made available over the summer, with 500,000 doses more to be released by the company throughout the fall, for a total of 1.6 million doses available this year.

The available Jynneos vaccine doses will be allocated in a tiered approach that prioritizes jurisdictions with the highest numbers of cases.