The U.S. is setting aside an extra 50,000 doses of monkeypox vaccines, specifically for large-scale pride events.
As monkeypox cases surge across the U.S., pressure is mounting on the White House and the CDC to distribute more vaccines. But in many cities, there is still a major shortage.
“States don’t really know when vaccines are coming; it’s kind of a day-to-day thing,” said Dr. Peter Chin-Hong, an infectious-disease expert at University of California San Francisco.
The Biden administration is now dividing up what were previously full doses in order to stretch the limited stockpile. Health care providers are also being encouraged to inject the vaccine just below the skin to stretch doses up to five times.
“Seeing a lot of people with sickness and suffering really makes me feel sad because, again, it’s something we have the tools to do, and it really shows us the importance of a system and a well-oiled machine,” Dr. Chin-Hong said.
It’s a distribution hurdle: With the COVID vaccines, the CDC’s detailed “VTrckS” system allows states to track and reorder vaccine supplies, but with monkeypox, the government is repurposing a shot originally designed for smallpox.
According to CDC data, the U.S. has the most infections of any country — nearly 14,000. About 98% of those cases are men, and about 93% were men who reported recent sexual contact with other men.
Officials announced an extra 50,000 doses of the monkeypox vaccine are being set aside and shipped to various cities ahead of upcoming pride celebrations.
“This is a two-dose vaccine series, and receiving the vaccine at these events will not provide protection at the event itself,” said Dr. Rochelle Walensky, CDC director. “We recognize that there are going to be some people who have traveled to large scale events and that they’re going to have to receive dose one of their vaccine at the event, and then they won’t necessarily receive dose two at their local jurisdiction, and we anticipate that.”
Health officials say the number of doses sent to each location will be based on event size and the number of health workers available to administer shots, as well as the number of attendees considered “high risk” for catching or spreading the disease.
For those living in major cities and are able to travel, one health expert says taking a drive 20 or 30 minutes outside the city may create more luck finding doses in less crowded areas.
In the meantime, the White House says it will continue to stretch a limited supply.
EU authorities could decide “as a temporary measure” to use smaller doses of the vaccine to protect vulnerable people during the ongoing outbreak.
A smaller dose of the monkeypox vaccine appears to still be effective and can be used to stretch the current supply by five times, the European Medicines Agency said Friday, echoing a recommendation made earlier this month by the U.S. Food and Drug Administration.
The EU drug regulator said in a statement that injecting people with just one-fifth the regular dose of the smallpox vaccine made by Bavarian Nordic appeared to produce similar levels of antibodies against monkeypox as a full dose.
The approach calls for administering Bavarian Nordic’s vaccine with an injection just under the skin rather than into deeper tissue, a practice that may stimulate a better immune response. People still need to get two doses, about four weeks apart.
The EMA said national authorities could decide “as a temporary measure” to use smaller doses of the vaccine to protect vulnerable people during the ongoing monkeypox outbreak.
EU health commissioner Stella Kyriakides said the decision would allow the vaccination of five times as many people with the continent’s current supply.
“This ensures greater access to vaccination for citizens at risk and healthcare workers,” she said in a statement.
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Earlier this month, the U.S. FDA authorized a similar plan to extend the country’s monkeypox vaccine stocks. The technique has previously been used to stretch supplies of vaccines during other outbreaks, including yellow fever and polio.
The unusual recommendations from both regulators acknowledge the extremely limited global supplies of the Jynneos vaccine, originally developed against smallpox. Bavarian Nordic is the only company that makes it and it expects to have about 16 million doses available this year. On Thursday, the U.S. also announced a new agreement with a Michigan manufacturer to help speed production of 5.5 million vaccine vials recently ordered by the government.
The EMA authorized the vaccine in July based on experimental data that suggested it would work; the World Health Organization has estimated the shot is about 85% effective at preventing monkeypox.
Globally, there are more than 40,000 cases of monkeypox, of which about half are in Europe. Earlier this week, WHO chief Tedros Adhanom Ghebreyesus said there has been a 20% increase in cases reported in the last two weeks and that nearly all infections have been reported in men who are gay, bisexual or have sex with other men.
Tedros said WHO was in talks with vaccine manufacturers and countries to see if any might be willing to share doses. Africa has reported the highest number of suspected monkeypox deaths and although the disease has been endemic in parts of central and west Africa for decades, it has only a small supply of vaccines being used as part of a research study.
About 98% of monkeypox cases beyond Africa have been reported in men who are gay, bisexual or have sex with other men. WHO said there is no sign of sustained transmission beyond men who have sex with men, although a small number of women and children have also been sickened by the disease.
Monkeypox spreads when people have close, physical contact with an infected person’s lesions, their clothing or bedsheets. Most people recover without needing treatment, but the lesions can be extremely painful and more severe cases can result in complications including brain inflammation and death.
In the U.K., which at one point had the biggest outbreak outside Africa, officials said earlier this week they have seen signs the outbreak is slowing down.
Tecovirimat, or TPOXX, is only FDA-approved for smallpox, though the CDC has lifted requirements so doctors can prescribe it under expanded access.
It’s a long wait for a monkeypox vaccine in San Francisco.
“I arrived here at 7:30 in the morning, so it’s been three and a half hours right now,” said Parind Shah, a San Francisco resident.
The wait for the antiviral drug to treat monkeypox is drawn out, too.
“We don’t have an equitable system to really distribute them because they require so much paperwork,” said Dr. Peter Chin-Hong, an infectious disease specialist at UCSF.
The medication is called tecovirimat, with the brand name TPOXX.
Dr. Chin-Hong cares for severe monkeypox patients.
“It works by the envelope of the virus,” Dr. Chin-Hong said. “It disrupts the envelope. Monkeypox virus is a very straightforward virus. It’s not complicated with spikes like COVID.”
There’s not a shortage of TPOXX, but it’s only FDA-approved for smallpox. For monkeypox, it’s still considered an investigational drug.
The CDC has lifted some requirements, so doctors can prescribe it under something called expanded access. But that involves hours of forms and extra appointments.
Dr. Chin-Hong has seen it deter patients.
“He said, ‘Oh, you know, it’s okay. I don’t want to come in, go through all this paperwork again. I think I’m just going to deal with pain. And you know what? You are asking me too many questions. I’ll let you know if i need it,'” Dr. Chin-Hong said.
The latest CDC data from late July show doctors wrote about 230 TPOXX prescriptions for monkeypox. Since then, cases have more than doubled.
The CDC says monkeypox spreads when a person touches the skin of someone who is infected and is showing symptoms, like sores or scabs. It can also spread through respiratory droplets or oral fluids in close, intimate contact.
You can also get monkeypox from touching recently contaminated clothing or bedding used by an infected person who has symptoms.
“We are seeing lesions erupt that are very small,” said Dr. Jason Farley, infectious disease nurse epidemiologist at The Johns Hopkins School of Medicine. “They’re deeply seated, possibly under the skin, maybe look like a pimple that is forming.”
If you fit any of those descriptions, health experts say call your doctor for a test as soon as you can, because antivirals like TPOXX work best when taken early into illness.
That’s where public health emergencies come in. Declaring one frees up money in reserves that can’t be touched, and HHS rules won’t let providers dip from their COVID emergency funds for monkeypox.
Dr. Chin-Hong says for TPOXX, that means more help on that extra paperwork so he can care for more sick patients.
One is a toddler in California and the other an infant who is not a U.S. resident but was tested while in Washington, D.C., according to the CDC.
Two children have been diagnosed with monkeypox in the U.S., health officials said Friday.
One is a toddler in California and the other an infant who is not a U.S. resident but was tested while in Washington, D.C., according to the Centers for Disease Control and Prevention.
The children were described as being in good health and receiving treatment. How they caught the disease is being investigated, but officials think it was through household transmission.
Other details weren’t immediately disclosed.
Monkeypox is endemic in parts of Africa, but this year more than 15,000 cases have been reported in countries that historically don’t see the disease. In the U.S. and Europe, the vast majority of infections have happened in men who have sex with men, though health officials have stressed that anyone can catch the virus.
In addition to the two pediatric cases, health officials said they were aware of at least eight women among the more than 2,800 U.S. cases reported so far.
While the virus has mostly been spreading among men who have sex with men, “I don’t think it’s surprising that we are occasionally going to see cases” outside that social network, the CDC’s Jennifer McQuiston told reporters Friday.
Officials have said the virus can spread through close personal contact, and via towels and bedding. That means it can happen in homes, likely through prolonged or intensive contact, said Dr. James Lawler, an infectious diseases specialist at the University of Nebraska Medical Center.
“People don’t crawl on each other’s beds unless they are living in the same house or family,” he said.
In Europe, there have been at least six monkeypox cases among kids 17 years old and younger.
This week, doctors in the Netherlands published a report of a boy who was seen at an Amsterdam hospital with about 20 red-brown bumps scattered across his body. It was monkeypox, and doctors said they could not determine how he got it.
In Africa, monkeypox infections in children have been more common, and doctors have noted higher proportions of severe cases and deaths in young children.
One reason may be that many older adults were vaccinated against smallpox as kids, likely giving them some protection against the related monkeypox virus, Lawler said. Smallpox vaccinations were discontinued when the disease was eradicated about 40 years ago.
Monkeypox is spreading in the U.S., with a lack of tests and a disorganized testing system adding to criticism of the country’s response.
A new disease outbreak has been detected on another continent. It has spread to the U.S., where growth has been exponential, especially in New York City. While it’s been two months since the disease was first spotted, the U.S. is struggling to muster the tools it needs to contain the outbreak.
It sounds like where the country was with COVID in March of 2020, but now we’re seeing something similar with monkeypox.
The latest outbreak of the disease has spread to most U.S. states and dozens of countries worldwide.
The U.S. has at least 2,000 confirmed monkeypox cases nationwide, with the official case rate rising more than tenfold in the past month. With a testing shortage, it’s likely that the actual case count is higher.
Though they sound the same, the diseases are a bit different.
COVID currently spreads more easily than monkeypox, as it primarily infects people through airborne transmission. Monkeypox spreads through close physical contact and exchanging of fluids, transmitting and often presenting in ways that can resemble sexually-transmitted illnesses.
And, monkeypox only can spread once a person has symptoms, unlike COVID’s asymptomatic, or pre-symptomatic transmission. Also, unlike with COVID, there is an approved vaccine ready that prevents monkeypox transmission; an existing smallpox vaccine was found to work against monkeypox as well.
There’s also help on the way. The CDC announced last week that it has the capacity for 70,000 monkeypox tests per week and that at least 300,000 shots have been made available to states, with nearly 800,000 more expected to be ready for distribution by the end of this month, according to Health and Human Services.
But the jump from having the tools needed to stop an outbreak to actually using them has proven difficult. Vaccine rollout has been a bit of a mixed bag.
Federal health officials have been working on getting vaccines out to cities and states. But with demand outstripping supply in epicenters like New York City, it’s not a guarantee that everyone who wants, or needs, a monkeypox vaccine can get one.
“We’ll certainly need much more vaccine and quickly to meet the burden of disease here in New York City, the epicenter of the monkeypox epidemic in the United States,” Ashwin Vasan, commissioner of the New York City Department of Health and Mental Hygiene, said. “We share our New Yorkers frustrations with about waiting to make appointments or long lines. Please hear us when we say every action we’ve taken to date has been with one goal in mind: to get vaccine to the city and to get shots in arms as quickly as possible.”
It’s a misstep that has come as the U.S. has had more than two years of experience combatting an existing outbreak and after a year and a half of experience distributing vaccines to slow an outbreak.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and President Biden’s top medical adviser, has acknowledged the response hasn’t been perfect.
“It would have been good to have had a lot more vaccines available early on, but right now we have accelerated that extensively,” Dr. Fauci said. “Could we have done better? Always. You never say we did perfectly.”
In New York, health officials say they will now focus on delivering the vaccine to people who have not received the first dose. But, this puts into question if those who already got the first shot will be at risk of not getting the second dose at all. The second dose of the vaccine is meant to be administered 28 days after the first to be fully effective.
Authorities in New York City are doing this despite advice from the FDA and CDC.
GENEVA, May 27 (Reuters) – Countries should take quick steps to contain the spread of monkeypox and share data about their vaccine stockpiles, a senior World Health Organization official said on Friday.
“We think that if we put in place the right measures now we probably can contain this easily,” Sylvie Briand, WHO director for Global Infectious Hazard Preparedness, told the U.N. agency’s annual assembly.
Monkeypox is a usually mild viral infection that is endemic in parts of west and central Africa.
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It spreads chiefly through close contact and until the recent outbreak, was rarely seen in other parts of the world, which is why the recent emergence of cases in Europe, the United States and other areas has raised alarms.
So far, there are about 300 confirmed or suspected cases in around 20 countries where the virus was not previously circulating. read more
The World Health Organization logo is pictured at the entrance of the WHO building, in Geneva, Switzerland, December 20, 2021. REUTERS/Denis Balibouse
“For us, we think that the key priority currently is trying to contain this transmission in non-endemic countries,” Briand told a technical briefing for member states.
Needed measures included the early detection and isolation of cases and contact tracing, she added.
Member states should also share information about first generation stockpiles of smallpox vaccines which can also be effective against monkeypox, Briand said. read more
“We don’t know exactly the number of doses available in the world and so that’s why we encourage countries to come to WHO and tell us what are their stockpiles,” she said. A slide of her presentation described global supplies as “very constrained”.
Currently, WHO officials are advising against mass vaccination, instead suggesting targeted vaccination where available for close contacts of people infected.
“Case investigation, contact tracing, isolation at home will be your best bets,” said Rosamund Lewis, WHO head of the smallpox secretariat which is part of the WHO Emergencies Programme.
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Editing by Andrew Heavens
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JOHANNESBURG — The detection of the Omicron variant in southern Africa signals the next stage of the battle against Covid-19: getting many more people inoculated in poorer nations where vaccines have been scarcest in order to deter new mutations from developing.
But while world leaders sometimes talk about this as if it were largely a matter of delivering doses overseas, the experience of South Africa, at least, hints at a far more complex set of challenges.
Like many poor countries, South Africa was made to wait months for vaccines as wealthier countries monopolized them. Many countries still do not have anywhere near enough vaccines to inoculate their populations.
The problems have not ended as shots began arriving in greater numbers.
Neglected and underfunded public health infrastructure has slowed their delivery, especially to rural areas, where storage and staffing problems are common.
turned away shipments of doses from Pfizer-BioNTech and Johnson & Johnson, worried that their stockpile of 16 million shots might spoil amid insufficient demand.
Dr. Saad Omer, a Yale University epidemiologist, and they have had a deeper effect.
have said. In several countries, fewer than half say they intend to get vaccinated.
sometimes-violent resistance in rural communities. Vaccine hesitancy rates there approach 50 percent among those who have not completed high school.In some parts of the country, more than a third of doses spoil amid the low demand.
Still, many are eager to be vaccinated. When doses first became widely available in South Africa earlier this year, a third of the country’s adults swiftly got inoculated, a pattern that is repeating elsewhere.
allegations of corruption amid last year’s lockdown, have heightened public unease.
“There’s a lack of confidence in the public health system’s ability to provide vaccines,” said Chris Vick, the founder of Covid Comms, a South African nonprofit group.
The group has been holding vaccine information sessions, but overcoming skepticism is not easy. After a session in the Pretoria township of Atteridgeville, one 20-year-old who attended said she had not been persuaded.
briefly pause delivery of the Johnson & Johnson vaccine, leading South Africa to delay its rollout to health care workers. Both countries decided to resume the shots after concluding that they were safe.
The South African government held regular briefings, but these were on television and in English, when radio remains the most powerful medium and most South Africans do not speak English as their mother tongue.
a recent study found. That is in part because of mistrust of the Black-led government, but also because American Covid conspiracists have found wide reach among white South Africans on social media, according to Mr. Vick of Covid Comms.
Covid pill from Merck for high-risk adults, the first in a new class of antiviral drugs that could work against a wide range of variants, including Omicron. The pill could be authorized within days, and available by year’s end.
The first modern, worldwide campaign, begun in 1959 against smallpox, provoked deep skepticism in parts of Africa and Asia, where it was seen as a continuation of colonial-era medical abuses. Some W.H.O. officials used physical force to vaccinate people, deepening distrust. The campaign took 28 years.
The effort to eradicate polio, which finally ramped up in poor countries in the 1980s and is still ongoing, has run into similar resistance. A study in the science journal Nature found that vaccine avoidance was highest among poor or marginalized groups, who believed that the health authorities, and especially Western governments, would never voluntarily help them.
In Nigeria in the early 2000s, amid a spike in religious tensions, unfounded rumors circulated that foreign health workers were using polio vaccines as cover to sterilize the country’s Muslim population. Boycotts and local bans led to a polio resurgence, with cases spreading to 15 other countries, as far as Southeast Asia.
survey by the Africa Center for Disease Control found that 43 percent of those polled believe Africans are used as guinea pigs in vaccine trials — a legacy of Western drug companies’ doing exactly this in the 1990s.
Even within their own borders, Western governments are struggling to overcome vaccine resistance. So it is hard to imagine them doing better in faraway societies where they lack local understanding.
Any appearance of Western powers forcing unwanted vaccines into African or Asian arms risks deepening the backlash.
“If the objective is to keep the U.S. and the rest of the world safe, it should be pretty obvious that the success of the domestic program depends on what happens internationally,” Dr. Omer said.
To some, Alaska’s announcement that it would try to entice travelers by offering Covid-19 vaccinations at its airports might signal the state’s plucky resolve and determination to revive a tourism industry that has been devastated by the pandemic.
To others, it’s a sign of everything that is wrong with the way that the United States is distributing its vaccines, as calls for more doses in surge-stricken Michigan are rebuffed.
“It’s hard for me to believe that we’ve so maldistributed a vaccine as to make this necessary,” said Dr. Larry Brilliant, an epidemiologist who was part of the effort to eradicate smallpox in the 1970s. “You don’t want to exchange a bad carbon footprint for a vaccination.”
Starting on June 1, any tourist traveling to Alaska will be able to receive a Pfizer or Moderna vaccine at the Anchorage, Fairbanks, Juneau or Ketchikan airports. It’s part of a larger multimillion-dollar marketing campaign, funded by federal stimulus money, to attract tourists back to the state, Gov. Mike Dunleavy of Alaska, a Republican, announced.
news conference on Friday.
Alaska is the latest state to announce plans to extend vaccine eligibility to nonresidents as production and distribution have increased around the country. Twenty-one other states do not have residency requirements for vaccination, according to the Kaiser Family Foundation.
Some U.S. experts have worried for months about the growth in “vaccine tourism” — Americans crossing state lines to get a vaccine where there are excess doses. Virologists like Dr. Brilliant say that rather than incentivizing people to fly to Alaska to get a shot from the state’s abundant vaccine supply, doses should be redistributed to states most in need and no longer be allocated strictly by population.
Alaska is not lacking vaccines, said Heidi Hedberg, the state’s director of public health. Health administrators will begin the airport vaccine program for tourists at the Ted Stevens Anchorage International Airport, with a five-day trial at the end of April to gauge interest. Some visitors may have to get their second dose of mRNA vaccines in their home states, depending on how long they remain in Alaska.
Almost 40 percent of Alaskans have received at least one dose of a coronavirus vaccine, according to a New York Times database. Thirty-two percent of the state’s population is fully vaccinated. The state has used 68 percent of its doses.
first state to open up vaccine eligibility to anyone 16 or older living or working in the state, on March 9. At the time of the announcement, Alaska had the highest vaccination rate in the country.
What You Need to Know About the Johnson & Johnson Vaccine Pause in the U.S.
On April 13, 2021, U.S. health agencies called for an immediate pause in the use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the United States developed a rare disorder involving blood clots within one to three weeks of vaccination.
All 50 states, Washington, D.C. and Puerto Rico temporarily halted or recommended providers pause the use of the vaccine. The U.S. military, federally run vaccination sites and a host of private companies, including CVS, Walgreens, Rite Aid, Walmart and Publix, also paused the injections.
Fewer than one in a million Johnson & Johnson vaccinations are now under investigation. If there is indeed a risk of blood clots from the vaccine — which has yet to be determined — that risk is extremely low. The risk of getting Covid-19 in the United States is far higher.
The pause could complicate the nation’s vaccination efforts at a time when many states are confronting a surge in new cases and seeking to address vaccine hesitancy.
Johnson & Johnson has also decided to delay the rollout of its vaccine in Europe amid concerns over rare blood clots, dealing another blow to Europe’s inoculation push. South Africa, devastated by a more contagious virus variant that emerged there, suspended use of the vaccine as well. Australia announced it would not purchase any doses.
The United States has continued to speed up vaccination efforts, and is now averaging 3.2 million doses a day, up from roughly two million a day in early March. The Centers for Disease Control and Prevention said on Saturday that about 129.5 million people had received at least one dose of a Covid-19 vaccine.
Dr. Brilliant said states like Michigan, the center of the country’s worst surge, should be receiving larger allocations of doses.
The Biden administration and Gov. Gretchen Whitmer of Michigan, a Democrat, have been at odds over her calls for an increase in her state’s vaccine supply. But the Biden administration held fast to distributing vaccines by state population, not by triage.
“The vaccine should go where it will do the most good,” Dr. Brilliant said. “Given the scarcity of vaccine in the world, every dose should be given in a way that is most effective at stopping this pandemic.”
But the issue could be moot by the time that Alaska’s tourist vaccination programbegins in earnest on June 1: most Americans who want to be vaccinated might already have received at least one dose by then, said Dr. Peter Hotez, a vaccine scientist at the National School of Tropical Medicine at Baylor College of Medicine in Houston.
“We’re going to reach a point where people don’t need to fly to Alaska to get vaccinated,” he said. “I think it’s going to be more of the case that, here’s an opportunity to visit Alaska and it’s convenient to get vaccinated.”
BERKELEY, England — It has been called the birthplace of modern vaccination.
More than 220 years ago, the residents of an English village lined up outside a small wooden hut to have their arms scratched with a lancet as they were given the first vaccine for smallpox.
The pioneering local doctor administering the vaccine, Edward Jenner, called the modest building in his garden the “Temple of Vaccinia,” and from this place grew a public health movement that would see smallpox declared eradicated globally by 1980.
But a new scourge has left this place — where the gnarled wooden walls of Dr. Jenner’s hut still stand at a museum at the home and garden dedicated to his legacy — shuttered to the public, its future on shaky ground. Even as Dr. Jenner’s work was cited time and again as the world raced toward a coronavirus vaccine, the museum at his former home has struggled to survive.
“I think the issue has been an underfunding of museums for many, many years in this country,” said Owen Gower, the manager of Dr. Jenner’s House, Museum and Garden. “Covid has really shone a light on those problems, as it has with so many different issues.”
built upon a technique called variolation that was practiced in Africa and Asia for centuries, and his approach also leaned on local knowledge. His vaccine used samples of the milder disease cowpox — as it was long known in his rural community that women who were exposed to that illness in dairies were immune to smallpox.
nations scramble for limited vaccine supplies and anti-vaccine campaigns take root, the story behind how we got here is more important than ever.
“He did remarkable things — and the number of lives saved and changed as a result of vaccination — it all started here,” Mr. Gower said. “But I think it’s also the idea that it’s not just something of the past, it’s something that is ongoing.”