Feds promise more monkeypox vaccine for Philly region soon

After Philadelphia health officials warned that a federal decision to deliver only a fraction of the monkeypox vaccine originally promised could derail efforts to contain the fast-spreading virus, federal officials said Wednesday that more supplies are on the way.

The Administration for Strategic Preparedness and Response (which handles national vaccine distribution) on Monday, alerted states, large cities, and territories that they would receive just a fifth of the number of vaccine vials they were promised.

After announcing last week that vaccine administrators could give a fifth of a dose through the skin with the same effect as a full dose, federal health officials worried that some parts of the country may end up with too much vaccine, while others wouldn’t have enough. The smaller deliveries of vaccine doses will give the agency time to ensure doses are being distributed equitably, a senior official with the agency said on condition of anonymity.

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The agency plans to begin shipping more vaccine doses by the end of August.

Philadelphia-area health officials said the move could jeopardize their efforts to contain the virus. There are 13,500 confirmed cases nationally, with about 800 new cases a day.

“I’ve been very hesitant criticizing agencies I know have a very difficult job,” said Philadelphia health department chief Cheryl Bettigole. But “I felt like we had made a promise to Philadelphians and to the communities that were most impacted we were going to have more vaccine.”

Philadelphia is now expected to receive just 720 vials this week, instead of the expected 3,612 vials.

Bettigole questioned why Philadelphia — a city with documented shortages — had to lose its allocation because of logistical concerns in other parts of the country.

The federal health official acknowledged the vaccine scarcity in Philadelphia, which is made worse by the fact that it’s unlikely each vial will actually yield five smaller shots, he said.

The smaller doses are injected directly into the skin to prompt an immune response similar to the larger dose amounts injected under the skin. People prone to keloids, permanent scarring on their skin, won’t be eligible for those shots. Children aren’t either. The kind of needle used could also mean providers get fewer than five doses out of a vial.

“The reduced numbers being delivered will create challenges in meeting ... demand, which remains high,” said Nancy Kearney, a spokesperson for the New Jersey Department of Health.

The Pennsylvania Department of Health was less concerned about the smaller allocation, saying it is ending up with the same number of doses originally planned -- if they shift to the smaller doses.

“There have been technical issues along the way, as expected with any new system, but Pennsylvania continues to partner with the federal government in order to ensure vaccine is received and delivered to residents who need it,” a spokesperson from the state office said.

Health-care providers, meanwhile, are struggling to keep up with the protocol changes.

“It’s pretty grim,” said Dusty Latimer, a nurse-practitioner at the Mazzoni Center, an LGBTQ-focused Philadelphia health center. “We’re in this kind of constant shuffle.”

Jay Kostman, a doctor at Philadelphia FIGHT, another LGBTQ-focused health provider, said his staff was still training to administer the smaller shots, and this week’s announcement only increased confusion for patients who are clamoring for vaccine.

“It’s a logistical complication, just being able to give people information that’s correct,” he said.

Monkeypox has not been fatal to anyone in the United States, but it causes rashes and lesions that can be extremely painful, infectious, and can last up to a month. The virus is transmitted through skin-to-skin contact, and is not a sexually transmitted disease. Still, most cases in the U.S. during the two-month outbreak have been among men who have sex with men. Some transgender and nonbinary people, as well as sex workers, are also considered at high risk and are eligible for vaccination in Philadelphia.

A supply of 300,000 to 350,000 vials of the monkeypox vaccine JYNNEOS should be available nationally by late August, and possibly sooner, the senior federal health official said.

It was unclear, though, how many doses would be sent to Philadelphia, Pennsylvania, and New Jersey — or when they would arrive.

Case counts heavily influence national vaccine allocation, though an area’s population of at-risk people is also taken into account. Some jurisdictions that initially had larger case counts, but smaller at-risk populations, would receive far more vaccine than needed. There has also been a problem receiving data on vaccine use, the senior official said, with the agency not clear on how much of the shipped vaccine was getting used.

The uncertainty has upended Philadelphia’s plan to make it easier for people at high risk of exposure to get vaccinated. Bettigole acknowledged the monkeypox vaccine has not been distributed equally throughout the city, though the health department has yet to release specific demographic information.

“This is why I’m saying we have to have community partners to work on this,” Bettigole said. It’s hard to establish such partnerships, though, when there is such a short supply of vaccine doses, she said.