Feds slash Philly’s monkeypox vaccine supply, forcing a scramble to keep providing doses

Philadelphia’s plans to expand access to monkeypox vaccine have been thrown into disarray by a federal decision to give the city just a fifth of the supply it was expecting.

The state is getting 1,520 vials, instead of the 7,560 it expected. Federal authorities have said it will provide additional educational support, vaccines, and treatments, a state health department spokesperson said.

The city learned late Monday of the decision to allot just 720 vials of the monkeypox vaccine JYNNEOS, instead of the expected 3,612. The news forced health officials to scuttle plans to make vaccine available to anyone at high risk of exposure to the virus, said Cheryl Bettigole, the city’s health commissioner. People who have already been exposed to the virus will continue to be the priority, she said. It’s unclear when the 720-vial shipment of vaccine is arriving, though it is expected soon. Officials also don’t know when the city might be allocated more.

Philadelphia vaccine providers must now adhere to a Food and Drug Administration strategy to conserve doses by administering a dose a fifth the volume of what had been recommended. The smaller doses can cause a similar immune response to a full dose if injected into the top layer of skin, rather than beneath the skin. The city had hoped to use that dosing strategy — along with the larger allocation — in order to expand eligibility to everyone considered at high risk. But giving Philadelphia just one-fifth of the volume of vaccine it had expected means that even with the dose-stretching technique, there isn’t enough vaccine for everyone who should get it. Providers have been turning away patients trying to get vaccinated against a disease that usually is not fatal, but which can be extremely painful.

“The whole discussion was expanding the vaccine to vaccinate many more people,” Bettigole said. “The larger scale, more preventative vaccination campaign we were hoping to move to, we’re not in a position to do that.”

» READ MORE: Monkeypox vaccine limits cause frustration and fear in Philadelphia

It was unclear Tuesday if Philadelphia’s experience reflected the vaccine distribution policy nationally, though some 20 states have reported a variety of problems with getting doses, the New York Times reported. A spokesperson at The Centers for Disease Control and Prevention said she had not heard about a change in Philadelphia’s distribution and was seeking more information. A local spokesperson for the Department of Health and Human Services, which oversees the Administration for Strategic Preparedness and Response, which notified the city of the shipment change, forwarded a request for comment to the department’s national office.

New Jersey’s health department did not respond to questions about whether its vaccine allocation was similarly changed.

The city was in the process of introducing a plan to administer the smaller doses, and had even found a supply of needles needed for the intradermal injections. Some people with certain skin conditions or who are more prone to scarring would potentially receive permanent blemishes from an intradermal injection, and may still need a subcutaneous injection — meaning they need a full-volume dose.

“Even with the intradermal strategy we don’t have any more doses than we previously had,” Bettigole said. “We might in fact have fewer.”

Bettigole has estimated the city would need roughly 24,000 vaccine doses to give two shots, the recommended series, to every person at high risk of exposure in the city.

As of Monday, Philadelphia reported 198 cases of monkeypox, an increase of 70 cases from a week before. It has just over 1,000 doses available to be administered. Philadelphia accounts for almost half of all the monkeypox cases in Pennsylvania, according to CDC data. There have been more than 12,600 cases of the virus reported nationally.

Monkeypox has not been fatal to anyone in the United States, but it causes rashes and lesions that can be painful, infectious, and can last for as long as a month. The virus is transmitted through skin-to-skin contact with these blemishes, 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.

Health experts have repeatedly said containing monkeypox effectively would require getting vaccine to people who are more likely than others to be exposed to the virus, not just those who have already encountered it. The high risk category includes men over 18 who have recently had multiple or anonymous sexual encounters with other men, some transgender and nonbinary people as well as sex workers. All of those at risk can’t count on getting vaccinated given the shortage of doses.

“Getting a vaccine appointment is like hitting the lottery,” said Michael LeVasseur, a Drexel epidemiologist whose research areas include health disparities among sexual and gender minority populations. “It’s like the Hunger Games.”

The city health department is working on a new vaccine distribution plan, Bettigole said, and has notified LGBTQ-focused health providers that have also been administering vaccine doses of the cut in supply. Giving the smaller doses properly requires special equipment and training, but the city is asking providers to do so as soon as possible. It is also asking federal authorities to allocate more vaccine to the city.

“This is far from ideal in the midst of an outbreak,” Bettigole said in a statement Tuesday. “However, with no guarantee of additional doses before September, we see no other choice.”

Staff writer Justine McDaniel contributed to this story.