San Francisco Chronicle - (Sunday)
What’s driving monkeypox vaccine shortage
The monkeypox outbreak across the country prompted San Francisco officials to declare a state of emergency, as the city’s LGBTQ residents wait in hours-long lines to get a vaccinination, sometimes to be told there isn’t any left.
But a vaccine for the disease has existed since 2019. So why is it in such short supply?
Officials in San Francisco and California say they are at the mercy of the federal government because it orders and distributes the vaccine. Both have say they are continuing to ask the federal government for more doses.
U.S. Department of Health and Human Services Secretary Xavier Becerra said his department is doing everything it can to increase the national supply of the vaccine, and that doses now available “are the result of years of federal investment and planning.”
The federal government already had some vaccine ready to go when the outbreak began — it already owned thousands of doses of the Jynneos vaccine in case of a smallpox outbreak. Bavarian Nordic in Denmark produces the Jynneos smallpox vaccine that can be used against monkeypox, and the U.S. government has been working with Bavarian Nordic on it since 2003.
When the current U.S. monkeypox outbreak began, the federal government had only 2,400 doses of the Jynneos vaccine in its national stockpile, the Health and Human Services Department said. It requested another 36,000 doses from the manufacturer on May 20.
On May 23, President Biden told reporters that the U.S. had enough vaccine “to deal with” the monkeypox outbreak. At that time, there were only two cases reported in the U.S., according to the Centers for Disease Control and Prevention.
Michael Rouppet of the Harvey Milk LGBTQ Democratic Club holds a sign urging increased monkeypox vaccine production during a protest outside the San Francisco Federal Building.
On June 10, the federal government ordered another 36,000 doses. Later in June, the U.S. ordered 300,000 more to be shipped in June and another 500,000 to be produced, according to the Health and Human Services Department.
All told, the federal government said it had ordered 5 million additional vaccine doses since the start of the outbreak in May, which would bring the total supply to 6.9 million, with the doses becoming available in phases through mid-2023.
But much of what has been ordered still needs to be manufactured in Denmark, slowing how soon the doses will be able to get to local jurisdictions. Only Bavarian Nordic manufactures Jynneos.
That means what’s currently available falls well short of what several cities, including San Francisco, have ordered. City officials said Friday they
have received about 12,000 doses of the vaccine, though they have requested 35,000. Mayor London Breed said that the actual need is closer to 70,000.
While there is seemingly not much the federal government can do at this point to speed up that manufacturing, many people have argued that it should have acted more quickly when monkeypox started circulating more widely in late May.
Dr. Monica Gandhi, an infectious disease expert at UCSF who specializes in HIV, wrote in an opinion piece for The Chronicle on Friday that “the U.S. is still woefully behind in procuring adequate vaccine supplies” for monkeypox despite early calls for more action.
Gandhi wrote in June for the Atlantic magazine that the “U.S. is underreacting to the monkeypox outbreak,” criticizing the Centers for Disease
Control and Prevention for not doing more to offer the smallpox vaccine more widely for use against monkeypox.
“Given that a vaccine is available for the infection — and can be targeted toward the people most at risk—publichealth authorities and healthcare providers need to move more quickly and forcefully to change the outbreak’s trajectory,” she wrote in June.
In early July, Bay Area officials criticized the federal government for not prioritizing the distribution of the monkeypox vaccine the same way that they did the COVID-19 vaccine when it became available. LGBTQ groups like the San Francisco AIDS Foundation have been ringing the alarm on monkeypox since May.
State Sen. Scott Wiener, who is gay, criticized the federal government’s early response as sluggish. Earlier in July, he called the vaccine shortage “avoidable” saying experts had warned about the potential for monkeypox to spread.
“Then a vaccine was developed in 2019 and instead of ordering a massive amount of vaccines, it was ignored,” he said.
Many officials have likened the federal response to that of the AIDS crisis in the 1980s.
“Gay and bisexual men are once again being failed by our federal government,” Supervisor Rafael Mandelman, who is gay and represents the city’s Castro district, said at a media briefing this month. “Would monkeypox receive a stronger response if it were not primarily affecting queer folks?”
For its part, the federal government has said “aggressively responding to the monkeypox outbreak is a critical priority,” noting that the FDA expedited inspections to make the vaccine available more quickly “soon after it learned of the first monkeypox case in the U.S.”
“Within days of the first U.S. case, we activated a multipronged response, significantly increasing vaccine supply and distribution, expanding access to tests, making treatments available for free, and educating the public on steps to reduce risk of infection,” Becerra said in a statement this week.
“We will continue to accelerate and strengthen our response in the coming days, and will work with partners on the ground, in the community, and internationally to combat this virus and protect those at risk,” he said. “I applaud the entire FDA team for their tireless work in making this additional vaccine available as quickly as possible while ensuring it meets the highest standards of quality and safety.”