White House strategy on monkeypox vaccine causing ‘chaos in the field’

These officials have had to scramble to reorganize vaccination efforts, canceling clinics, rescheduling staff and delaying plans to expand entitlements.

When, The federal government allowed states to order more vaccines on Monday, but states warn they still don’t have enough to contain the rapidly spreading outbreak that has infected nearly 16,000 people. As public health experts fear, ever people window of opportunity Closed to stop the spread of the virus.

“The federal government applauds us for accelerating vaccine delivery,” said Patrick Ashley, senior deputy director of the Department of Health in Washington, DC. “What they did was move the numbers.”

In Washington, D.C., which has more monkeypox cases per capita than anywhere else in the United States, health officials expected a new dosing strategy (injecting small doses of the vaccine into the outer layer of the skin) could grow by 12,000 vials. rice field. They were promised 60,000 doses. Instead, I received 2,400 vials, one-fifth of the original number. And when the latest vaccine allocations were made earlier this week, about 4,000 vials were allocated.

DC has just over half of the expected vials left. And healthcare providers can “only occasionally” get five doses out of the vial for her, Ashley said.

This comes amid widespread criticism of the administration’s response to monkeypox, messages to the LGBTQ community about the risks of the virus, and its failure to supply enough vaccines to immunize the most susceptible. It’s the latest issue.

“I was frustrated this week just thinking I was getting a certain amount, but not much and I wasn’t getting that many doses from the vial. State and Territory Health Officials: “This will probably cause chaos on the field as people have run away.”

Federal health officials stress that this is not a static public health response and say they are continuously coordinating with states and cities to ensure needed vaccines.

“We are working very hard to make sure that more supplies are available when you are in a supply-constrained environment,” a senior government official told POLITICO, adding that the administration’s monkey He spoke on condition of anonymity to discuss sensitive details of the pox response. .

States are being sent vaccines based on a five-dose-per-vial calculation, The administration recognizes that some practitioners have not received all five doses and is encouraging states to submit data on vaccine administration so that responses can be adjusted as needed. .

Nonetheless, some public health experts have criticized the federal immunization strategy forcing state and local health departments to scale back vaccine coverage when they should have increased it. .And some people think that this approach is widen an already deep racial divide For monkeypox, blacks and Latinos have higher rates of skin disease that are not candidates for intradermal administration than whites.

“The move to intradermal was intended to increase supply so public health officials could quickly extend protection to as many people as possible,” said a senior research fellow at the Johns Hopkins Center for Health Security. Kaitlyn Rivers said. Instead, “state and local health departments and their membership are shrinking.”

In Seattle, health officials limited the number of scheduled first doses and delayed second doses. The Portland, Oregon, health department warns that supplies are “still very limited.”And in Philadelphia, city officials Plans they made to significantly ramp up their vaccine business in preparation for the switch to intradermal administration were scrapped.

“Our plan was that we were ready to do this massive expansion, so we called everyone back and said, ‘Put it on hold. We’re not getting any additional doses with this. Philadelphia Public Health.’ Agency spokesperson James Gallow said that since they receive the same amount of dose, they should be used in such a split. has not done so.”

and federal health officials make Additional 360,000 vials, or up to 1.8 million doses, can now be ordered by states on Monday. This is ahead of schedule and only a fraction of the vials we expected a week ago.

“The challenges we are most concerned about are [is] It’s a total limitation of the vaccine supply,” said Jess Nelson, spokesperson for the Washington State Department of Health.

Federal health officials say they are trying to respond quickly to a rapidly changing situation. They say the new split-dose strategy and accompanying policy changes are necessary steps to respond to evolving outbreaks with limited vaccine supplies.

the plan is Based in part on a 2015 study According to the National Institutes of Health, two doses of a one-fifth vial of monkeypox vaccine between layers of skin have been shown to be at least as effective as a single vial of subcutaneous injection. rice field.

Last week, the federal government began sending vaccine orders to states based on the calculation that there should be five viable doses in each vial. You cannot order additional vaccines until you have used

In some regions, practitioners say deployments are working as planned.

Across Los Angeles, St. John’s Community Health is delivering hundreds of vaccine doses per day under a new strategy in clinics in black and Latinx neighborhoods disproportionately affected by the outbreak.

Jim Mangia, president and CEO of St. John’s, said clinic staff were already familiar with the technique of tuberculosis testing that was also performed, making the transition to intradermal administration easier. He also said that he has a syringe with a suitable specialized needle on hand, so he consistently extracts five doses per vial. It leaves a small amount of vaccine after administration, making it difficult to get the full 5 doses from each vial.)

“This is a complete game changer,” says Mangia. “This allowed us to vaccinate more than 1,500 people last week.”

In other clinics where staff were not trained in intradermal administration, Or if you don’t have the right needle on hand, it’s getting harder to keep up with changing federal guidance.

North Carolina will require all practitioners to switch to intradermal administration next week, and UNC hospitals will have to wait until the deadline to administer the vaccine, said David Wohl, professor of infectious diseases at UNC College of Medicine. He said he was “hurrying” to train his staff. .

“Is it impossible? No,” said Wall. “Another set of hoops we have to jump over? Yes.”

Some local health officials and providers are particularly concerned about the impact of the new federal vaccine allocation strategy for black and Latino men, who account for the majority of known monkeypox cases in the United States. However, they are the least likely to be vaccinated.

Wall thinks intradermal administration might work, but he wonders if the sudden change is providing communities of color with inferior vaccines.

“People get annoyed when we change things in the middle of the course, move the goalposts, change the rules of the game,” he said. in, ‘Wait a minute, you’re reaching out to the black and Latinx community right now, and you’re giving us a fifth of what you gave white people? What’s wrong?'”

Given that some people, including those with a history of keloid scarring, may not be able to administer the vaccine intradermally, the new federal allocation strategy assumes states can obtain five doses from each vial. Keloids are more common among dark-skinned people of African, Asian and Hispanic descent. Skin condition 4.5-16%.

People with a history of keloid scars can get the monkeypox vaccine, but one-fifth the dose is not enough. He said it wouldn’t be a problem.

“In Philadelphia, according to the data we just released, the majority of our cases are black Philadelphians who are more likely to have keloids and therefore the best way to manage it. “I don’t want to say, ‘Well, I just can’t get it right now.'”

The administration says it will work with states to coordinate vaccine orders if they need to administer a large number of full doses.

And since the Food and Drug Administration cleared the vaccine for emergency use earlier this month, the Centers for Disease Control and Prevention has been training providers on how states and cities administer new doses and holding training calls with practitioners. We have released useful information for

Claire Hannan, Executive Director of the Immunization Administrators Association, said: