In-Depth: Why has monkeypox vaccine distribution been so slow?

Monkeypox California
Posted at 11:09 AM, Aug 17, 2022

SAN DIEGO (KGTV) – San Diego County health officials have asked for more than 26,000 doses of the monkeypox vaccine to deal with the current outbreak. To date, they have received fewer than one-fifth of their request.

Across California, doctors have complained about the slow rollout of a vaccine that was stashed and ostensibly ready to deploy when the first U.S. cases emerged in May.

Logistical stumbles in moving doses from the federal stockpile to states have left clinics with far fewer shots than they need, and little clarity about when more will arrive.

“We need more vaccine and we need it now,” said Dr. Francesca Torriani, program director of clinical epidemiology at UC San Diego Health.

So far, healthcare providers in San Diego County have administered nearly 3,000 doses of the monkeypox vaccine, called JYNNEOS.

With the COVID vaccines, the distribution was managed by the Centers for Disease Control and Prevention using a battle-tested logistics system called VTrckS. The system coordinates billions of doses of annual immunizations, and it allows states to track and reorder supplies.

But with monkeypox, the government is repurposing a shot originally designed for smallpox that was squirreled away in the Strategic National Stockpile. Smallpox was eradicated in 1980, but the U.S. government maintains a supply of the shots in case of a bioterrorism attack.

The stockpile is overseen by a different agency, the Department of Health and Human Services. They use a different logistics system that was not built for ongoing orders of vaccine. State officials have had to track doses manually, and until recently, they had to order them via email, not an automated system.

“States don't really know when vaccines are coming. It's kind of a day-to-day thing. And it's not like the COVID vaccine rollout by a longshot,” said Dr. Peter Chin-Hong, an infectious disease specialist at UC San Francisco.

“Seeing a lot of people with sickness and suffering really makes me feel sad. Because it's something we have the tools to do,” he added. “It really shows us the importance of a system and a well-oiled machine.”

Within California, it is the job of the California Department of Public Health to distribute vaccines to counties, except Los Angeles County which receives a direct supply from the federal government.

As of August 16, San Diego County had been allocated 5,070 doses, fewer than the less-populous counties of Alameda (5,470) and Riverside (5,384). San Francisco County, the site of the first monkeypox cases in California, has received 22,508 doses. Los Angeles County has received 43,282.

“We clearly have not gotten much of that in San Diego, and we need much more,” said Dr. Torriani.

CDPH uses formulas to allocate its supply of monkeypox vaccine to counties. Those formulas look at the reported cases of monkeypox and a second metric: early cases of syphilis among men.

Monkeypox is not classified as a sexually transmitted disease because it can be acquired through other means of close contact, but the virus has been closely linked to sexual activity, primarily among men who have sex with men.

Public health officials believe syphilis cases are a useful proxy for estimating the level of risky sex in a community that would be conducive to monkeypox spread.

“With vaccine that is limited, we don’t want to vaccinate people who are not at high risk for getting infected with monkeypox,” Torriani explained.

But are syphilis cases the ideal metric to direct allocation of this scarce resource? “That’s a subject of debate,” she said.