Failed Monkeypox Vaccine Rollout Now Bringing Fresh Pandemic Threat

While 300,000 doses sat unused in Denmark, signing up for a vaccine in the U.S. was “like getting tickets to Burning Man”
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It was mid-June and New Yorker Mordechai Levovitz started getting texts from friends and former partners: “Hey, I think I have monkeypox. Maybe you should get tested.” This likely seemed surprising because at that point, toward the end of spring, the federal government was reporting only about 20 cases of the novel disease in the U.S. 

About a month later, on July 22, monkeypox would be declared a global pandemic by the World Health Organization.

As Levovitz heard of an increasing number of positive results around him, noting friends reporting intense pain and disruptive, month-long quarantines, he realized, “there was a huge disconnect between our lived experiences and what was being recorded.” He said one friend even ended up in the hospital from the disease, fearing he might go blind from ophthalmic manifestations of the virus.  

Then, when a partner he had been with two days before contracted monkeypox, his scramble for a vaccine revealed an even deeper issue. With the government dropping just a few thousand appointments at a time, slots would fill up almost immediately. 

“It was like getting tickets to Burning Man,” Levovitz said.

Even when he secured an appointment, Levovitz arrived at the facility in Queens to find out it had closed. Though he didn’t ultimately contract monkeypox, he wasn’t able to obtain the JYNNEOS vaccine until over a month after his exposure. 

Meanwhile, the U.S. had 300,000 doses of the JYNNEOS vaccine that remained stored in Denmark, where the producer is headquartered and was waiting weeks to ship them to desperate Americans, according to the New York Times. Dr. Gary Disbrow, a senior official at the Department of Health and Human Services, attributes the government’s lack of action to concerns that vaccines could go to waste if all 300,000 of them were not necessary for this outbreak; as U.S. storage facilities aren’t as cold as those in Denmark, the doses would have to be used more rapidly.

As a result, Levovitz said he never viewed the situation as a vaccine shortage, because they were available. They just weren’t being distributed.

“I didn’t get the vaccine because of those government decisions not to give it to me,” he said.

The 72,000 doses that the government initially ordered at the end of May proved to be far from enough. After later deciding to ship the remaining stockpile, they arrived over a span of two weeks and many didn’t get into the back arms of Americans until July, over six weeks after the first recorded case. This allowed the disease to run rampant through parades and parties for Pride Month during the last weekend in June. 

Now, with monkeypox cases having spread worldwide, including the 4,907 in the U.S. reported to the CDC as of July 28, a shortage of vaccines is proving incredibly problematic as the disease could bring about another global pandemic. Lawrence Gostin, with Georgetown’s O’Neill Institute for National and Global Health Law and director of the WHO’s Collaborating Center on National & Global Health Law, expects that cases will rise because of what he says is a “disaster” of a vaccine rollout—particularly in Los Angeles and New York. 

CEO of the San Francisco AIDS Foundation Dr. Tyler TerMee is seeing the impacts of the shortage firsthand. After launching a monkeypox vaccination program at their sexual health clinic on June 30, the foundation requested 200 vaccines per week; it received 90 in the first distribution. 

Since then, TerMeer said that some weeks’ requests are fulfilled, but it varies. During the week of June 23, the foundation received less than 200. “We are rapidly running out of vaccines on hand for our day-to-day operations,” he said.

Having vaccinated 840 individuals for monkeypox, the waitlist of people eligible to receive the first of two doses that are spaced out by at least 28 days, still leaves 7300 high-risk patients without access to the vaccine. As the foundation works every day to advocate for more vaccines, TerMeer notes a palpable “lack of urgency” from the federal government; he says that this is reminiscent of the HIV crisis in the 80s. While he draws a clear distinction between monkeypox and the epidemic that launched the foundation he helms, TerMeer acknowledges the government isn’t leaning into lessons learned over the last 40 years. 

Though the WHO made its global health emergency declaration last week, Biden has yet to declare a national public health emergency for the U.S. Calling for more globally coordinated action, Gostin said, “The window for containing monkeypox is rapidly closing, if it has not already closed.” 

In an effort to handle the vaccine shortage, the Los Angeles County Department of Public Health limits JYNNEOS vaccine eligibility to people who have had contact with a person with monkeypox, as well as gay or bisexual men and transgender people over the age of 18. While LADPH’s reference to sexuality and gender identity is meant to target higher-risk groups, the singling out of the LGBTQ+ community has been controversial. 

As a black gay man living with HIV, TerMeer notes that for him and others at high risk “a long history of medical harm and mistrust” makes the eligibility requirements potentially stigmatizing. At the same time, because he said vaccines should be going to communities most affected, there is a “very fine line that needs to be walked.” 

Dr. Aftab Khan, who is a board-certified internist at Davenport Medical Center, warns that limiting concerns over monkeypox to the LGBTQ+ community can be harmful from a medical standpoint, as well. Starting his residency in Brooklyn in 1999, he said, he “saw the same thing” in terms of how HIV/AIDS was treated then and how monkeypox is viewed now. Though testing is most common for men having sex with men, Dr. Khan calls it “a disease of anybody.” 

On the other hand, Levovitz, clinical director at Jewish Queer Youth, believes that while the issue of stigma for the LGBTQ+ community is important to consider, vaccines should be directed at men having sex with men and other higher-risk groups. It was Levovitz who jump-started a protest in New York’s Foley Square on July 21 to advocate for more access to vaccines in his community, which gained momentum after it saw the involvement of Prep4All, a nonprofit that aims to put lifesaving HIV prevention medication in the hands of anyone who seeks it out.

Levovitz says that monkeypox has the potential to become a wider pandemic and an even greater issue within the LGBTQ+ community. “The only way we can help everybody is if we stop the epidemic where it is,” he said.

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