The Biden administration’s plan to stretch the available supply of monkeypox vaccines to accommodate the overwhelming demand is running into problems. The strategy was to fractionalize doses so that healthcare workers can administer five doses from one vial of the approved Bavarian Nordic monkeypox vaccine, called Jynneos.
But, according to STAT News, drawing that many doses from one vial is proving to be a challenge.
“Our team is getting three to four (doses) currently,” said Jeffrey Duchin, health officer for Seattle and King County Health Department, adding that the actual number of doses per vial is lower than the official allocation, which assumes there are five doses to each vial.
Demetre Daskalakis, deputy coordinator for the White House monkeypox response team, acknowledged that clinics across the country are echoing this complaint. He said that the administration is suggesting that healthcare workers use low dead space syringes, which can increase the number of doses people can extract from the vials.
“It’s a learning curve,” he said. “We are learning together.”
Another problem is that the caps on the vials sometimes break before all the doses have been given. Apparently, according to some officials, the foil that holds the caps in place on the Jynneos vials is very fragile and must be handled gently or the caps loosen, and the vaccine doses are lost.
Another challenge for health workers is how the vaccine is given. Fractionalized doses must be given intradermally, or into the skin, to be effective and that’s a technique not often used. Many healthcare workers need to be trained to accurately administer the vaccine this way.
A clinical trial on the Bavarian Nordic vaccine found that two fractional doses administered intradermally were as effective as two standard doses administered subcutaneously, or under the skin, says STAT. That’s the evidence that prompted the current guidelines and as a result, dose allocations were quickly modified. Locations that were eligible to receive 10,000 doses, for example, got 2,000 vials instead.
Caitlin Rivers, an infectious disease expert at Johns Hopkins School of Public Health, said that vaccine allocations should not have been lowered until all the logistics were in place for fractional dosing.
“Because then, when we’re figuring out how to get five doses out, there’s some wiggle room,” she said. “Those lost doses really matter.”
Daskalakis assures the public that if locations run out of doses in the real-world scenario, they can ask for more.
“If they burn through their vaccine, there’s more allocation right behind,” he said. “We’re learning how many doses can get pulled and we’ll know that from the administration data that we get back form the jurisdictions compared to what their allocation is.”
He added that while a more gradual introduction of the monkeypox vaccine program may have made more sense, “I think that in reality, the emergency scenario in this really means we need to learn and go at the same time.”
According to GoodRx, there are two licensed vaccines available in the U.S. to prevent monkeypox. These include the Jynneos vaccine and the ACAM2000, an older smallpox vaccine that has been approved for monkeypox. Click here to find more information on availability, eligibility, and access to vaccines.