The Department of Public Health is again trying to figure out a way to stretch a limited supply of vaccine doses to protect as many people in Massachusetts as possible, but this time the viral disease that's spreading is monkeypox.
There have been 174 cases of monkeypox reported in Massachusetts since May 18, according to the Centers for Disease Control and Prevention, with the latest weekly update from DPH is due Thursday. Monkeypox is marked by a signature rash or lesions and can include flu-like symptoms, and it spreads to anyone through close personal, often skin-to-skin, contact.
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The U.S. Food and Drug Administration has licensed a two-dose vaccine, JYNNEOS, which can help prevent against monkeypox illness if given before or shortly after exposure. But the supply of JYNNEOS is sharply limited and its distribution is tightly controlled by the U.S. Centers for Disease Control. There were 14 locations across Massachusetts where the JYNNEOS vaccine was available to eligible individuals and 5,875 doses had been administered here as of Aug. 3, DPH said. The federal government said it shipped 16,251 doses of the vaccine to Massachusetts as of Aug. 8.
Massachusetts health officials announced this week they would follow a new monkeypox vaccination strategy, one that aims to get more eligible people a first dose of JYNNEOS even if that means that not everyone is able to get the second dose right away.
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"While the vaccine is approved as a two-dose series, given the severely limited national supply of JYNNEOS, the Massachusetts Department of Public Health and our vaccine partners are prioritizing first doses for as many people as possible," DPH said on its website, adding that the change was effective Aug. 8. "This approach is intended to provide the broadest possible protection against the spread of monkeypox virus in Massachusetts and is consistent with a growing number of states, jurisdictions and large municipalities."
The federal government is also trying to stretch the supply of JYNNEOS. On Tuesday, the FDA announced that it had approved an alternative vaccination approach that allows health care providers to administer the vaccine intradermally -- between layers of the skin rather than into the muscle or fat beneath. That method means that what is currently a single dose could be split into five, greatly expanding the number of people who could be protected by the current supply of the vaccine.
"In recent weeks the monkeypox virus has continued to spread at a rate that has made it clear our current vaccine supply will not meet the current demand," FDA Commissioner Dr. Robert Califf said in explaining the decision.
During Wednesday morning's Massachusetts Public Health Council meeting, Public Health Commissioner Margret Cooke was asked how Massachusetts would be handling the 1/5 dose recommendation. She said DPH is "evaluating our supply right now and we likely will be announcing in the short-term what our next moves will be on that."
But increasing vaccination capacity five-fold here will not be like flipping a switch, DPH officials said.
"It is a bit of a different type of injection, the intradermal injections, and so not only do they need the training, but they also need the syringes, special syringes and needles," DPH Chief Medical Officer Dr. Estevan Garcia said. "So all of that we need to make sure is appropriate and ready for us to be able to move forward with the 1/5 of the dosing. But absolutely we will be doing that, is our recommendation moving forward."
Asked whether the state will prioritize single doses or the standard two doses, Cooke said DPH is still trying to determine that.
"We don't know the full supply that we'll be getting from the federal government and so we are trying to determine with the numbers and the dosage how we can most protect the residents of the commonwealth," she said.
The FDA, in its announcement of the intradermal authorization Tuesday, said, "Two doses of the vaccine given four weeks (28 days) apart will still be needed. There are no data available to indicate that one dose of JYNNEOS will provide long-lasting protection, which will be needed to control the current monkeypox outbreak."
