Mpox Vaccines Are Headed to States. Will They Be Enough?

The Biden Administration announced on Tuesday a nationwide vaccine strategy to control the spread of the mpox (formerly known as monkeypox) virus in the United States as cases continue to increase. 

So far, there have been 306 confirmed cases of mpox identified across 28 states, according to the Centers for Disease Control and Prevention (CDC).

The U.S. Department of Health and Human Services (HHS) will make 296,000 doses available in the coming weeks with 56,000 of those doses made available immediately to areas with high mpox transmission.

HHS will begin by prioritizing states with the highest case rates of mpox, which include California (66 cases), New York (63 cases), Illinois (45 cases), Florida (27 cases), and Washington, D.C. (20 cases).

Other states with confirmed cases will also be able to order/request vaccines using a tiered allocation system.

"The administration’s current strategy is focused on containing the outbreak by providing vaccines to those most in need to prevent further spread of monkeypox in the communities most impacted,"  Rochelle Walensky, MD, MPH, the Director of the CDC, told reporters during a media briefing Tuesday. "As additional supply becomes available, we will further expand our efforts, making vaccines available to a wider population."

Cities like New York and Washington, D.C. were among the first to begin vaccinating at-risk groups for mpox, however, appointments ran out quickly with no more appointments available at the moment.

What Is the Mpox Vaccine?

The vaccine being distributed is the Jynneos vaccine, which is administered in two doses and delivered 28 days apart. People who receive the vaccine are not considered vaccinated until two weeks after they receive the second dose of the vaccine, Teena Chopra, MD, MPH, professor of medicine, division of infectious diseases at Wayne State University, told Verywell. 

HHS expects an additional 240,000 doses to be shipped out over the next few weeks with thousands of more doses to come this summer and fall. All told, officials anticipate making at least 1.6 million mpox doses available in the U.S. by the end of the year.

Despite the ramp up in production, health experts worry the limited supply now will not be sufficient enough to stop or significantly slow the spread of the virus.

“The supply of vaccine is limited at this point, and to prevent transmission, vaccination should be given as early as possible after exposure,” Robert Bollinger, MD, MPH, professor of infectious diseases and professor of medicine at Johns Hopkins Medicine, told Verywell. “The hope is that vaccination of exposed persons could reduce the spread of the infection. We will have to see if this current effort is sufficient to slow down transmission.”

Who Is Currently Eligible for an Mpox Vaccine?

The updated White House mpox outbreak response plan recommends people with confirmed and presumed mpox exposure receive the Jynneos vaccine.

Initially, the only people who could get mpox vaccines were those with a confirmed exposure. But due to the difficulty identifying close contacts during the current outbreak, the new plan states contact tracing or confirmed exposure are not prerequisites for vaccination; if someone believes they've been exposed, that's enough.

"This expands the ring from known contacts to possible contacts," Richard Reithinger, PhD, vice president of global health at research nonprofit RTI International, told Verywell. "If people have been at an event where monkeypox is known to have spread, they are now eligible for vaccination."

According to the White House, eligible groups include: 

• People who had close physical contact with someone diagnosed with mpox
• Those who know their sexual partner was diagnosed with mpox
• Men who have sex with men who have recently had multiple sex partners in a “venue where there was known to be monkeypox or in an area where monkeypox is spreading"

Reithinger said a booster may be necessary every 10 years.

He noted that an older smallpox vaccine called ACAM2000 is also available, but that vaccine is considered to have a greater risk of side effects and is not recommended for people who have HIV.

Is The Current Vaccine Distribution Plan In The U.S. Going To Be Enough? 

While the U.S. is expanding the availability and number of mpox vaccines over the course of the year, Chopra said more vaccines are needed quickly so that they are accessible to all states, not just the ones where case numbers are high. 

"We also need to make sure we recognize the illness early on and offer vaccines to high-risk individuals," she added.

Reithinger said that the virus is easy to recognize. Mpox symptoms like rashes and lesions are quite visible and only symptomatic individuals are infectious. You'll know if you have it and if you can spread it.

Therefore, Reithinger said mass testing is not a recommended or effective approach. Diagnostic testing is only recommended to confirm clinically suspected cases. 

Since there have been about 300 cases of mpox and no deaths in the U.S., the risk to the American public is still considered low. The main transmission route requires person-to-person contact, Reithinger said—it's not currently believed to spread through airborne particles like COVID-19 can be.

To effectively mitigate the human-to-human spread of mpox, Reithinger said important public health measures include:

• Early case-finding
• Early diagnosis and care
• Isolation and contact-tracing
• Vaccination
  

How Does Someone Get Exposed To Mpox? 

Mpox is typically spread person-to-person through sex, kissing, and being in close contact with someone else who has the virus, Chopra said. 

"Even though a large number of cases have been in gay/bisexual men, it can spread to anyone through close contact and through the respiratory route," Chopra added. "People can also catch the virus through contact with contaminated bedding."

According to the CDC, there can be multiple degrees of exposure. You can be exposed to mpox in several ways:

• Direct contact with the infectious rash, scab, or other body fluids
• Respiratory secretions during prolonged, face-to-face contact
• Intimate physical contact, such as kissing, cuddling, or sex
• Contact with items such as clothing or linens that previously touched an infectious rash or body fluids

Pregnant people can also spread the virus to their fetuses through the placenta.

It is also possible to get mpox from infected animals if you are bitten or scratched, though that's not what's causing the current outbreak.

What Can I Do To Protect Myself? 

To prevent getting mpox or to minimize exposure to the disease, people should try to avoid locations where clusters of mpox have been reported, Reithinger said. 

Other prevention measures include:

• Avoiding contact with people who have suspected or confirmed mpox
• Avoiding sexual behavior or physical contact like kissing, hugging, or cuddling if you believe you partner(s) may have been exposed
• Limiting attendance at crowded events 
• Following good hygiene practices 
• Wearing personal protective equipment like masks and gloves (particularly healthcare workers) 

If you are showing any symptoms of mpox, Reithinger recommends contacting your healthcare provider for next steps, including for confirmatory testing and follow-up medical care. If possible, people with confirmed or probable exposure should isolate themselves for at least 14 days and avoid close contact with other people.

"For contacts of confirmed cases, vaccination is recommended, ideally within four days of first exposure, and up to 14 days in the absence of symptoms," Reithinger said. "This can prevent the onset of disease or reduce severity of symptoms."