While the trajectory of monkeypox spread in the US remains uncertain, we do know that the virus is unlikely to behave like other more contagious germs, such as the coronavirus.
“Monkeypox is never going to have the explosive spread that the coronavirus had,” Dr. David Freedman, president-elect of the American Society of Tropical Medicine and Hygiene, told BuzzFeed News. It’s a zoonotic disease, so it’s most common that people get sick by coming into contact with infected animals. (People can give the virus to animals too.)
Even though transmission between people can occur via prolonged face-to-face contact with large respiratory droplets, spread mostly involves direct contact with skin lesions, body fluids, or contaminated materials such as bedding.
“You might see clusters of cases in certain areas, especially if people aren’t taking precautions and are routinely touching each other in healthcare settings,” Freedman said.
All this means the vaccination strategy to contain monkeypox infections will require a “different approach,” Freedman said.
One effective method to quell monkeypox outbreaks is “ring vaccination,” Freedman said. The strategy was used to wipe out smallpox in the 20th century by sending a SWAT team of sorts to rapidly vaccinate all primary and secondary close contacts of confirmed smallpox patients.
“It’s like putting a ring around the person that’s infected,” Freedman said, adding that this approach would work well to control monkeypox infections because of the virus’s telltale symptoms.
CDC officials said the US is not employing the ring vaccination strategy during a media briefing on Monday, but that it is taking similar actions by vaccinating contacts of confirmed cases if they fall into a high-risk category.
“The good thing about this is that unlike COVID, which can look like a lot of different illnesses and transmit asymptomatically … the only people that transmit monkeypox are those who have lesions,” Freedman said. (The WHO says “the extent to which asymptomatic infection may occur is unknown.”)
“You can isolate them and do a ring vaccination and be fairly certain that only the people they had contact with are suspicious because they wouldn’t have been infectious before they develop skin lesions,” he said.
The CDC suggests people who are eligible receive the monkeypox vaccine within four days of exposure to prevent the development of disease, but sooner is better. If someone who was exposed gets the shot between four and 14 days after exposure, they’ll likely still develop the disease but will be protected against severe symptoms.
Monkeypox infections usually subside on their own without treatment, although you can treat the symptoms. There are no medications developed specifically to fight monkeypox virus, but there are three treatments — cidofovir, ST-246, and vaccinia immune globulin — that can be used to treat it in emergency scenarios.
There is an antiviral drug called TPOXX (tecovirimat), which was approved for the treatment of smallpox in 2018, but it’s not approved for use in monkeypox patients in the US. (It is in Europe.)
Is the US prepared to vaccinate people against monkeypox if necessary?
The US already has doses of Jynneos in its Strategic National Stockpile, a supply of lifesaving medical supplies and drugs for use in public health emergencies, according to the FDA.
The CDC said the national stockpile has over 1,000 available doses of the Jynneos vaccine, which the US expects will increase over time, and over 100 million doses of the ACAM2000 shot.
Health officials said they plan to maximize the distribution of the vaccine to those they know will benefit from it, including healthcare workers, people with known contact with the virus, and people at high risk for severe disease. The agency said a request to release doses of the Jynneos vaccine from the national stockpile is “actively happening.”
Bavarian Nordic, the biotech company that developed Jynneos, said last week that the US purchased $119 million worth of its monkeypox vaccine in freeze-dried form. The first doses of this version of the shot, which have longer shelf lives, will be manufactured and delivered beginning next year.
The announcement was “completely coincidental,” a company spokesperson told BuzzFeed News over email, adding that the purchase was based on a 2017 contract “several years in the making” and not tied to the current monkeypox spread.
But how easily the monkeypox vaccine could be administered in the event more cases appear in the US remains uncertain because the CDC has yet to formally publish its recommendations on who should receive it and when, both Freedman and Weber said.
In November, the CDC’s Advisory Committee on Immunization Practices voted to recommend the Jynneos vaccine for people at “occupational risk for orthopoxviruses,” including laboratory employees, those who administer the smallpox vaccine, and people who care for patients infected with orthopoxviruses. The recommendations also say these individuals should receive a booster every two years.
Freedman said the CDC typically doesn’t like to green-light the release of vaccines from the national stockpile unless there are published recommendations from the ACIP.
During the Monday briefing, the CDC said it’s working to develop recommendations to ensure vaccine supplies are available for those who need them.
“It’s a technicality, but that’s the way it is,” Freedman said. The last time the CDC published recommendations for orthopoxviruses was six years ago, when a vaccine wasn’t yet licensed against monkeypox, he said, “so they couldn’t consider a monkeypox indication.”
Weber said the ACIP could theoretically make its recommendations official at any time. But as a physician, he said, he would still need approval from the FDA before writing a prescription for the Jynneos vaccine to treat a patient with monkeypox at this time.
Officials in the UK already said vaccination is being offered to higher-risk contacts of the infected, the WHO said last week.
“I do expect in a short time that we’ll start getting some guidance on those issues,” Weber said.