As cases of monkeypox increase, it is evident that vaccine demand is greater than the supply. Although the FDA had previously indicated sufficient supply for double doses, scientists at the NIH are exploring alternatives to a two-shot regime in order to increase access to JYNNEOS, the vaccine licensed for use against monkeypox in the United States.  

The intention is to explore “fractional dosing”, using a fifth of the recommended dosage per person, as well as single dosage. They will compare the results with the current programme of two doses, 28 days apart. The study should provide answers as early as November, with potential to alleviate the strain on vaccine supply if positive.  

As of August 2022, more than 80 countries have recorded over 25,000 confirmed cases of monkeypox. At least 6,600 of these are from the United States. Despite this, the FDA and CDC have “stressed that the vaccine should be used as licensed”. However, there are suggestions that generous dosage recommendations from vaccine manufacturers might lend themselves to fractional dosing.  

Fractional dosing has been used effectively in previous outbreak situations, such as the 2016 yellow fever outbreak in Angola and the Democratic Republic of the Congo. At that time, global supplies of the vaccine were stretched thin and the WHO recommended doses a fifth of their usual quantity.  

The tension between dose quantity and quality raises questions about our preparedness for outbreaks of disease. Dr John Beigel of NIAID stated that there isn’t a “consistent message” but that some were getting “one dose now for six months or maybe longer”.

As the outbreak spirals, doses of the vaccine have yet to reach the “source”. Will we see another pandemic of vaccine selfishness, or will we work collaboratively to spread the vaccine as evenly as possible? 

To participate in a day of monkeypox discussion at the World Vaccine Congress in Europe 2022 head here to get your tickets!