Background
The current Monkeypox (MPX) outbreak continues in the United States, with more than 22,000 cases confirmed in less than five months, and likely many more yet to be diagnosed. Although the cases seem to be decreasing somewhat, they continue at a high level. The World Health Organization (WHO) declared the current outbreak to be a public health emergency of international concern on 23 July 2022, and the US Department of Health and Human Services (HHS) declared MPX to be a national public health emergency on 4 August. 2022. Vaccines are a key component of the public health response to the outbreak. The federal government announced plans to begin providing MPX vaccines to state and local jurisdictions from the Strategic National Stockpile (SNS) in June and has increased supply and distribution since, primarily focusing on JYNNEOS, the vaccine of choice due to its safer profile compared to the other available vaccine (ACAM2000). JYNNEOS is being allocated to jurisdictions “to address the needs of at-risk individuals, and [HHS has] prioritize[d] the hardest-hit jurisdictions that have high caseloads and monkeypox transmission rates” and the greatest at-risk communities. Most of those affected and at risk to date are gay and bisexual men and other men who have sex with men (MSM).
While supply has increased over time, supply challenges hampered the initial rollout and continue in some areas of the country. Given who is at greatest risk and supply constraints, Centers for Disease Control and Prevention (CDC) guidance to jurisdictions for determining MPX vaccine eligibility currently focuses on the following priorities (see also Table 1): post-exposure prophylaxis or PEP (vaccination after a known exposure) as well as extended post-exposure prophylaxis and PEP++ (vaccination for people with actual or suspected exposure due to their risk factors or recent experiences). A third strategy, pre-exposure prophylaxis or PrEP, for specific groups that may be at risk due to occupational exposure (eg, laboratory workers) has also been identified but not prioritized at this time. See the article : Vaccines, curry chicken, mushroom talk and a musical duo. However, each jurisdiction determines its own distribution approach, including its eligibility criteria and which groups are prioritized for vaccination.
We sought to assess vaccine eligibility criteria across the country, focusing on state and local jurisdictions that receive direct vaccine allocations from the federal government, including all 50 states, Washington, D.C. and five cities (Chicago, Houston, Los Angeles, New York City, and Philadelphia). We compared local eligibility criteria with the approach recommended by the CDC and identified which groups and/or situations were prioritized for vaccination. We also assessed the extent to which information on vaccine eligibility was clearly available. Our analysis is a time assessment with data per 12 September 2022 and as such it is possible that the criteria may have changed. Links to source documents are included.
Overall, we find that nearly all jurisdictions have adopted PEP and PEP++ vaccination strategies, with a much smaller number using PrEP as currently defined by the CDC. However, there is considerable variation in how eligibility is defined within and in some cases beyond these categories. In addition, several jurisdictions lack clear criteria or information about who is eligible or where to be vaccinated. Such variation has implications for access and may affect how equitable vaccination rollout is across the country, particularly as new MPX cases are increasingly concentrated among MSM of color.
Findings
As of September 12, across the 56 assessed jurisdictions, we find that: To see also : The Department of Health is launching a Monkeypox Vaccine Clinic for people who may have been exposed to monkeypox.
Discussion
Jurisdictions have approached defining MPX vaccine-eligible populations with considerable variation, and these decisions may have an impact on curbing local transmission. In some cases, the vaccine eligibility or access process information is difficult to locate or not very clear, potentially creating barriers that limit individuals’ ability to understand whether they are eligible and/or how to find vaccination. Variation also means that an individual at higher risk in one jurisdiction would have access to vaccination, while a person at similar risk in another region would not. Many jurisdictions note that eligibility requirements are in place due to limited vaccine supply, and several suggest they will expand eligibility in the future when more vaccine is available. Until then, understanding how local vaccine eligibility is defined and how clear the vaccination process is for those at risk can provide insight into uptake and equity going forward.
