Juan Lopez, a Miami graphic designer, got his first monkeypox vaccine about a month ago. He was set to receive his second dose of the monkeypox vaccine on Friday.
But an email he opened on Tuesday afternoon said his second dose was canceled, as Broward County health officials were holding back the vaccine to only those in need of a first shot.
“Florida Department of Health in Broward County just notified us of the following: ‘To maximize the supply of smallpox/monkeypox-JYNNEOS vaccines, the Department of Health is using all available doses as first doses only. Second doses will be rescheduled as vaccine supply increases. You will be notified at that time,” read the email Lopez received from the Pride Center at Equality Park in Wilton Manors, where he had his appointment.
Lopez, who works at a Miami law firm and is a former Herald designer, wasn’t happy. The vaccine is supposed to be administered in two doses about a month apart to be effective.
“They told me that the only way the vaccine is going to be 100% is if I get a second dose. So now, not getting the second dose, I feel cheated. I totally feel cheated,” said Lopez, 52, a gay man who knows several men who have contracted monkeypox, which the U.S. has recently declared a public health emergency.
The Pride Center, one of only a few South Florida clinics that have secured the vaccine, said it had no choice but to cancel the second-dose appointments after the Broward health department told them of the policy change.
“Very disappointing, very understandable because yeah, to have it canceled at the very last minute. Very frustrating,” Robert Boo, the Pride Center’s chief executive told the Herald Thursday.
By late Thursday afternoon, however, Lopez received another email from the Pride Center saying his second dose appointment was back on.
The change came after the Food and Drug Administration issued an emergency use authorization Tuesday to allow the JYNNEOS monkeypox vaccine to be administered between skin layers, or intradermally in adults, a method of injection that uses only one-fifth of a dosage but provides the same protection, federal officials said Tuesday at a White House briefing.
By Thursday afternoon, Broward County vaccination sites began to reschedule the canceled appointments for second doses. The FDA has recommended second shots be given with the new one-fifth dose.
Using only one-fifth of the vaccine dose per person will help alleviate the vaccine shortage in the U.S. at a time when monkeypox cases are rapidly growing. As of Wednesday, the total confirmed U.S. monkeypox cases had topped 10,000, at 10,768, the Centers for Disease Control and Prevention reported Thursday, a more than 50 percent increase over two weeks ago.
Clinics scramble for vaccines
The initial decision to cancel the second-dose vaccine led to anxiety and confusion over transmission, testing and vaccines in South Florida, the state’s epicenter of the monkeypox outbreak. With Miami-Dade’s 414 confirmed and probable cases, and Broward’s 374, the two counties accounted for 788 confirmed and probable cases as of Thursday, or 75% of the state’s 1,055 cases .
Broward County has nine monkeypox vaccination sites: DOH-Broward main campus, Pride Center at Equality Park, Poverello Center, Sunserve, Richardson House (City of Wilton Manors), Hagen Park (City of Wilton Manors), Broward House, Broward Wellness Center and Children’s Reading Center and Museum.
But unlike Miami-Dade, Broward does not have any monkeypox vaccine sites run by the county. Miami-Dade will open its first two monkeypox vaccination sites at Tropical Park and in Miami Beach on Friday, County Mayor Daniella Levine Cava announced Wednesday. The vaccines will be free but for those at high risk, as defined by the CDC. More than 600 appointments had been made as of Wednesday afternoon.
People considered at high risk for monkeypox include some lab and healthcare workers; those in close contact with people who have had monkeypox; gay or bisexual men who’ve had a recent history of sexually transmittable diseases; and those living with HIV, the virus that causes AIDS, the CDC said.
Even with the vaccine dosage multiplied by five, local clinics are overwhelmed.
”We are desperate for more supply of vaccine,” said Stephen Fallon, executive director of Latinos Salud, with clinics in Miami Beach, Westchester, North Miami and Wilton Manors. “Each of our four locations could easily be vaccinating hundreds of people per week.”
The initial shipments received in July were small: 20 to 60 doses, Fallon said. Now, the clinics regularly receive 100 to 300 once every week or two. But that’s still not enough.
Latinos Salud needs that amount of shots every few days, Fallon said. Their phones keep ringing with patients’ concerns over vaccine availability. On Wednesday, the Miami Beach and Westchester locations received 1,500 doses of the monkeypox vaccine and the Wilton Manors location got another 500 doses.
The clinics will now inject the vaccine between the layers of skin, since the FDA allowed this Tuesday.
Fallon said he was originally told the Florida Department of Health would send second doses three weeks after the first jab. Now, they told the clinic to use all of their shots as first doses. Latinos Salud is looking into if it can set some vaccines aside for second doses.
The Florida Department of Health did not respond to requests from the Herald.
Boo, the CEO of the Pride Center in Wilton Manors, has had similar experiences.
“We opened up the first 864 appointments on a Friday at 4 and by Saturday morning at 11, they were all filled. Then the next opportunity, the Department of Health called on a Friday with 180 additional doses ... within an hour and a half those 180 were gone. That Monday they came back with 864 [doses] ... those 864 appointments were filled within three hours.”
When the Herald asked about the vaccine shortage and its change in policy, the Department of Health in Broward County issued a statement Thursday: “Given the newly increased vaccine supply, as a result of the FDA Emergency Use Authorization of intradermal administration of JYNNEOS, we are working with municipalities and community partners in continuing and expanding existing sites where possible and opening additional sites next week.“
The department said all canceled second-dose appointments had been rescheduled for next week.
Miami-Dade will offer the vaccine in two doses separated by four weeks, County Mayor Daniella Levine Cava said at the Wednesday press conference.
Questions about one-fifth dosage
The idea behind using only one-fifth the dosage and injecting it between the skin layers has led public health experts to be wary.
Dr. Aileen Marty, a professor of infectious diseases in the Department of Medicine at FIU Herbert Wertheim College of Medicine, isn’t sure how effective this approach will be.
“We don’t know,” Marty said. “This is an experiment. That’s what it is; it’s an experiment. It’s a hope and a prayer in a desperate situation.“
Recent preliminary studies suggest that administering the vaccine within the skin rather than underneath it, as is usually done with the smallpox and monkeypox vaccines, can cause one dose to be sufficient, Marty said. This is because very specialized “sentinel cells” exist in the more superficial layers of the skin.
They are “excellent at immediately recognizing some weirdness that has come into their zone, be it a virus, a vaccine” and trigger an effective immune response, she noted.
However, Marty stresses that the study was preliminary. It wasn’t a clinical trial or even efficacy study.
She notes that better vaccines exist, but the U.S. is stuck with an “old-fashioned technique that’s based on early 20th-century science. We didn’t anticipate that this was going to happen this soon,” Marty said. “And so we didn’t prepare.”
Playing the system
With the severe shortage of vaccines, Lopez turned to alternate methods to acquire doses.
“I had to play the system,” Lopez said Wednesday. “So I found out that Miami-Dade was giving out appointments for [the first dose of the] vaccines. So I had to sign up as a new patient. And they gave me an appointment.”
On Thursday, Lopez learned his vaccine appointment was ultimately rescheduled to Aug. 17 at the Broward County Health Department. While relieved, he still was concerned.
“It makes me feel like there’s nobody really looking after anybody here.” Lopez said. “You have to look after yourself.”