A new method for administering the monkeypox vaccine has the potential to stretch New York City’s limited supply of doses. But at a City Council hearing Wednesday, City Health Commissioner Dr. Ashwin Vasan said the pivot would likely take several weeks to complete.
Part of the holdup stems from the additional training health care workers will need for the new strategy, which is known as intradermal dosing. It works via a shallow injection of a vaccine in between the body’s skin layers, rather than the normal tactic of plunging all the way into a person’s muscles. Intradermal dosing requires more delicacy and smaller needles, which can be harder to work with — but it also uses smaller volumes of the vaccine.
“This is a promising strategy to expand supply,” Vasan told members of the City Council. But, he added, “to make a switch like this midstream in a vaccination campaign is extraordinarily difficult for a number of reasons.”
The Jynneos monkeypox vaccine, which is distributed to states and localities by the federal government, has been in short supply. The federal government has distributed about 1 million doses so far. Switching to intradermal vaccination could make it possible to extract as many as five doses from each vial, instead of just one.
Vasan also added that the new method is not optional — it is being mandated by the Biden administration and New York won’t receive additional doses of the vaccine until the transition is complete.
The switch starts Wednesday evening with a new batch of 12,000 vaccine appointments. All of these appointments will be for intradermal vaccination, unless the patient has a condition such as keloid scarring, which would make the method less effective for them, Vasan said. Those patients will receive the dose through the traditional method, known as subcutaneous vaccination.
To start, the city is rolling out the new method with its own public health clinics and mass vaccination sites. However, the city has been working to bring more community-based organizations and health care providers into the vaccination effort, in part, to address disparities in who is getting vaccinated and reach those who are most vulnerable.
The city convened a meeting with some of these community groups on Monday to gauge what they need to make the transition, Vasan said.
Research with past vaccines suggests that the intradermal route could produce a similar immune response as the traditional vaccination method, although it may also cause more redness, itchiness, and swelling at the injection site, according to the U.S. Food and Drug Administration, which issued emergency authorization for the method earlier this month.
But health experts have said publicly that it’s unclear if the same will apply for Jynneos without more clinical trials. Only a single human study from 2015 has reported positive results with intradermal administration of the Jynneos monkeypox vaccine. Vasan also noted at the hearing that if the procedure is done incorrectly, it could be ineffective.
Councilmember Lynn Schulman, chair of the health committee, expressed concerns that many health care providers lack practice with this method. “I’m guessing even current providers are not that used to giving intradermal vaccines,” she said, noting that the city is working to bring on additional vaccine providers as well.
Vasan admitted that even he had not given an intradermal vaccine since medical school, but said he didn’t necessarily think it was difficult to do. He said city health department staff are going into the field to work with providers to make sure they get it right.
The new vaccination strategy has created challenges elsewhere in the country, as well as uncertainty about how many doses will ultimately be available. Although the federal government has said the new method uses one-fifth the amount of the vaccine per dose, some health officials in other states are saying that they are only getting three or four doses out of each vial, instead of five, according to Politico.
But Vasan emphasized that, so far, the city’s immunization campaign has been effective. City data shows that the number of daily cases being diagnosed is finally starting to trend down after climbing throughout the summer. Vasan attributed that to a combination of education and outreach in the communities most affected by monkeypox as well as vaccination. The city has vaccinated more than 69,000 New Yorkers considered at risk for the virus so far.
In addition to educating health care providers about the new vaccine delivery method, the city should also educate community members, said Anthony Fortenberry, chief nursing officer for Callen-Lorde Community Health Center, which serves LGBTQ patients. He also called on the city to monitor the effectiveness of the new method, particularly for immunocompromised patients.
“Our patients are those who have historically lacked appropriate health care access and we need to ensure they are not left behind again,” Fortenberry said.
