US health officials sought to reassure the public that the risk of monkeypox is low and the country is prepared to handle its spread, though they acknowledged more cases are likely.
While monkeypox doesn’t appear to be a major threat to the general public, health authorities say there’s a stockpile of vaccines and antivirals which are ready to use if needed. Treatment guides for those who would benefit most are also being developed.
New and suspected cases of the illness have been cropping up in Europe and North America in recent days. The rare and potentially deadly cousin of the smallpox virus is traditionally confined to regions in Africa, but health officials are concerned about its wide spread.
With one confirmed case in Massachusetts and four suspected cases in New York City, Florida and Utah, US health officials are investigating the virus’s origin. Within 48 hours, it was determined that the Massachusetts patient’s case closely matched the one reported from Portugal.
The US cases are the West African strain of monkeypox, which tends to be milder than another type more commonly seen from Central Africa. The strain currently circulating is believed to kill about 1% of those infected. No one has died in this current outbreak so far.
Although anyone can get or spread the monkeypox virus through intimate or sexual contact, many of those affected by the current global outbreak identify as gay and bisexual men, public health administration officials said on a call with reporters on Monday. Sharing bedding, clothing or a toothbrush with an infected person would create greater risk.
Katrine Wallace, an epidemiologist with the School of Public Health at University of Illinois Chicago, said that the US is better positioned to combat a monkeypox outbreak than it was for Covid-19 at the start of the pandemic. That’s in part because monkeypox is substantially less transmissible than SARS-CoV-2.
The US has also bolstered its smallpox and monkeypox preparedness for decades at both the local and federal levels due to longstanding fears that smallpox could be used in a biological weapon. As a result, public health departments across the country have continued to regularly update training and response protocols for handling a potential smallpox or monkeypox outbreak, Wallace said. So when cases were identified in the US last week, it was easy for health departments to deploy those years of practice.
“Covid was a brand new virus, we had no knowledge of it and it was more contagious,” Wallace said. “That’s not the case here.”
At the federal level, the Strategic National Stockpile has a supply of FDA-authorized smallpox vaccinations and therapeutics, most of which have also shown effectiveness against monkeypox, officials said.
During a call with reporters Monday, health officials from the Centers for Disease Control and Prevention said that the US has stockpiled doses of Bavarian Nordic’s Jynneos vaccine and is seeking out more. The US has contracts in place for millions of doses of the vaccine.
Officials added that there are more than 100 million doses of Emergent BioSolutions Inc.’s ACAM2000 vaccine, which the company acquired from Sanofi in 2017. Two years later, Emergent clinched a $2 billion contract with the Department of Health and Human Services to supply ACAM2000 for the national stockpile for 10 years.
That vaccine isn’t specifically authorized for monkeypox, but because smallpox is so closely related, it can hold up against both viruses. However, CDC officials warned that it can have serious side effects in those with certain health conditions because the vaccine contains live-replicating virus.
The officials said that there had already been a request for the release of doses of Jynneos’s vaccine for people considered high-risk contacts of the monkeypox cases identified in the US. The vaccine is considered to be safer than ACAM2000.
“There are relatively few governments that are prepared or take medical countermeasures seriously,” Bavarian Nordic Chief Executive Officer Paul Chaplin said in an interview on Monday, adding that the US that is one of the few that is ready. “Most governments are purely reactionary, but vaccine production can’t be turned on and off like a light-switch.”
Bavarian Nordic is now working to get the its vaccine approved in the European Union and other large markets.
“We’re getting a lot of calls,” he said, “There’s a lot of concern here in Europe. But this is not a product with which we have large inventory sitting on the shelf. It’s really made-to-order. We do have some doses on stock. We’re gearing up production as we speak.”
He said he’s hopeful supply will be available for countries this summer. Chaplin, who was in charge of Bavarian Nordic’s smallpox program from its inception, said his company has “quite a bit” of the main substance for the Jynneos vaccine, but it would take up to 6 weeks to get that ready for end users.
Bloomberg reported earlier on Monday that Bavarian Nordic could ramp up production to make up to 30 million doses a year, if needed. Chaplin said the company is expanding, seeking to hire another 200 employees before the end of the year to meet stockpiling demands.
Wallace, from the University of Illinois Chicago, said that it’s unlikely the entire population would need to be vaccinated against monkeypox. Because it spreads primarily through close contact, the US could vaccinate only those that have come into contact with an infectious person. Requests have already come to release doses of Jynneos for high-risk contacts of the four monkeypox cases identified in the US so far.
In addition to the smallpox vaccines, there’s ample supply of an antiviral medication that has shown potential for monkeypox based on trials done in animals. That is SIGA Technologies Inc.’s Tpoxx, in the national stockpile.
During Monday’s call, CDC officials said they are also in the process of negotiating with Chimerix Inc. for the procurement of Tembexa, another antiviral, for the national stockpile.