An electron microscope image of monkeypox viruses. Credit: Centers for Disease Control and Prevention

The Chicago Department of Public Health (CDPH) will prioritize giving monkeypox vaccines to individuals who still need a first dose until more supply is available. The vaccine, called Jynneos, requires two doses, the second given at least 28 days after the first, with full protection expected two weeks after the second shot is administered. Public health officials say there is evidence that the first vaccine dose provides some protection against monkeypox.

The CDPH will still offer second doses to people who have already made appointments for them, in addition to immunocompromised people and those who are known to have come in contact with people who have monkeypox. Once more supply is available, the CDPH will open second doses to others as well.

“We’re prioritizing giving those first doses because in the context of meaningfully interrupting the outbreak, the more doses we’re able to deploy, the bigger the gain,” said Massimo Pacilli, the CDPH deputy commissioner for disease control. “That is anchored around the fact that we know the biggest boost in immunity is acquired a few weeks after the first shot.”

He added that delaying the second dose does not diminish the vaccine’s total, eventual potency.

The initial 5,000 doses of Jynneos vaccine the CDPH got from the federal government’s Strategic National Stockpile were distributed to clinical providers that cater to LGBTQ+ people, sexual health clinics, community providers, and settings that cater to the communities like Steamworks, a gay bathhouse in Lakeview East.

The Food and Drug Administration expedited the application and necessary inspection of 786,000 Jynneos doses stored in Denmark, where the vaccine is manufactured, in July. Another 15,000 doses are due to come to Chicago next month. The Department of Health and Human Services (HHS) has ordered another 5 million doses, which are expected to come in through the middle of next year.

Dr. Anu Hazra, an infectious disease specialist at UChicago Medicine who practices at the Howard Brown Health network of clinics, told the Reader that it’s unclear precisely how effective Jynneos is at preventing monkeypox infections, because randomized controlled trial data doesn’t exist. He added that it is reasonable to extrapolate data from extant models that suggest Jynneos will be “highly effective” against monkeypox—but giving out single doses and waiting until more supply comes in before giving out second shots “is going a step further.”

“We don’t really know what the efficacy of a single dose is against monkeypox, and now we’re going to try to see if that’s going to help stem new infections,” he said.

People can still contract monkeypox after getting their first Jynneos dose. Pacilli said immunity is gained “some time after” getting the first shot, not immediately afterwards. Layering the vaccine with other protection measures, like staying home when sick and avoiding casual sexual contact, is important.

So far, the overwhelming number of cases have been transmitted among men who have sex with men. The disease spreads through skin-to-skin contact over a long period of time, or through repeated exposure.

The CDPH plan, initially outlined at a July 11 press conference, is to vaccinate identified contacts of cases or clusters to interrupt ongoing transmission. But because some sexual encounters between men are anonymous, contact tracing cannot link all people who have been exposed to infected parties with vaccine.

CDPH is therefore vaccinating anyone who has close physical contact with someone or an intimate partner who was diagnosed with monkeypox; and any man (cis or transgender) who has sex with men who has intimate or sexual contact with other men in a social or sexual venue, who has given or received money or other goods or services in exchange for sex, or who has intimate or sexual contact with multiple or anonymous partners.

At a press conference on July 22, CDPH Commissioner Dr. Allison Arwady said that those who are currently having casual sex need to get their partners’ names and contact information.

There is still not enough vaccine to meet the current need.

LGBTQ+ demographics are notoriously difficult to gauge, but Pacilli said there are around 130,000 men who have sex with men in Cook County. Twenty thousand doses of the two-dose Jynneos vaccine will not be enough to contain a worst-case monkeypox outbreak affecting men who have sex with men because around 50,000 of those men have multiple partners or are HIV-positive.

The slow trickle of vaccines in light of the number of people who need to get vaccinated and the seriousness of the disease—severe pain and three weeks of isolation—are prompting criticism of the federal response.

“This feels like we’re going through a cycle, dealing with a new disease that people are experiencing here, often for the first time, and like we’ve been here before,” said Alderperson Maria Hadden (49th), who is lesbian, at a July 21 Howard Brown town hall.

The Illinois Department of Public Health made the decision late in July to allocate thousands of doses from its federal allocation to fight the outbreak in Chicago, where most of the infections in the state are occurring. (The state and city get different allocations.) On July 20, Gov. J.B. Pritzker wrote to HHS Secretary Xavier Becerra to say that the City of Chicago “has faced substantial delays in receiving their allotted federal supply of vaccine despite increasing cases.” He said the process of vaccine allocation “must be simplified and expedited to ensure people are adequately protected,” and that “states and cities with the most cases and largest at-risk communities should be prioritized for future doses.”

Trevor Hedberg, a Howard Brown physician assistant, said at the July 21 town hall that if people are going to Market Days from August 6-7, they should think about going to circuit parties where they will have prolonged contact with people versus going to the street fair, where there is more room to spread out.

Steven Glass, Howard Brown’s chief operating officer, said the clinical network was about three weeks out from being able to schedule appointments and is examining ways to expand hours, days, and locations where vaccines can be offered.

Howard Brown’s vaccination scheduling number is 872-269-3600; the CDPH is referring people concerned about monkeypox who need a medical provider to the HIV/STI Resource Hub at 1-844-482-4040.

Hazra said he is glad that the city is partnering with community organizations that deal with LGBTQ+ people and not just supplying vaccines to academic medical centers. But he added that he wishes there was a consolidated list of places to get the vaccine.

On Halsted Street in Lakeview East, Gabriel Cralley, 31, said he has an appointment for his monkeypox vaccine but that getting it was “a nightmare.”

“There was conflicting information about where to get it,” he said. “I had to track down Twitter accounts instead of actually looking at a trusted health-care website to find out where I should look.”

Cralley said he isn’t sexually active right now—he just stopped dating a guy and said he is “sitting on the bench” until he could take other precautions to keep himself safe. “I’ve been avoiding going to bars that are super close-contact, because I don’t want to brush up with somebody who doesn’t realize that they’re symptomatic,” he said. He has left venues when they get too crowded.

He was trying to move up his vaccine appointment, scheduled in early August at Howard Brown, as his primary care provider also had a backlog in distributing vaccines.

Cralley’s friend Luis Catalan, 33 and also of Lakeview East, wants to get vaccinated at a pop-up, but he said long lines begin forming three hours before they open. He has a primary care physician and an appointment this month; he plans to ask if they have vaccines.

In South Shore, Devonte Warrior, 23, said he is interested but in no hurry to get vaccinated against monkeypox, though he is worried about it. He’s got a boyfriend of three years and a primary care provider at the Hyde Park Howard Brown clinic, but he said he wasn’t familiar with how the disease is contracted, aside from what he’s seen on The Shade Room, a Black-oriented celebrity culture, news, politics, and style website.

“I always try to play it safe, because I don’t want anything bad to happen to me. I always try to stay consistently with one person,” Warrior said. “I never really know what the next person is doing.”

Hazra is telling his patients to think about who they are having sex with and where they are having sex.

“The same kind of counseling I give to folks who maybe come to clinic with multiple STIs and feel really frustrated with that,” he said. “I tell them, ‘OK, take a step back, and think about who you’ve been having sex with, what kind of sexual behaviors you’ve been engaging with, and try to see if there are ways that you can modify things to help reduce your risk.’”

It’s easy to tout behavioral changes, but they can be difficult to implement. “We have a lot of data that shows the way to empower folks and actually reduce those types of adverse events is to give folks the knowledge and education they need to make informed decisions on their own,” Hazra said.

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