Louisiana makes moves to stretch monkeypox vaccine supply

The Louisiana Department of Health is encouraging health care providers to stretch the state’s meager monkeypox vaccine supply by splitting individual doses as much as five ways, following a federal government directive Wednesday that allows them to do so.  

“This is a potential game changer for our monkeypox response, especially ahead of upcoming large events in Louisiana,” State Health Officer Dr. Joseph Kanter said in a written statement Wednesday.

President Joe Biden’s administration is facing political backlash for not acting quickly enough to secure more doses of the monkeypox vaccine from a Danish pharmaceutical company that makes it. Across the country, people considered high-risk for monkeypox haven’t been able to get fully vaccinated because demand for the medicine far exceeds the U.S. supply.

The shortfall is particularly acute among gay men, bisexual men and transgender people, where monkeypox is currently the most pervasive.

The disease is spreading rapidly, mostly through close, skin-to-skin contact with people who have active infection. Any person, regardless of their sexuality or gender identity, can contract the virus.

In Louisiana, there have been 92 confirmed cases of monkeypox since early July. The state has been allocated 9,200 vaccine doses that must last through the middle of September, which health officials complained was not enough to protect the community.

The Louisiana health department has been particularly concerned that it does not have enough vaccine doses to prepare for Southern Decadence, an LGBTQ+ festival held over Labor Day weekend in New Orleans that attracts between 100,000 and 300,00 people. 

The federal government’s new guidance however, will allow health care providers to vaccine as many as five times as many people with the same supply of vaccine.

With the smaller dose, the vaccine has to be administered directly under the skin to be effective, as opposed to deeper into a person’s tissue. 

There are critics of the new vaccine distribution plan. Evidence that a dose just one-fifth the size of the original will provide enough protection is essentially limited to one study.

Health care providers giving the vaccine are also going to have to use a new technique to administer it. If they falter – and inject the smaller dose into the wrong part of the human tissue – the person being vaccinated might not receive the protection expected.

“We have grave concerns about the limited amount of research that has been done on this dose and administration method, and we fear it will give people a false sense of confidence that they are protected,” David Harvey of the National Coalition of STD Directors said in a statement to the Associated Press.

The messaging around the monkeypox vaccine is also at risk of becoming muddled. Initially, people were told that they need two full doses of the vaccine administered 28 days apart to be fully vaccinated. Then, some health care providers in U.S. began giving out just one dose to each person in an effort to stretch the supply.

Now people will be given smaller doses, but they will need to get at least two of those smaller doses in order to be adequately protected against an outbreak, according to experts. Those who have already been vaccinated against monkeypox are also being advised to get the second, smaller dose about a month after their first shot. 

With limited vaccine, Louisiana restricted access to people who had been directly exposed to monkeypox as well as men who have sex with men, transgender women and nonbinary people assigned the male sex at birth who had intimate contact with multiple or anonymous partners over the previous 14 days. 

Sex workers and people who have paid for sex, regardless of their gender or sexuality, in the last 14 days also qualify for the vaccine.