We Should Vaccinate Gay and Bisexual Men for Monkeypox Now

Monica Gandhi, MD, MPH


June 23, 2022

I previously reported on the history of the current outbreak of monkeypox among mainly men who have sex with men (MSM) in this Medscape blog. As we discussed, there is a large monkeypox outbreak going on across the United Kingdom, Europe, Australia, Canada, the United States, and other countries. Prior to this outbreak, monkeypox had usually been reported from West and Central Africa (regions in which the infection was previously called endemic) or in travelers from this region. However, from May 13 to June 22, 2022, over 3100 cases have now been reported in 58 nonendemic countries, mainly among MSM, with no signs of abatement.

Moreover, testing for monkeypox is cumbersome. Optimal diagnostic samples for monkeypox are from skin lesions, where a pustule is actually unroofed (the top is taken off) and the material taken from underneath to send for polymerase chain reaction. Testing from more than one lesion is encouraged and the clinician taking the samples must wear personal protective equipment. Moreover, the Centers for Disease Control and Prevention has to confirm any suspected case of monkeypox after confirmed diagnosis at the state level.

The United States is underreacting to this outbreak. Given that we have a vaccine available for this infection, we need to move more quickly and forcefully to change its trajectory.

A highly effective vaccine (called Jynneos) has been licensed in the United States to prevent monkeypox and smallpox. On June 1, the CDC updated its recommendations to say Jynneos is the preferred postexposure prophylaxis for close contacts of monkeypox cases (eg, household contacts or healthcare workers); we currently have approximately 36,000 doses in our stockpile.

The Jynneos vaccine is highly effective in protecting against monkeypox. COVID-19 did not have an effective vaccine when it initially spread in early 2020 and required masks, distancing, ventilation, testing, and contact tracing to try to minimize transmission until we could get to an effective vaccine. We are not at that disadvantage with monkeypox; we have a vaccine and our current attempts to test and contact trace our way out of this epidemic are failing.

We need to act and act now to offer this vaccine to all sexually active MSM in the United States.

Canada just signed a $56 million deal with the manufacturer of the Jynneos vaccine, and Quebec has started offering the vaccine to all MSM. The United Kingdom is expanding its vaccination campaign as of this week to offer the vaccine to gay and bisexual men. The United States is expanding its Jynneos vaccine supply and the CDC Advisory Committee on Immunization Practices (ACIP) is discussing today (June 23, 2022) whether we should quickly move to purchase doses and offer the vaccine to all MSM who are at risk. I believe the answer should be a resounding yes.

Moreover, as the World Health Organization points out, we have ignored endemic monkeypox in West and Central Africa for far too long, despite having effective vaccines. The monkeypox vaccine needs to be equitably distributed to the populations who are at risk worldwide. As the emergency phase of the COVID-19 pandemic fades, per the WHO, the European Union, and US public health officials, we have to stop underreacting to this latest infectious disease threat and act now.

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About Dr Monica Gandhi
Monica Gandhi, MD, MPH, is an infectious diseases doctor, professor of medicine, and associate chief in the Division of HIV, Infectious Diseases, and Global Medicine at the University of California, San Francisco (UCSF). She is also director of the UCSF Center for AIDS Research (CFAR) and medical director of the HIV Clinic ("Ward 86") at San Francisco General Hospital. Her research focuses on HIV and women; adherence measurement in HIV treatment and prevention; and, most recently, on how to mitigate the COVID-19 pandemic.

Connect with her on Twitter: @MonicaGandhi9


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