The state of Maryland has now received 6,405 doses of a vaccine for monkeypox, but few Marylanders will be able to get a shot in their arm anytime soon.
Demand for the vaccine in Baltimore is high, city officials say, but local and state officials are largely at the mercy of the federal government, which is controlling the flow of vaccines to states and setting guidelines on who is eligible to get one.
A spokesperson for the Maryland Department of Health declined to say where the state is deploying its shots, but health officials held a listening session Wednesday night where they discussed their vaccine strategy.
Lynda Dee, founder of AIDS Action Baltimore, said she was one of more than 250 people on the call and took notes on the two-hour conversation. About a tenth of the state’s monkeypox vaccines have been deployed so far, according to Dee, with 200 each going to Baltimore City, Montgomery County and Prince George’s County.
Monkeypox can spread through close contact with an infected individual. It causes painful lesions, swollen lymph nodes, fevers and chills, and can require weeks of isolation and quarantine, but it’s rarely fatal. So far in America, the disease has been primarily spreading among men who have sex with other men.
Maryland, which had its first presumed monkeypox case June 16, has recorded 101 confirmed cases of monkeypox as of Wednesday, according to the CDC, and the pace of confirmed cases has accelerated in recent days. Nearly a quarter of the state’s monkeypox cases have been identified in the Baltimore area, city Health Commission Dr. Letitia Dzirasa said this week.
The monkeypox vaccine, which can be given before or after exposure, requires two shots, spaced four weeks apart.
“Vaccines are being distributed by the portion of the population at higher-risk as well as the number of cases ... ” said Chase Cook, a Maryland Health Department spokesman, in an email. “All jurisdictions have access to vaccine, and have been surveyed for their needs.”
While Baltimore — with a tenth of the state’s population — has gotten only 3% of the state’s vaccines so far, experts interviewed by The Baltimore Sun explained that there are other factors beyond population that epidemiologists take into account.
Caitlin Rivers, an infectious disease epidemiologist at the Johns Hopkins Center for Health Security, said health departments try to target at-risk populations or identify outbreaks.
“I think it’s really important that we identify and pursue containment as a goal,” Rivers said.
But allocating vaccines based solely on the number of confirmed cases could be problematic if people don’t have access to testing or are unaware of testing, she said.
“One pitfall to be aware of is that it could further entrench existing inequities,” Rivers said.
Michael Schwartzberg, a spokesman for the University of Maryland Medical System, said there are no “on-demand” monkeypox tests for the public right now. Instead, he said patients must have symptoms like lesions before getting tested, which is the current guidance from state and federal health officials. According to Schwartzberg, external labs conduct the tests and can take up to three days to provide results.
Rivers said health departments should be leveraging their relationships with LGBTQ and sexual health clinics to address monkeypox, and she was heartened to hear that the Baltimore City Health Department was partnering with Chase Brexton, a longtime health care provider for the LGBTQ community.
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Dr. Joshua Sharfstein, a professor at the Johns Hopkins Bloomberg School of Public Health and former Baltimore health commissioner, said using vaccines to target active outbreaks should be the top priority when trying to rein in an infectious disease like monkeypox.
“A strict population by county distribution would probably not be the most obvious or sensible [strategy] at this point,” said Sharfstein, who also has been secretary of the Maryland Department of Health. “The vaccine should be going to people who can benefit the most, the people at greatest risk for illness.”
Sharfstein emphasized the state should explain its approach to administering the monkeypox vaccine transparently.
Dee said Wednesday night’s call with state officials was productive and informative but also disheartening. She came away with the impression the state is doing all it can to contain the spread of monkeypox but is hamstrung by a lack of vaccines from the federal government.
The New York Times reported earlier this week that the federal government had about 300,000 doses of monkeypox vaccine stored in Denmark in June but that it waited weeks before shipping them to the United States.
Dee said the report reminded her of the government’s response to the AIDS crisis in the 1980s.
“It’s a mess. A mess occasioned by the federal government’s inactivity,” she said. “Why are gay men always last in this?”