Oviea Akpotaire, M.D., who works as a gastroenterology specialist at a major hospital in the Seattle area, found himself traveling to Canada back in June to obtain a monkeypox vaccine.
While he was not directly exposed to the monkeypox virus, he had many close friends who were diagnosed between Seattle Pride and the Fourth of July. He grew concerned after hearing about many monkeypox cases within a short time frame.
Throughout his personal research on the monkeypox virus, Akpotaire realized a vaccine had already been developed, although its availability was limited.
“That’s kind of when I started to panic in terms of, okay, what’s actually being done?” said Akpotaire. “At that time — this was over a month ago — there was very little information out about what is the plan for vaccinating residents in Seattle, and I didn’t find anything that was very reassuring.”
While many individuals in his close circle were getting diagnosed, one friend brought up how they traveled to Vancouver, British Columbia, where they received a monkeypox vaccine. Akpotaire said he had the spare time and the means to make a trip up north, so he took the chance.
“We got vaccinated very easily,” said Akpotaire. “We made an appointment and then two days later made the drive, and then within 10 minutes of getting into the clinic, [we were] vaccinated and out of there.”
Akpotaire received his monkeypox vaccination in Vancouver, B.C., in late June. He attempted to receive a monkeypox vaccine locally, but residents of King County could only receive a vaccine if they could prove they had a direct exposure to the virus, he said.
“Even for the people who had had direct exposures to some of our friends, it was proving to be very difficult,” said Akpotaire. “We had talked about what are ways to get vaccinated within our city, and found the resources lacking, which is why we made the drive.”
DOH’s early response
On May 27, the Washington Department of Health (DOH) announced the first probable case of monkeypox in the state.
“In May and June, the vaccine was in very short supply. In Washington, we only had enough vaccine on hand to vaccinate close contact of cases for post-exposure prophylaxis (PEP),” said Nikki Ostergaard, public information officer for the DOH.
According to Ostergaard, for most of June, the state could only acquire small quantities of the vaccine at a time from the federal government — five to 10 doses, to be exact.
“It wasn’t until the very end June (June 28) that Washington was informed of our first federal allocation of 398 courses of the vaccine,” said Ostergaard. “Even at that time, there was still only enough for vaccinating close contact of known cases identified through contact tracing activities.”
Ostergaard said availability for JYNNEOS, the monkeypox vaccine, was different in Canada and Washington state, and some people crossed the border to obtain the vaccine.
Concerns surrounding monkeypox
Akpotaire said the state’s response to the monkeypox virus has been complicated, particularly after three years of dealing with the COVID-19 virus.
“My concerns are that this is more of a federal issue now because the Department of Health only has so much power in terms of requesting enough vaccines for its residents,” said Akpotaire.
The U.S. Department of Health and Human Services announced on Aug. 4 that it would accelerate the delivery of 150,000 doses of the JYNNEOS vaccine to arrive in the country in September. These doses were originally planned to arrive in November.
While the country is facing uncertainties about vaccine availability amidst rising case numbers, Akpotaire hopes the federal government partners with manufacturers in the United States to produce a monkeypox vaccine, rather than relying on supplies to come from a single source in Denmark.
Akpotaire said the current response to the monkeypox virus seems better than it was back in June.
“It still did not feel as if we were being taken seriously, or that our health was being prioritized, but I think that is probably the fear that kind of motivated a lot of me and my friends to get vaccinated in Vancouver instead,” said Akpotaire.
One stark difference between vaccinations in Vancouver, B.C., and Seattle that Akpotaire appreciated was the fact that he was able to go on one website and immediately see all the resources for different clinics in Vancouver that were offering the monkeypox vaccine — as well as book an appointment.
“Whenever I tried to do the same thing in Seattle, there’s not a centralized approach,” said Akpotaire.
There is currently not enough of the monkeypox vaccine to distribute, and no centralized database has been created, according to Ostergaard. The monkeypox vaccine is being managed by local health jurisdictions that are giving the vaccine to the most high-risk individuals, which include close contact with known cases or people that are at highest risk for disease.
“When there is enough supply of JYYNEOS vaccine for people to have access more widely, we can use the current Vaccine Locator platform to help people locate sites offering vaccine,” said Ostergaard.
The DOH reports that as of Aug. 3, at least 166 people in Washington have tested positive for the monkeypox virus. Monkeypox is spread through direct contact with the skin or bodily fluids of an infected person, to include sexual contact. The virus is also spread through contact with virus-contaminated objects such as bedding and clothing, or through respiratory droplets during direct and prolonged face-to-face contact, according to the DOH.
Additionally, monkeypox is a zoonotic disease, which means that it can be transmitted from animals to humans, and vice-versa.
Monkeypox can cause flu-like symptoms, swollen lymph nodes and a rash that can appear anywhere on the body, according to the DOH. The monkeypox rash will turn into raised bumps, which then fill with fluid. Eventually, the rash will scab over and the scabs will fall off, with the most common locations of the rash being on the face, arms, legs and hands.
If a person was infected with the virus during sexual contact, then the rash may appear on the genitals. The DOH reports that within the current monkeypox outbreak, many cases have presented with lesions on the genitals or in the anal area.
The incubation period, which is the time from exposure to the start of symptoms, is generally 7-14 days, but can range from 5-21 days.
The DOH emphasizes that anyone can get monkeypox. The current cases across the country primarily involve men who have sex with men, but anyone who is sexually active with multiple partners, or those who are partners with someone who has sex with multiple partners, is susceptible.
Ostergaard said containing the spread of the monkeypox virus will require using all the public health tools in place, which includes rapidly identifying cases through increased testing and helping people know when to self-isolate; interviewing cases to find their close contacts and getting high-risk contacts vaccinated as soon as possible; promoting actions people can take to prevent and reduce the spread; and provide education to help people make decisions to protect themselves such as recognizing the signs and symptoms, and what to do if they need to get tested.
In addition to vaccines, prevention consists of avoiding close, skin-to-skin contact with people who have a rash that looks like monkeypox; avoiding contact with materials, like bedding, that a person with monkeypox used; washing hands with soap and water before eating or touching one’s face, and after using the bathroom; and being mindful of settings of activities.
According to Ostergaard, the DOH will continue to work closely with tribal, local, community and state partners to prioritize vaccination for those at highest risk. Furthermore, the DOH is also recommending prioritizing the administration of first vaccine doses instead of retaining inventory for second doses.
“This means that some people may have their second dose of the vaccine delayed beyond 28 days until vaccine supply increases,” said Ostergaard, who stated there were exceptions for people with moderate to severe immunosuppression, for which the second dose should be administered as close to 28 days after the first dose as possible.
Who is monkeypox affecting?
Akpotaire understands that vaccines are limited and that monkeypox is impacting primarily men who have sex with men. He understands why, from a public health standpoint, officials are targeting that community to ensure they are aware of their risks and taking measures to protect themselves.
“At the same time, we unfortunately live in a country where the political climate is kind of ripe for something like this to be used as a talking point by some politicians to say, ‘Hey, this is another gay disease’ and to inspire fear in people who are already primed for that sort of messaging, and make them further marginalize a community that has already faced so much over the last few decades,” said Akpotaire.
While there’s been national buzz about the relationship between monkeypox and men who have sex with men, Akpotaire said much of the messaging he’s seen from the Centers for Disease Control and Prevention (CDC), the Department of Health and media outlets have been responsible with having statements that relay how even though monkeypox is primarily affecting men who have sex with men, the virus can affect anyone.
During that process, Akpotaire has found misinformation about the monkeypox virus, which during a time of fear and confusion, only makes the situation worse. Akpotaire hopes to see greater emphasis from the government and media outlets about being careful with information they are spreading.
“I think that it is important that the media continue to say that because it helps prevent physicians from ignoring a possible diagnosis when it appears in someone who’s not the typical population,” said Akpotairewho has spent the last several weeks using his personal social media accounts to spread accurate information to peers. “Something that’s really important is that we have to all be better as a country and as a community with staying informed, but also learning how to assess information to make sure that it’s actually good quality information.”