If you missed my opening salvo on this topic, go back and read it here. It'll get you mostly caught up. The executive summary is that the Biden administration has botched the monkeypox outbreak terribly, which should be a significant scandal. It's also another indictment of Biden's "diversity" hire Health and Human Services Secretary, who has zero public health experience in his career – yet who Democrats nominated and confirmed as health minister in the middle of a historically deadly pandemic. Due to abject incompetence and neglect, the US has far fewer available vaccine doses than we should and than we've paid for. The current supplies are not even enough to accommodate the relatively small population with (by far) the highest risk from the disease, gay and bisexual men. Because the government's failures are so bad, and the vaccine cavalry won't be arriving until mid-fall or even next year, with an acute outbreak spreading right now, they've been reduced to changing the dosage and delivery methods on the fly. This is wild:
Biden administration officials announced Tuesday a new strategy to split monkeypox vaccine doses in hopes of vaccinating up to five times as many people against the virus. The plan, unveiled days after the federal government declared monkeypox a public health emergency amid criticism over the administration’s response to the rapidly unfolding crisis, would allow public health officials to stretch their limited supply of monkeypox vaccine doses by changing how those shots are administered. Rather than inject doses of Jynneos subcutaneously, a traditional way of delivering vaccines into the fatty tissue under the skin, the doses would instead be injected under the top layer of the skin. This approach, known as an intradermal injection, uses a thinner needle and less vaccine but leads to a small bubble forming on the surface of the skin that can scar...The change in injection method would maximize the immune reaction generated by the vaccine and allow U.S. officials to only administer one-fifth of the original dose, officials said, stressing that the approach would not compromise safety or efficacy...
...The change in vaccine dosing would be a large-scale, real-time experiment as officials race to stave off a monkeypox outbreak that has infected nearly 9,500 people in the United States. The announcement has drawn support as well as skepticism among public health experts eager to combat the virus, with some questioning its practicality and effectiveness...The change is not without risk. People who receive the pared-down version of the Jynneos vaccine, which is intended as a two-dose regimen, may end up needing additional shots if the new vaccine strategy leads to an insufficient level of protection against the virus. Local officials may also struggle to administer the new strategy, which could require additional training and supplies like new needles to safely deliver the shots.
The government bureaucracy is insisting that reducing doses by 80 percent (!) will not impact efficacy, supposedly because the new, smaller doses are being administered differently. Why would anyone have confidence in that assertion, which does amount to an enormous experiment on hundreds of thousands of people, with no real data to back it up? The story also mentions how the new delivery method requires different training, different needles, and is likelier to cause scarring. I spoke to a doctor earlier this week who was stunned at the pivot on dosing, wondering what data the government had to justify it. Lo and behold, the vaccine manufacturer is also sounding very skeptical of the plan – which would require even more shots down the line if efficacy deteriorates, an entirely logical fear:
The manufacturer of the only vaccine approved by the Food and Drug Administration to protect against monkeypox privately warned senior Biden health officials about their plan to split doses and change how the shots are delivered. “We do have some reservations … due to the very limited safety data available,” Bavarian Nordic CEO Paul Chaplin wrote to Health and Human Services Secretary Xavier Becerra, and Food and Drug Administration Commissioner Robert M. Califf in a letter sent Tuesday and obtained by The Washington Post. “It would have been prudent” to conduct further studies before overhauling the nation’s monkeypox vaccine strategy, Chaplin said, adding that his company had been “inundated with calls from U.S. state government officials with questions and concerns” about how to implement the new plan. In interviews Wednesday, Biden administration officials acknowledged Bavarian Nordic’s concerns but said they would not affect their vaccine strategy. “We’ve had conversations with them about this, and so has FDA,” Becerra said. “We wouldn’t have moved forward unless we thought it was safe and effective, and if FDA hadn’t dotted its I’s and crossed its T’s.”
Well, career politician and lawyer Xavier Becerra insists the T's have been crossed, so no worries. Who's convinced? This Post story also suggests that Biden officials are quietly telling reporters that concerned parties might consider dismissing the manufacturer's concerns because they could be rooted in greed and profits, not medical safety. That's brazen innuendo coming from the crew that's making up a new plan, without strong data, due to their own incompetence and failures. What's the point of requiring robust safety data from companies if the government can just throw it out the window and accuse said companies of prioritizing profits? Perhaps the administration will figure out a way to impugn this famous CNN doctor, too:
However, there’s little data on the efficacy of the vaccine against monkeypox and even less with this new method. In theory, it should work, but this plan still comes with challenges (2/2)https://t.co/jTSBejeQ6A— Dr. Sanjay Gupta (@drsanjaygupta) August 12, 2022
He's putting it very diplomatically. One of the other big points I've been making on this front is that public health officials must prioritize clear and accurate communication over politicized messaging or woke sensibilities. Writer Josh Barro highlights a jaw-dropping exchange on NPR Oregon, calling it an example of how not to talk about monkeypox (or anything else, frankly):
This answer alone is instantly immortal: pic.twitter.com/8U2Pn653rc— Ross Douthat (@DouthatNYT) August 11, 2022
You'd need two graduate degrees in gender studies from Wesleyan to make sense of that mess, which does an active disservice to public health. So, in my opinion, does stuff like this:
The internet being a terrible place warrants this clarification: Monkeypox is NOT an STD and can be transmitted through non-sexual skin-to-skin contact like hugging (not a euphemism) as well as through contact with contaminated objects like towels, sheets, couch cushions, etc. https://t.co/N8TBF0LT6P— Kristen Hwang (@khwangreports) August 10, 2022
Monkeypox, like various STDs, can be spread non-sexually. But just as women and straight men can get monkeypox, the overwhelming majority of known cases are among men who have sex with men. That's a fact that should be exceptionally relevant to, and emphasized in, public health messaging. Similarly, while monkeypox can be spread non-sexually (I'm not disputing that at all), there's a very strong sexual component to the current outbreak. Pretending that facts aren't facts in order to muddy waters, avoid "stigma," and sidestep hurt feelings is not the job of public health officials. I'll leave you with this flashback:
Remember, he's on a big winning streak, folks. The media says so.