New York to split monkeypox vaccine to increase number of shots available amid dose shortage

New York State is switching to a new method of administering the monkeypox vaccination that would to lead a fivefold increase in the number of shots amid a shortage of doses as the latest virus epidemic spreads through New York City and Long Island.

In state data released Monday, the number of monkeypox cases in Nassau and Suffolk counties combined was 77, while New York State had more cases — nearly 3,200 — than any other state in the country. 

New York City now accounts for 2,964 of those cases, according to state data released Monday. But the next largest concentration is just outside the city: Nassau, Suffolk and Westchester counties, the data shows. 

Of the 3,560 new vaccine vials ordered and delivered in the coming days, 900 will be delivered to Suffolk and 400 to Nassau, the state said.

The new vaccination approach — called fractionating — means that what was one dose under the old method will now be turned into five smaller doses given a different way, Dr. Mary T. Bassett, the state health commissioner, said at a news conference with Gov. Kathy Hochul.

Each fifth of a dose must be delivered via an intradermal method into the skin. The previous approach injected the full dose under the skin, or subcutaneously. Providers must use the new method, although it could switch back if more vaccines come in, Hochul said.

Bassett said the intradermal approach is just as effective as the subcutaneous method and can work with a far lower dose because of the intradermal method.

This method is thought to increase the effectiveness of the smaller dose because there are more immune cells within the skin than in the fatty layer under the skin, said medical experts.

There are downsides, Bassett said. Giving shots intradermally is more difficult to do, and often causes side effects such as pain, scarring and other complications. They “aren’t serious, but they’re unpleasant,” she said.

Research on fractionating is also limited and the vaccine's manufacturer, Bavarian Nordic, has expressed concerns over that.

But the state has little choice, she said, since the federal government has not been able to deliver sufficient doses. “We have been struggling with not having enough doses, and our obligation in public health is always to do the most good for the most people, and intradermal will vastly expand our access to a scarce resource,” Bassett said.

The state expects to fully switch over to the new method by next Monday, she said. 

In the current outbreak, nearly all of those who have been infected with monkeypox are men who have sex with other men, according to health agencies. The virus can be spread through close physical contact with infectious lesions or pustules, or, far less commonly, by touching items such as clothing or bedding that had contact with the rash. It can also spread through respiratory droplets when an infected person coughs or sneezes.

“Although monkeypox is very rarely fatal, it is extremely unpleasant and painful,” Bassett said.

Dr. Anthony Fauci, the chief medical adviser to President Joe Biden, has said those who are at greatest risk in the current outbreak are men who have anonymous or random sex with other men. That is a current criteria to qualify for the vaccine. Fauci suggested such men reduce their number of sexual partners to decrease the chances of getting infected with monkeypox.

The United States now has the largest number of reported monkeypox cases in the world, and New York has more than any other state — 3,180 out of the total of more than 15,000, Bassett said.

Nassau now has 34 cases, Suffolk has 43 and Westchester has 75. Some 24 out of 57 counties outside NYC now have monkeypox cases reported, state data shows.

Hochul said the state is pushing the federal government to get more doses of monkeypox vaccine, and if the supply increases substantially the state would likely revert to the original subcutaneous method.

“They know that we want more,” Hochul said. “My hand is out. People want to get vaccinated. They’re anxious, they’re desperate for this.” The intradermal method is an “interim approach” until supply chain problems are resolved, she said.

Bassett said that “if we had unlimited supply of vaccinations, I think everybody would have preferred to stay with” the subcutaneous method. “But that’s not the situation that we’ve been in. That has not been our situation from the start.”

The state-provided monkeypox vaccine is administered at more than a dozen clinics run by Nassau University Medical Center, Northwell Health, Stony Brook Medicine and Sun River Health, according to representatives of each organization and of Nassau and Suffolk counties. Most said earlier this month that fractionating was under review. 

Suffolk's Fire Island, home to the gay vacation communities of Cherry Grove and the Pines, has been one of Suffolk County’s main vaccine sites.

Nationwide including on Long Island, appointments for the monkeypox shot have been scarce for months. Those slots have booked up almost immediately after becoming available online. Fractionating in New York could expand appointments fivefold.

Monkeypox cases are now confirmed in about 90 countries, Bassett said.

The state expects to see more cases of monkeypox among children — there is already one confirmed — but is not concerned about schools being a place of transmission and does not expect children to account for many cases, she said.

Still, she said, teenagers should be careful. About 50% of teenagers have had sexual relations by the time they are 18, she said studies show.

With Matthew Chayes