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D.C. expands monkeypox vaccine eligibility to counter falling demand

A sign outside a D.C. Health Department clinic providing monkeypox vaccinations. (Michael Reynolds/EPA-EFE/Shutterstock)

D.C. public health officials expanded eligibility for the monkeypox vaccine Friday and loosened the residency requirement as a strategy to destigmatize the virus, even as the city sees record numbers of infections.

As of Saturday, all people of any sexual orientation or gender who have had multiple sexual partners in the past two weeks will be eligible for the vaccine, in accordance with the Centers for Disease Control and Prevention. Previously, men who have sex with men and have had multiple sexual partners in the past two weeks were eligible.

The new language emphasizes that people at highest risk are still gay, bisexual, and other men who have sex with men, transgender men and transgender women.

Under the new criteria, anyone who works in the District, goes to a D.C. university or college or receives care through a D.C. Department of Health program can receive the vaccine as long as they meet one of the other criteria. The vaccine was previously for D.C. residents only.

“This new language is really about destigmatizing the individuals who may need a vaccine,” said Patrick Ashley, senior deputy director at the health department. “As we know, monkeypox can affect anyone. We want individuals, especially in the [men who have sex with men] community, to get vaccinated but we also want individuals to get access if they feel they are at a higher risk.”

The District has more cases — 321 as of Friday — than any state, but has seen a decline in demand for the vaccine, which Ashley attributed to discomfort people may feel answering intrusive questions about their behaviors or sharing other identifying details.

The city’s preregistration website, preventmonkeypox.dc.gov, will be updated Saturday to reflect the new strategy and the reality that people may not feel comfortable sharing personal information at a government-run clinic, he said.

Instead of specifying the behavior that qualifies individuals for vaccine, they will only have to attest that they meet one of the criteria. Additionally, people who attend Friday walk-up clinics starting on Aug. 19 will not have to share their name or date of birth when filling out a survey before they can get vaccinated.

“The natural assumption is we’ve hit everyone who is interested,” Ashley said. “I still think there are communities that may be interested but may not feel comfortable presenting at a clinic with very specific information or criteria that is necessary.”

The city has administered 15,671 doses of Jynneos, the only vaccine approved to treat monkeypox, of 21,755 received from the federal government. Another 400 appointments are scheduled through Aug. 16.

More than 28,700 District residents preregistered for vaccine, but public health officials estimated the number eligible could be three times as high.

Ashley said District public health officials have asked the Virginia and Maryland health departments to share vaccine to accommodate their residents who work and go to school in D.C.

Maryland reported 259 monkeypox cases as of Thursday, according to the CDC tracker. Virginia has 186 cases, state data updated Friday shows. Both states have thousands of vaccine doses waiting for arms.

Virginia has received 13,459 doses and 3,143 have been administered, leaving more than 10,300 unassigned, a Virginia Department of Health spokesman said Friday.

A Maryland Department of Health spokesman declined to say how many doses were on the shelf in Maryland, but Ashley said much like Virginia, thousands of vaccines are available in Maryland — a problem he attributed to the federal government’s distribution program.

“The more barriers we can remove the more people we can get vaccinated,” he said. “We don’t want those vaccines to be sitting on the shelf.”

Federal officials this week announced a new strategy to stretch hundreds of thousands of Jynneos doses into several million, as local health departments scramble to allocate limited doses.

Ashley said D.C. could implement the procedure of administering one-fifth of a dose as early as the week of Aug. 22. New syringes are on order and nurses are being trained on the new technique, he said.

In the meantime, people who work with high-risk individuals said intrusive questions could be a barrier to access.

DeMarc Hickson, executive director of Us Helping Us, which provides medical, behavioral health and social services to Black gay and bisexual men and Black transgender women, said uptake of the vaccine was down this week at the second of two D.C. clinics his organization hosted.

About 70 people were vaccinated at a D.C. event in July, compared to about 50 this week. The organization administered about 90 doses in Prince George’s County on Wednesday, exceeding the supply and referring about 60 people to other clinics.

“If we are really wanting to eliminate the stigma then we eliminate those stigmatizing things like narrow questions,” he said.

Peter DeMartino, the director of infectious disease prevention and health services at the Maryland Department of Health, said answering questions about sexual behavior is necessary because eligibility is based on behavior.

“As a gay man, I have been answering those questions since I was a teenager,” he said. “Sadly I am a gay man who grew up in the age of HIV and AIDS and so our risk factors for viruses, for disease, have always been monitored by public health.”

The virus is primarily spread through personal, often skin-to-skin contact, including contact with a rash, scabs or bodily fluids from a person with monkeypox, the CDC says.

“We don’t have enough resources to provide blanket coverage,” he said. “We are monitoring that data like a hawk, and as the data evolves our response will evolve.”

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