The UK will run out of the monkeypox vaccine despite having one of the biggest number of cases worldwide, triggering warnings that the illness could become endemic.
The country looks likely to exhaust stocks of the vaccine in the next two to three weeks, and then face a delay of almost a month before the next supplies arrive in late September.
An internal NHS England letter has disclosed that there are just 8,300 doses of vaccine left. That has prompted fears among sexual health doctors that the NHS will be unable to inoculate people, including those at highest risk of getting the disease.
Dr Claire Dewsnap, the president of the British Association for Sexual Health and HIV (BASHH), said the letter accurately portrayed the looming unavailability of the vaccine, called Imvanex.
“By current estimates, only 8,300 vaccines remain available, with 5,000 earmarked for London, where demand has been the greatest, making it likely that the remaining number of vaccines will run out in approximately 10 to 20 days, leaving a gap in supply until the next shipment arrives in September.
“Without urgent action to procure more vaccines and avoid a gap in supply, we risk the disease spreading further throughout the UK and becoming an endemic public health challenge,” Dewsnap said.
She praised the Department of Health and Social Care (DHSC) for ordering the vaccine early on in the outbreak, but warned that “there is an insufficient supply of vaccines to meet demand and that a significant number of people eligible for vaccination against monkeypox are yet to be vaccinated”.
The BASHH estimates that 250,000 doses of vaccine must be procured in order to vaccinate approximately 125,000 eligible people, yet the government has only procured over 100,000 to date.
Dewsnap criticised the DHSC, NHS bosses and the UK Health Security Agency (UKHSA), which has been monitoring the outbreak, for what she said were key failings in their response so far.
“In addition to supply challenges, the current vaccination rollout is too slow; with vaccine access hampered by a lack of centralised leadership to coordinate across the various responsible agencies and providers, alongside poor communication about the vaccine to affected communities,” she added.
The NHS England letter, which was obtained by the Financial Times, urged the health service to “urgently” draw up a plan to address the looming three to four-week shortage, “bearing in mind these acute supply constraints and the urgency of reaching those at highest risk”.
It added: “This is clearly all very difficult and very sensitive, and not a position that any of us would like to be in.”
One sexual health doctor in London told the Guardian their clinic was likely to run out of the vaccine next week.
“My understanding is that there are about 5,100 doses of vaccine left in London for all patients until likely the end of September when 100,000 doses are due to arrive in the country,” they said.
“Our clinic has only a few doses left that we are having to give out opportunistically and we have been told we are unlikely to get any more doses, so we will likely run out next week.”
Britain had recorded 2,859 cases of monkeypox by last Thursday, mainly in men who have sex with men. Worldwide there have been about 30,000 cases and nine deaths.
“Clinics are having to shelve plans for vaccination drives as they cannot get the vaccine,” the doctor added. “At one point the aim was to be vaccinating 10,000 patients a week. Clinics have waiting lists of patients who have been identified as at high risk of infection who have not been vaccinated yet. They are trying to honour appointments for people who have already been booked for the vaccine but are unable to book in new patients.”
The NHS in London has been given the bulk of the vaccine supplies received so far from the manufacturer Bavarian Nordic, as it was the initial centre of the outbreak. However, doctors in Brighton, which has a large gay population, are understood to be concerned that they have been given too few doses, given the demand they are facing.
Dr Mary Ramsay, director of clinical programmes at the UKHSA, told the FT: “The thousands of vaccines administered by the NHS to date among those at highest risk of exposure should have a significant impact on the transmission of the virus.”
But the London sexual health specialist said: “The feeling is that vaccination is the only way we will contain the outbreak long-term. Clearly the longer that it takes to vaccinate the people at risk the more chance the outbreak has to grow and extend.”
The DHSC and UKHSA have been approached for comment.
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