The UK could be short of at least 100,000 doses of monkeypox vaccine because government health chiefs grossly underestimated the number of people who need them, experts have warned.
The UK Health Security Agency (UKHSA) placed an order for 150,000 doses in June based on its calculation of the number of people at risk from the rapidly spreading virus, as well as an assessment of anticipated demand.
But documents seen by Sky News suggest the public health body has underestimated the number of gay, bisexual and other men who have sex with men (GBMSM) who need vaccination. And its calculation of likely uptake has also proved well wide of the mark.
Sexual health experts are so concerned that they have convened a Consensus Statement Group (CSG) to demand the UKHSA orders a total of 250,000 doses of the vaccine to ensure there is enough to go round.
They say the window to cut short the outbreak could be missed without swift action. The longer the virus continues to spread through the population, the greater the chance that it becomes endemic.
The CSG, which includes the British HIV Association, the British Association for Sexual Health and HIV, and the Association of Directors of Public Health, calculates there are around 125,000 men at risk, rather than the original estimate of 70,671 by the UKHSA – an increase of 77%.
And it says multiple community response teams have reported uptake of the jab to be closer to 90%, rather than the 70% anticipated by the public health body, which was based on demand for a vaccine against hepatitis B.
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In total, the CSG estimates the UK needs at least 213,000 doses to immunise GBMSM and health workers – but says even that could be an underestimate because of uncertainties over how many sex workers require vaccinations, and tens of thousands of men who have sex with men who are HIV positive.
It believes 250,000 doses would be a safer initial target.
In June, the UKHSA procured 150,000 doses of the smallpox vaccine Imvanex as part of its strategy to contain the monkeypox outbreak. This included an initial shipment of 50,000 doses, the most immediately available, with a further 100,000 set to arrive in late September.
On Monday, the UKHSA confirmed the UK will run out of the vaccine in the next two weeks, leaving clinics unable to make new appointments and left with tough decisions over whom to prioritise with their remaining stock.
A sexual health consultant involved in the vaccine rollout told Sky News: “It’s left us in a position of needing to allocate a scarce resource, we have provided no further new vaccine slots since the beginning of last week. It’s also worrying that there seems to be no communication about what happens after these doses arrive in September.”
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Monkeypox outbreak seen as one of UKHSA’s first major challenges
There is a global shortage of the Imvanex vaccine as it is manufactured and distributed by only one company, Denmark-based Bavarian Nordic, which until recently was using a third party to help make the vaccine.
Sky News understands that a method approved by the US government is under consideration as a way of helping ease the reliance on procuring more doses. The Biden administration has approved intradermal vaccination, which involves delivery of the vaccine into the outer layers of the skin and requires up to one-fifth less dosage.
The monkeypox outbreak is seen as one of the first major challenges the UKHSA has faced since it was created during the COVID pandemic.
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The Terrence Higgins Trust, an HIV charity, says there are lessons to be learned from the response so far.
Campaigns director Richard Angell said: “The lack of decisive leadership shown to halt the outbreak is telling. Tackling the monkeypox outbreak must finally be prioritised – we need a plan and a Tsar now.
“Mistakes have been made in terms of the vaccine programme, and we want to see these rectified going forward.
“With limited supplies but the promise of more availability, the emphasis placed on sexual health clinics was to get the vaccine to as many gay and bisexual men as quickly as possible.
“Little did they know they would be facing a cliff edge in vaccine availability until supplies were already nearly gone. This means that some people who should already have been prioritised for the vaccine will be forced to wait.”
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Outbreak ‘beginning to slow’ in UK
While anyone can get monkeypox, cases in Europe and the US are predominantly in gay, bisexual and other men who have sex with men, with the virus largely being passed on in closely connected sexual networks.
The UKHSA says that the outbreak is beginning to slow in the UK with roughly 29 cases a day now being confirmed in the first week of August, compared to 52 a day in the last week of June.
They worked with clinical experts to agree on proxy markers of increased risk of exposure to monkeypox, such as eligibility for HIV PrEP and history of a bacterial STI. Using this method, they estimated that around 38,470 GBMSM were eligible for the pre-exposure vaccine in England, with a further 5,770 in the rest of the UK.
However, it was acknowledged at the time this would be an underestimate as not everyone would be in contact with sexual health services, and so the original number of eligible men was increased by 60%.
Head of immunisation, Mary Ramsay, said: “UKHSA’s monkeypox vaccination strategy is kept under continuous review to ensure doses of the smallpox vaccine are reaching as many people at high risk of exposure as possible. If there are any changes, they will be announced as and when decisions are taken.”
