Tyler Bowman opened his phone on Monday and called San Francisco’s public health department over and over — five times in all — while desperate for a vaccine that could help him avoid becoming the latest patient in a burgeoning monkeypox outbreak.
And for days, he confronted a widespread problem: There just weren’t enough shots to go around.
Infectious disease experts treating monkeypox patients across the Bay Area say the region — and the United States as whole — appears dangerously vulnerable to the continued spread of a virus that, until just a couple of months ago, was little known outside of a few African communities. The reason is simple: Too few vaccine doses are making their way to clinics across the country, leaving America susceptible to yet another public health crisis even as it seeks to emerge from its worst pandemic in a century.
Already, one clinic in San Francisco closed on Wednesday, and at least two more appeared likely to shut their doors to monkeypox patients by the end of the week due to a lack of vaccine, according to the San Francisco Department of Public Health.
For Bowman, the journey to his vaccine left him pessimistic about the Bay Area’s chances to avoid a larger outbreak. He finally was able to get an appointment on Thursday — four days after he first started scrambling for a dose of his own.
“It’s frustrating,” said Bowman, as he was filling out the clinic’s three-page form.
“And we saw with COVID what happens when you let it get out of control. (Eventually) it’s not just going to be a thing that hits gay men. It’ll start spreading amongst almost everybody.”
Bay Area public health officials and epidemiologists emphasize that the risk of the virus to the general population remains low, and the disease itself, while painful, is almost never fatal. Throughout the country, the virus largely appears to be affecting men who have sex with other men, and physicians in the Bay Area say they have encountered few — if any — patients who don’t fall into that demographic.
But the lack of vaccine doses has left the region — and the nation as a whole — at a perilous moment as it seeks to prevent the spread of the disease to the larger population, physicians say.
In San Francisco — a city where 68 probable and confirmed cases have been reported as of Wednesday — the shortage is worrisome, said Dr. Peter Chin-Hong, professor of medicine and an infectious disease specialist at UC San Francisco. The health department has administered 1,702 doses as of Wednesday — a figure that doesn’t include vaccines given at hospitals and clinics elsewhere in the city.
He said it’s still too early to tell if the virus will become endemic — meaning that it would be a regular part of life, not just a rare, one-off outbreak. But he said that vaccine availability is “probably the most important” factor in determining the course of the outbreak at the moment. And, he warned, “it could easily be something that we have to live with.”
“I think we’re in a very vulnerable place right now where we may be losing time,” Chin-Hong said. “Time is of the essence right now.”
Myriad reasons appear to exist for the current vaccine shortage, including the unexpected ease with which the virus has moved through certain communities and the fact that only one vaccine exists that’s approved by the Food and Drug Administration specifically to prevent monkeypox — a vaccine called Jynneos, produced by the Danish company Bavarian Nordic.
The manufacturer has experienced closures at a plant this year, the New York Times reported. That has complicated efforts to manufacture enough supplies for countries suddenly clamoring for its product, which until this summer was in relatively low demand.
While another vaccine exists to guard against monkeypox, it’s much older and was created to address smallpox — a related but different disease. As a result, it carries with it a far higher risk of complications.
In late June, the Biden Administration promised to deliver nearly 300,000 doses across the nation over the coming weeks and another 1.6 million doses in the months to come. As of Wednesday, it had distributed about 132,000 doses — nearly 27,000 of which were sent to California. In the Bay Area — and especially in San Francisco — the supply had yet to catch up with demand.
“It is my sense that we don’t have sufficient access to vaccines at the moment,” said Dr. Jorge Salinas, hospital epidemiologist for Stanford University. “People are interested in them, but the number of doses available in our region is still quite limited.”
Still, much of the outbreak’s persistence also comes down to its relatively stealthy nature and an unexpectedly efficient means of transmission, experts said. Early symptoms of the disease can be difficult to detect, Chin-Hong said, meaning that people may unknowingly spread it.
Except for a 2003 outbreak in the United States that sickened about 80 people, monkeypox has rarely been reported beyond Africa. From 2018 to 2021, for example, only a dozen travel-associated cases had been reported outside of the continent, according to the European Union’s health agency. And, Salinas said, the federal government already had 56,000 doses stockpiled away when the virus hit — a figure that would have appeared to be enough.
“This outbreak is quite special,” Salinas said. “The precautions that America had in place were unfortunately not enough for this challenge.
The outbreak appears to be affecting some parts of the Bay Area harder than others — leaving counties to shift resources to areas in greater need of vaccine doses. Officials with San Mateo County’s health department said that they were working on a plan to shift some of its 200 doses to other parts of the area — such as San Francisco — due to a lack of monkeypox cases on the Peninsula.
For now, many health officials are focusing their limited supplies on people who are at highest risk — often those who have been previously exposed to the virus. Unlike the COVID-19 vaccine, the monkeypox shot can help someone avoid infection even after an exposure has occurred.
“We’re racing against time,” Chin-Hong said.
