DC Health announced on Friday that the city will start a split-dose strategy for the monkeypox vaccine, following federal officials’ guidance to stretch the limited vaccine supply as the nation’s outbreak continues to grow.

The new administration procedure uses one-fifth of a single-dose JYNNEOS vaccine and inject the it into the skin rather than fat — a largely untested dose-sparing strategy taken on by the Biden administration as it attempts to mitigate a bungled vaccine rollout that’s left local public health departments’ hamstrung for doses. The new plan, according to DC Health, will allow the agency to maintain its newly expanded vaccine eligibility to anyone (regardless of sexuality or gender) that has had more than two sexual partners in the past two weeks, and also to resume administration of second doses, which had been indefinitely postponed since July 26.

“In order to stop the spread of monkeypox, it is critical to surround the disease with a wall of immunity by providing the vaccine to the greatest number of high-risk individuals as quickly as possible,” reads the agency’s release from Friday. “DC Health’s new vaccine strategy is designed to ensure that more doses of the monkeypox vaccine will be available to close contacts and the recently expanded pool of eligible residents.”

Residents who have already gotten their first doses should check their email for a notice from DC Health with an option to book a second dose. According to the city, these appointments will be booked as supply allows on a rolling basis, and according to the administration of the initial dose.

The split-dose strategy, introduced by U.S. Health and Human Services Secretary Xavier Becerra earlier this month and granted emergency-use by the Food and Drug Administration, uses a thinner needle and less vaccine to inject the vaccine intradermally — into the top layer of skin — rather than the traditional subcutaneous method which injects the vaccine into the fat below the skin. The new administration method has prompted concerns from the JYNNEOS manufacturer over the lack of research around the safety and efficacy of the split-dose strategy, but federal officials have defended the move as necessary and effective, as the next batch of vaccine shipments aren’t set to arrive in the U.S. until September.  The U.S.’s decision rests heavily on one 2015 study, which found that the JYNNEOS vaccine, initially developed to protect immunocompromised individuals against smallpox, proved similarly effective when administered both subcutaneously and intradermally in healthy, white adults.

“The FDA has determined that the known and potential benefits of JYNNEOS outweigh the known and potential risks for the authorized uses,” reads the FDA’s statement granting authorization for the split-dose strategy.

In announcing the pivot on Friday, DC Health officials said the new posture would allow for greater equity in vaccine distribution. According to the agency’s new MPV data dashboard, 98% of the city’s 350 cases are male, and 39% are white. While Black residents account for 33% of cases, only 21% of the city’s roughly 16,000 administered vaccines have gone to Black residents, while 62% have gone to white residents. Currently residents can pre-register for a vaccine appointment online or visit a weekly walk-up clinic, which take place every Friday.

Regionally, Maryland has reported 349 cases of the virus, per the CDC, but Prince George’s and Montgomery counties have not expanded vaccine eligibility on the scale D.C. has. In Prince George’s County, only those who have been identified as close contacts of a confirmed case, or those who are presumed contacts based on their sexual partners in the past 14 days are eligible for a vaccine. Appointments can be booked online. In Montgomery County, vaccine eligibility is restricted based on gender and sexuality, and whether a person has had multiple sexual partners in the past 14 days in an area with known MPV. Residents can complete a pre-registration survey online, but may not be selected if they do not meet all criteria. Both Montgomery and Prince George’s counties are holding town halls on the MPV response this week, on Monday and Wednesday respectively.

PREVIOUSLY:
After Letter from Councilmembers, D.C. Officials Release Data On Monkeypox
D.C. Expands Monkeypox Vaccine Eligibility, Removes Gender And Sexuality Criteria
D.C. To Open Walk-Up Monkeypox Vaccine Clinics Every Friday
How Monkeypox Messaging And Response Is Failing, According To Local LGBTQ+ Advocates
Amid Supply Constraints, D.C. Postpones Residents’ Second Monkeypox Vaccine Doses
D.C. Has The Highest Number Of Monkeypox Cases Per Capita In The U.S.
D.C. Launches Pre-Registration System For Monkeypox Vaccinations