Mark Webber and Doug Brown got up before dawn to make the journey from Agoura Hills and arrived at the Leimert Park clinic around 6am hoping to be vaccinated against monkeypox.
“We came out in the 80s. We remember when HIV broke through,” said Webber, 54, a Maryland resident who was in Southern California to care for his late father. Because monkeypox has become a health threat, “we take it very seriously.”
The line began forming hours before the Crenshaw Boulevard clinic began administering shots on Wednesday and snaked through the parking lot of the St. John’s Community Health site. At the clinic, health workers had split each vial of Jynneos vaccine into five doses after federal officials gave the green light on Tuesday to change the way the vaccines are administered.
In the sweltering heat, St. John’s Director of Nursing Gale Castillo walked down the line of patients waiting for their shots and explained what to expect: the vaccine would not be given subcutaneously—into the fatty tissue under the skin— but at a shallower level in the skin. “If you’ve ever had a TB test? Same,” Castillo told them, showing photos of the process.
The Jynneos vaccine, a shot approved by the Food and Drug Administration to protect against monkeypox, has limited availability as Angelenos tries to avoid the virus. The infectious disease is rarely fatal but can cause fever, pain, swollen lymph nodes and painful lesions and has forced people to isolate themselves for weeks.
As demand has exceeded supply, Los Angeles County has restricted who is eligible for the vaccine, only offering the shots to those who are at higher risk. It has also urged healthcare providers to prioritize giving out the first doses of the Jynneos vaccine – to be given in two doses at least four weeks apart – rather than ensuring people get their second dose.
Federal officials also announced Tuesday that they would expand the supply of monkeypox vaccines by allowing medical providers to administer smaller doses at a shallower level into the skin. Dubbed intradermal injection, the method was previously used alongside other vaccines that were in short supply. The FDA cited a clinical study that found the smaller, shallower doses elicited a similar type of immune response as subcutaneous injections. This could effectively quintuple the number of shots available since the method uses only one-fifth of a full dose.
“I think that’s a very smart use of the vaccine,” said Anne Rimoin, a professor of epidemiology at UCLA’s Fielding School of Public Health. Rimoin said the plan is rooted in solid science, “but we still need to do some work to assess how effective it will be.”
CDC Director Dr. Rochelle Walensky told reporters Tuesday that the intradermal method is a better way to expand vaccine access than just giving people a single shot. dr LA County Public Health Department chief medical officer Rita Singhal said Thursday it would “open up for second doses as we move to the intradermal or alternative regimen.”
“We’re pretty strongly convinced that the two doses are necessary, in part because we just don’t have the evidence to back it up…Months later after a single dose, we know people are adequately protected,” said Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research. “And we don’t want to give people a false sense of security.”
Though the shift in strategy surrounding the vaccine has raised questions and concerns, the White House deputy coordinator of the monkeypox response said the group hit hardest by the virus so far — men who have sex with men — in general trust in vaccination has shown COVID vaccination rates “well over 90%”.
For monkeypox, “we’ll probably still run out of vaccines before we run out of guns,” said Dr. Demetre Daskalakis.
The change was welcomed by St. John’s Community Health, which had already scheduled a vaccination clinic for the day after the vaccination strategy change was announced. dr Anitha Mullangi, the nonprofit’s chief medical officer, said his team quickly mobilized to make the switch. A key change was that the intradermal inoculations are placed on the underside of the forearm, where it is easier to place the injection into the skin.
Ernesto Barahona, chief development officer at St. John’s, said splitting up the doses meant they now had enough on hand for 1,800 patients. Demand was evident in the August heat, with dozens of people queuing outside. Ruben Ramirez, from West Adams, who encountered the line snaking through the parking lot on his 9am arrival, said he was undaunted.
“The waiting time doesn’t matter. It’s important,” said Ramirez, a 59-year-old antiques dealer, in Spanish. Ramirez didn’t want to get sick, but “my bigger concern is infecting other people.”
The rising number of monkeypox cases had stoked fears in Taylor Tobias, a 42-year-old actor who came to the clinic from West Hollywood. “What do I do when I’m full of wounds and can’t work?” asked Tobias. At one point, “I went into a TikTok wormhole that really freaked me out.”
If Tobias gets the vaccine, “I will still take the same precautions” as I do now, the actor said. “But it relieves some of the anxiety.”
Derek Catao had seen on the news that the federal government was changing the way the vaccine could be given.
“I’m all for more people being protected,” said Catao, 47, who went to the vaccination clinic from Glendale. As cases have increased, “I fear it will get worse before it gets better.”
According to health officials, the virus is most commonly spread through skin contact with contagious lesions, typically in intimate settings, although it can also be transmitted through contaminated sheets and respiratory droplets with prolonged exposure.
So far, the virus has disproportionately affected gay and bisexual men: In Los Angeles County, the overwhelming majority of cases reported to date have been in men, the majority of whom identify as gay, bisexual or queer, according to the county.
Many gay and bisexual men have put off social and sexual activities or found other ways to reduce their risks until they can get vaccinated, but “the vaccine is the definitive solution to this,” said Dr. Timothy M. Hall, assistant health sciences clinical professor at UCLA’s Center for Behavioral and Addiction Medicine.
Hall lamented that gay men are expected to be different than straight men: “There’s this idea that gay men should be able to turn off their sex life, their romantic life, their relationships for an indefinite period of time.”
Although the virus has hit the gay community hardest, health and community groups have repeatedly stressed that the disease can strike anyone. Octavio Hardouin, a 35-year-old waiting in line for the vaccine on Wednesday, said “everyone needs to be aware of this virus”.
“This virus is not just for gay people,” Hardouin said. “Anyone can get it.”
As of this week, Los Angeles County had received more than 43,000 full doses of the Jynneos vaccine and administered more than 31,000 of them. Singhal, chief medical officer for the county public health department, said that with an imminent delivery of additional doses and the increased capacity of intradermal injections, LA County would be able to fully vaccinate 85,000 to 90,000 people — about half of what he has believes the population is now at risk.
Among those now eligible are gay and bisexual men and transgender people who have had multiple or anonymous sex partners in the past two weeks, or who are taking preventative medication to avoid HIV, and other target groups.
St. John’s officials said their clinics require patients to fill out screening questions on an attestation form to determine their eligibility for the vaccine. By noon, when the morning line had cleared, Barahona said more than 200 people had been vaccinated; The number surpassed 300 by the end of the day, according to a St. John’s spokesman.
The clinic had sent text messages to patients about the vaccination event, but also posted on Instagram and Facebook, where Webber learned about it. He and Brown were keen to get the vaccine after struggling to get appointments for the shots back home in Maryland.
Like Webber, Brown conjured up memories of the early days of the AIDS crisis when he spoke of trying to protect himself from monkeypox. The 58-year-old told how he buried a friend of his who lost his life to AIDS. Monkeypox is rarely fatal, but Brown still saw resonance in this story.
“Everyone says it’s no big deal,” Brown said, “until it’s a big deal.”
AIDS has also concerned Jim Mangia, President and CEO of St. John’s Community Health, as he sees gay men and others facing monkeypox as a health threat.
In the early days of the AIDS epidemic, “I went to a funeral every other week. All my friends died,” said Mangia, who is gay. “The LGBT community came together and developed their own response, from messaging to support services to a whole range of prevention strategies.”
Now “the community needs to come together again to spread these messages — that this can be prevented,” Mangia said. “We only need a few more weeks until we get enough vaccine.”
Rong-Gong Lin II, a Times contributor, contributed to this report.
https://www.latimes.com/california/story/2022-08-12/hundreds-seek-out-monkeypox-vaccine-at-south-l-a-clinic Hundreds receive monkeypox vaccine at L.A. clinic