Philadelphia’s health department faces logistical challenges and cultural concerns as it determines how best to expand monkeypox vaccine supplies as the outbreak grows.

Last week, the US Food and Drug Administration allowed health care providers to provide one-fifth of the standard dose of monkeypox vaccine JYNNEOS.

But switching to lower doses won’t be easy, city health commissioner Cheryl Bettygaard said in an interview Friday. She said, explaining why her institution has been holding off on offering smaller doses in the past.

“We’re trying to move very quickly,” Betty Gall said. “Both the provider and the community should participate in whatever we decide.”

She plans to announce how the Philadelphia Public Health Department will handle the new directive sometime next week.

Approximately 24,000 vaccinations are needed to provide the recommended two-dose series for each high-risk resident. This includes men over the age of 18 who have recently had multiple or anonymous sexual intercourse with another man. Some transgender and nonbinary people, as well as sex workers, may also be at higher risk. , this week’s scheduled delivery is likely to be the last in 2022.

» Read more: Monkeypox vaccine finally available for sex workers in Philadelphia

So far, the city has prioritized people already exposed to monkeypox, but said it needed to provide vaccines to everyone most likely to encounter the virus in order to contain it. health experts said.

The FDA’s decision to allow a lower dose came as the United States reported more than 10,000 cases of the virus nationwide. Philadelphia reported 128 cases on Monday. This is the most recent data available and represents nearly half of all reported cases in Pennsylvania, where demand for vaccine far exceeds supply.

The FDA says that smaller doses offer similar protection to full doses when injected directly into the skin rather than into the fatty layer of tissue beneath the skin.

“Five times that number could change things completely,” said Dusty Latimer, a nurse and practitioner at the Mazzoni Center, an LGBTQ-focused health clinic in Philadelphia. I’m here.

Bettigole noted that while the FDA cites small studies as evidence that small doses protect people, other studies done in Germany have boosted her confidence in the approach.

Of the vaccine approved in 2019, she said, “It’s the best so far. At least it’s safe.”

Not only do the cities run out of doses, they also don’t have the special needles used for skin injections. Health department staff are determining how quickly needles can be obtained.the city expects Federal funding for the monkeypox response, but I don’t know how much of it we’ll get.

Intradermal injection also requires greater precision — hence training — than the kind of injection that has been used to administer full doses of monkeypox or COVID-19 vaccines.

“It’s been a minute since most people in the medical community did an intradermal injection,” said Latimer.

Bubbles on the skin at the injection site indicate that the injection was done correctly. According to Bettigole, one of the unanswered questions is what he would do if one of those shots was given to him by mistake. Injecting a small amount deeply doesn’t produce the necessary immune response, she said.

Intradermal injections are more likely to leave permanent scars, especially in people prone to developing thick keloid scars. Some people may avoid injections altogether.

Some patients may have other skin conditions for which higher doses may be a better option, Latimer said.

But offering vaccine options to patients is yet another layer of record-keeping, which makes it even more complicated for providers.

Providers will also face questions from skeptical patients whether lower doses are as effective as higher doses, Latimer said. It’s an ongoing discussion, and I’m not too excited to have it on a regular basis right now.”

Clear guidance from the city about who is or isn’t eligible for deeper, higher-dose shots would help providers, he said.

A survey of providers and community leaders on how best to handle vaccine distribution is scheduled for Monday, and an announcement is expected in the next few days, the commissioner said.

“We need input from vaccine providers, community leaders and community members,” said Betty Gall. “About how they feel about this.”