PHILADELPHIA—The Health Department released the following statement in response to an announcement by the U.S. Department of Health and Human Services’ Administration for Strategic Preparedness and Response (ASPR) about changes to the City’s monkeypox vaccine allocation.

“Last night the Administration for Strategic Preparedness and Response announced that Philadelphia’s allocation for monkeypox vaccine has been cut following the announcement of a new dose conserving strategy. Previously, the City expected to receive 3,612 vials, but has been told that only 720 vials will be allocated to Philadelphia,” said Health Commissioner Dr. Cheryl Bettigole. “The dose conserving strategy hinges on a plan to inject one-fifth of a normal dose of vaccine into the layers of the skin rather than the traditional dosing into the subcutaneous area under the skin.”

“Since the U.S. FDA’s announcement of the dose conserving strategy, the Health Department has been reviewing the scientific literature, speaking with experts, and reaching out to vaccine providers and community members to understand their perspective on the new recommendation prior to making a decision on the new approach. We had hoped to announce that, due to the ability to quintuple the number of doses available in Philadelphia for those that this strategy is indicated for, we would be widely expanding eligibility and could work to protect people who might be exposed. This is different than our current strategy of focusing our limited doses on only those who have already been exposed. By getting ahead of the virus’s spread, we could actually prevent further spread of this virus, which causes painful lesions that can last up to 4 weeks and may leave permanent scars.”

“The Health Department acknowledges that the dose conserving strategy is not easily adopted. There are logistical issues with changing how doses are tracked, issues with ensuring that staff are trained staff on the intradermal injection technique, and issues with securing the smaller syringes required for this type of vaccination. There are also issues with who is indicated to receive this vaccine in this manner, as those who have a history of keloid formation should not receive their doses intradermally. Even with all of those issues, we were confident that we could vaccinate more people by integrating this strategy into our response.”

“After last night’s announcement, the Health Department will need to review plans and try to figure how to make the most of this situation. We are advocating to our federal partners to reconsider and restore Philadelphia’s allocation of vaccine, which is urgently needed. At the same time, we have no choice but to ask all partners to convert to using the intradermal strategy for all eligible patients, using 1/5th of the conventional dose, as soon as possible and to conserve vaccine for only those with an urgent need due to a known or suspected exposure until they are able to make that change. This is far from ideal in the midst of an outbreak. However, with no guarantee of additional doses before September, we see no other choice.”