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Before monkeypox outbreak, US officials knew for years they didn’t have enough of key shot

“Every time I meet a member of Congress, I let them know what the need is,” Dawn O’Connell, chief of the Administration for Strategic Preparedness and Response, said in an interview. “The SNS… is chronically underfunded. We need to get this SNS fully funded and equipped with what we think are the next threats.”

The Strategic National Stockpile would contain about 120 million doses of Jynneos, enough for 60 million people, said the officials who were given anonymity to discuss sensitive government issues. Jynneos was stored as an alternative to ACAM 2000, another vaccine not suitable for people with compromised immune systems. Before 2019, the US had only 20 million doses. In 2020, the US bought just over 1 million doses to replenish expired vaccine.

Bavarian Nordic CEO Paul Chaplin told POLITICO on Thursday that after the vaccine was approved by the Food and Drug Administration in 2019, the U.S. supply requirement called for the protection of 66 million high-risk Americans. That meant that about 132 million doses of the Jynneos injection were needed for people unable to receive ACAM 2000 in the event of a smallpox outbreak.

“Those are people [who] are vulnerable who really shouldn’t be getting first and second generation vaccines,” Chaplin said.

A Department of Health and Human Services official suggested the dose of 120 million was above the government threshold, but did not dispute that Jynneos’ stock level was lower than it should have been, and declined to provide what the SNS requirements actually say. .

The senior officials who spoke to POLITICO said the requirements for the stock – levels set in part by HHS – often shift and are sometimes outdated. For example, a former senior official said the department had two numbers on hand: the number of doses the stock could afford to buy and the number of doses actually needed to distribute to a given population. The number of Jynneos doses that the government could afford as of 2019 was about 40 million. But money for Jynneos shots competed with funding for more pressing priorities and threats that the government viewed as more likely.

“That’s not preparedness,” said the former senior health official. “It’s like telling the military… you need 100 planes, but we’ll only give you 10 because that’s all we can afford. And then we have to fight. Good luck.”

Since Biden’s administration took office, there have been ongoing discussions within the ASPR about adjusting the required levels and obtaining additional funding to help ramp up the supply of critical drugs and injections.

In November 2021, senior officials from HHS and the Centers for Disease Control and Prevention met to discuss responses to a possible smallpox outbreak. Officials there spoke of the Jynneos shot and noted that many doses had expired earlier. According to one of the former officials who attended the meeting, they planned to ask Congress for additional funding to bolster supplies.

“After that, there was a push to get hard, concrete numbers and budget numbers because they didn’t want to report… this huge gap [in supply] back to the White House,” said one of the officials.

In May 2021, POLITICS reported that the Biden government has diverted $2 billion from the SNS to help accommodate the flow of unaccompanied migrants at the border. In its most recent budget request, ASPR asked for $975 million in funds for the stock, about $130 million more than it was set for 2022.

“We all saw what happened in 2020 when the PPE we expected was not there. I think Congress felt that acutely when their voters were looking for things,” O’Connell said. “So it’s really important for me to use that as a critical example of why we need to move forward and make sure the SNS is properly funded against the current material threats.”

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