There's "substantial variation" across states' eligibility rules for monkeypox vaccines, which could result in unequal care as the outbreak lessens, a Kaiser Family Foundation analysis found.
There are three CDC strategies outlining vaccine eligibility: post-exposure prophylaxis or PEP, which is when a public health official can confirm exposure; expanded post-exposure prophylaxis or PEP++, which comprises known or presumed exposures and holds for individuals for whom a recent sex partner was diagnosed with the virus; and pre-exposure prophylaxis or PrEP, which is vaccination in anticipation of exposure and is for specific groups such as healthcare workers who might be at risk due to occupational exposure.
Of the 56 jurisdictions analyzed — all 50 states, Washington, D.C., and five cities with direct vaccine supply allocations — 18 offered PrEP, 51 offered PEP++ and 52 offered PEP. Illinois, New Mexico, South California and Washington, D.C., did not provide clear eligibility data.
Nearly half provided eligibility beyond the CDC's guidelines, such as vaccinations for those who are sex workers, people with a general or increased risk or those who use HIV PrEP.
"In many jurisdictions, eligibility information, even if ultimately available, was hard to find or unclear," the researchers wrote. In four states — Illinois, Indiana, Maryland and New Mexico — ascertaining eligibility information was especially difficult.
This variation in access and clear public health information can create care barriers, the researchers said: "Variation also means that a higher risk individual in one jurisdiction will have access to vaccination whereas someone with similar risk in [a] different region would not."