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How effective are MPX vaccines?

Vaccines will help control the monkeypox (MPX) outbreak.

The bad news is that we desperately need more doses. And we don’t know how much the vaccines help and in what manner they help (prevention, duration of disease, severity of disease).

This information is absolutely essential so people know how well they are protected and what behaviors they should (or should not) change. This information will also have major implications for controlling the outbreak worldwide.

How effective was the second generation vaccine against MPX?

The CDC website states the smallpox vaccine is 85% effective in preventing MPX among humans based on data from Africa. From what I can tell, this is based on a 1988 study in the Democratic Republic of the Congo.

Scientists looked at a pretty big sample (3,686 people) who were exposed to close contacts of MPX. Among people who were exposed and then infected, 15 were vaccinated and 54 were unvaccinated. This equates to an efficacy of 87%, which is great news! At least for the historical outbreaks.

The problem is that the virus has mutated, it’s spreading very differently than before, and it’s been a long time since people got this smallpox vaccine. So we cannot assume a smallpox vaccination from decades ago will act the same way during this outbreak.

How effective is a smallpox vaccine from decades ago?

A very recent study published in the Lancet collected data on 181 patients with an MPX infection in Spain during the current outbreak, including data on whether people had a previous smallpox vaccination. Among the 181 MPX cases, 32 (18%) had a history of the smallpox vaccination.

We cannot calculate efficacy because we don’t know how many people were exposed and not infected, but overall this was not great news. We need to better understand the protection provided in the context of the current outbreak, like investigating the duration of protection and why vaccine effectiveness may have changed.

How effective is Jyennos?

We have more than 22 clinical trials of Jyennos… against smallpox. This means we know it’s safe, but we don’t know how effective it is against MPX. A few years ago, the FDA approved the vaccine for monkeypox by relying on survival data from primate studies. (Far more primates survived after vaccination compared to those without vaccination.)

But this is really all we have to go on for the current vaccine rollout.

Scientists are smartly collecting data during the rollout, though.

For example, a French preprint study followed 276 people who received a shot after a high-risk contact. Ten people developed MPX quickly thereafter (which is not surprising as vaccines need time to be effective). But two people were infected at 22 and 25 days after vaccination, which was unexpected.

This means that the vaccine is not perfect at preventing infection after close contact. We certainly need more data.

We hypothesize that even among those who get vaccinated and infected, the vaccines still help reduce viral load and, thus, severity of infection.

We have yet to see the clinical data on that yet, though.

How effective are other innovative strategies?

Because of suboptimal vaccine supply in the U.S., we are forced to think innovatively about how to broaden the vaccine reach during this public health emergency. As a result, we are trying two methods, but they leave us with even more questions:

1. Intradermal vaccination. 
2. Earlier this week, the FDA authorized intradermal vaccination, which means administering the vaccine at the top layer of our skin. The skin is home to a number of immune cells that trigger a potentially better immune response and requires less vaccine liquid (we could get five vaccines with this new strategy compared to one with the intramuscular route). This strategy has been used in other emergencies, like Ebola. But we only have one study showing this works for the smallpox vaccine. In 2015, scientists randomized 524 people to test vaccination using this method and showed it was effective. When we use this method with other vaccines (flu and rabies), there is also significant skin irritation. We don’t know if that will be the case with this vaccine. Implementation is also going to be difficult, as it requires special training and confidence. How much will this impact effectiveness or uptake? We don’t know.
3. Dosage sparing. Some jurisdictions, like New York, are also spacing the dosing. So, people get the first dose (the regular intramuscular route) and then have to wait until we get more vaccines in the fall for the second dose. This increases reach, but the protection after one dose is unknown.

Given the (limited) evidence, vaccine shortage, and urgency of this emergency, I support these approaches, as long as people understand that this is experimental and we collect data along the way to make better, data-driven decisions in the future.

Bottom line

We really need real-world effectiveness studies on MPX vaccines. This will be coming. In the meantime, we have to make difficult policy decisions based on limited data. (Sound familiar?) But we cannot repeat our COVID-19 mistakes and provide a false sense of security with vaccines. Communication around scientific uncertainty and how it’s being used to make decisions needs to be at the forefront so we can build trust and effectively dampen the outbreak across the globe.

Love, YLE

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“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, biostatistician, wife, and mom of two little girls. During the day she works at a nonpartisan health policy think tank, and at night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well equipped to make evidence-based decisions. This newsletter is free thanks to the generous support of fellow YLE community members. To support the effort, please subscribe here:

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By Dr. Katelyn Jetelina.

Your Local Epidemiologist. August 10, 2022. Reprinted with permission.

School is starting. And, with it, the contentious debate on what schools should and should not do. While the pandemic ravages on, the landscape continues to morph, and because of that, every subsequent school year has looked very different (hopefully for the better).

Unfortunately, student absences continue. As seen in London, (BELOW) students’ absences continue to be higher than before the pandemic. They were especially high at the end of this school year when BA.5 took hold. (Editor’s note: this was true of the White Plains City School District, too).

We know this is partially driven by reinfections, as children have the highest reinfection rate compared to any other age group.

(Source Kit Yates)

It’s imperative that schools remain open, but they continue to seem stuck between “do everything” and “do nothing.” 

How many layers can a school feasibly implement given pandemic fatigue, limited resources, strong opinions, and differing risk calibrations?

The answer is multi-level; it requires a balance of tradeoffs from students, parents, teachers, schools, and the community. Our primary goal should be to maximize the number of days children are present. This can be accomplished many ways, but I think there are three buckets schools should really focus on.

Back-to-school vaccination campaign

We need strong, universal vaccine campaigns at schools.

Parents report that schools, pediatricians, and health departments are the most trusted sources of information about vaccines. Schools can also significantly improve access to vaccines, as 38% of parents say they do not have enough info on where their kid can get vaccinated. A fall back-to-school campaign could really help move the needle for vaccinations, and thus school absences. And not just for COVID, but other vaccine preventable diseases.

• COVID-19: The number of children vaccinated against COVID-19 remains abysmally low. (Only 10% of 5-11 year olds and 27% of 12-17 years olds are up to date.) Vaccines are safe, they prevent infections (especially within a few months of vaccination), prevent severe disease, and reduce risk of long COVID. But parents have a lot of great questions; we need to anticipate concerns.
• Flu. The flu season in Australia just wrapped up, and it wasn’t pretty.This is notable because, historically, Southern Hemisphere patterns predict what is to come in the Northern hemisphere. (We’ve been worried about a “twin-demic” since COVID-19 began, but it hasn’t happened yet. We are not sure why.) We should heed Australia’s warning and prepare for the worst.

• Other routine vaccines. New York is strongly warning parents about a dip in routine vaccinations. For example, 13.8% of children have not been vaccinated against polio. This reflects patterns we’ve seen nationally and internationally with other routine vaccinations, too. We cannot lose decades-long progress towards eliminating vaccine-preventable diseases.

We can reimagine how vaccines and information reach students and parents.

For example, the Teens for Vaccines campaign in Detroit was highly successful by empowering student ambassadors.

A school district in Florida recognized that active communication and education promoted vaccine confidence and uptake, so they sent text reminders, posted on social media, and provided credible information. Los Angeles School District even had a TikTok campaign.

Ventilation and filtration

Schools need to upgrade their ventilation and filtration systems.

This is one of the most powerful tools we have to curb COVID-19 and other viruses because it happens in the background—it’s an institutional-level intervention that doesn’t require the teachers, parents, or students to do anything. Unfortunately, a small proportion of schools report using these strategies, especially in rural and mid-poverty schools. Many administrators aren’t aware that federal funding is available for ventilation improvements.

Layman wording on how to improve ventilation and filtration is difficult to find. I worked with Dr. Whitney Robinson and Katie Harper, fellow epidemiologists, on a one pager that outlines available strategies and how to test effectiveness. This may help.

Testing and isolating

Now that everyone is eligible for vaccines, and treatments (monoclonal antibodies, antivirals and Evusheild) are available for high risk family members, a more targeted approach to testing, isolating, and masking in the upcoming school year is reasonable:

• Testing. Sick, symptomatic kids should stay home. At-home or at-school antigen tests would be a great tool to use for this. (Do not use PCR tests, as these could stay positive for weeks).
• Quarantining. Attending school far outweighs benefits of quarantining for a respiratory virus that is out of control in the community. It’s reasonable (and overdue) to remove quarantine requirements.
• Isolation. The ideal scenario is that a child tests-to-exit isolation using antigen tests. But this can mean a lot of school missed (and a lot of work missed for parents), with the average infection lasting 8-10 days.
• The CDC says people can leave isolation after 5 days if they remain positive as long as they mask. If children need to go back to school at that time, it’s certainly reasonable and should be expected that kids mask if they are still positive.
• Masks.
• Masks are effective to the wearer. They are even more effective if everyone is masking.
• If a school is in an area of high transmission, it’s certainly reasonable to mask to reduce transmission and, thus, reduce missing school.
• However, for that strategy to work, the wearer must mask everywhere else in the community. I don’t think it makes sense for a school to mandate masks if the larger community does not do so either. We shouldn’t ask students to hold down the fort if the larger community hasn’t also committed either.

Other random thoughts

Preparedness needs to be the name of the game. Schools need a plan in case we do get another Omicron-like event or if there’s is a big superspreader event, like a homecoming dance.

There need to be very important conversations about normalizing decisions around masking, even if not required. Very important conversations may also need to ensue if a child is high risk in a classroom, so they, too, can attend in person learning.

Bottom line

This pandemic landscape continues to change and, with it, we should adapt. But if we continue to fail to act, children will continue to have their education disrupted by COVID19. There are a number of measures schools can put in place to maximize the number of days children are in school so they can have a safe and successful school year.

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 CON EDISON HOLDS SUSTAINABLE WESTCHESTER SUPPLY RATE FOR MOST CUSTOMERS IN JULY GOES UP NOW IN AUGUST

DELIVERY WIRES HUM KILLERWATTS AT 15 CENTS PER KILOWATT HOUR.

AC AT 80 DEGREES DOUBLES POWER BILL IN 90-IN-THE-SHADE-SUMMER

NO NEW SUSTAINABLE RATE YET FROM SUSTAINABLE WESTCHESTER.

GRID REWARDS PROGRAM INTRODUCED TO HELP CUSTOMERS SAVE POWER COSTS

WPCNR THE POWER STORY. By John F. Bailey. August 9, 2022

Power consumption hit an all-time high in the month of July  in Westchester County.

Inflation  forced customers to purchase less for necessities like gas and food who are now Buck-smacked with doubling power bills in soon to double once more if the heat keeps on coming.

Power bills doubled this past month of July for a Sustainable Customer directly attributable to 95 degree in the shade-plus average temperatures which have scorched Westchester for 9 days.

The air conditioning has been humming non stop and the Con Ed Delivery charges delivering the juice 24/7 at 15 cents a kilowatt hour purchased.

The Con Edison Media Relations Department confirmed to WPCNR today that the Sustainable Westchester Green Energy Rate of 7.48 cents per kilowatt hour was kept in effect on Sustainable Westchester customers, as well as I believe the Sustainable basic rate (non green exclusive sources).

 WPCNR asked Con Edison Media Relations why Con Edison did not charge a higher rate than 7.48 cents for Green Energy for Sustainable Westchester Customers (not matching the market rate for July, which in mid July a Con Edison consumer representative said was averaging 9 to 10 cents kilowatt hour.

A Con Edison spokesperson in a written state answered:

My question is: on my Con Ed bill the 7.48 cents green rate charged by Constellation Energy the previous Constellation supply charge is still in effect. — is this because Con Edison was able to supply electricity at a rate very close to the 7.48 rate and chose to honor the 7.48 cent an hour charged in June as a good will courtesy to Sustainable customers?  

Constellation New Energy was the supplier on the bill provided in your email. You will be a Con Edison full service customer on your next bill.

My second question is why is the “Delivery Charge” up to 14.9 cents?

The delivery rate reflects higher delivery charges in the summer months. Delivery rates are set by the New York Public Service Commission.

Sustainable Westchester asked to explain why the 7.48 cents/rate was still charged in July saving about $60, wrote in a statement:

“ The current contract expired on June 30th and as such depending upon folks billing cycle (meter reads) many (to most) will still see the Westchester Power rates (and Constellation) on their bills in July.

That said, most (to all participants) will see their August bills reflect Con Edison isupply and supply rates.

We cannot speak to the intel you received from ConEd that the kWh rate (once switched to them) will reflect and increase vs.the Westchester Power prior contract fixed-rate.

While that would be our educated guess, we cannot confirm that nor predict where their rates might go.

We do hope to be able to have something to share (and a contracted rate by September as you suggest). That said, we are not in a position to confirm that today.”

That being said, we do have news to share about our GridRewards program. The residential demand response program executed with our partners Logical Buildings has been particularly this summer with unprecedented high temperatures and the resulting demand on the grid.

Currently the approximate 2500 Westchester County Con Ed utility area enrolled residents are experiencing a 4-day streak of demand response events. The events provide an opportunity to reduce electricity demand, save energy and money and earn cash rewards for actions taken and overall performance. It surely has newsworthy potential — its environmental impact, ability to reduce usage and earn participants savings and cash is potentially important messaging for your viewers.

GridRewards is the first-of-its-kind residential demand response program in the NorthEast and was piloted in 2020 in partnership with us in Westchester County. You can learn a bit more here https://sustainablewestchester.org/gridrewards/ (on our website) as well as https://www.gridrewards.com/ (Logical Buildings website for the program).

Background:

That rate to create electricity for customers who are not members of the Sustainable Westchester power cooperative (White Plains is a member), is set based on an average of a month of Con Ed costs to buy or create the electricity. The delivery rate is dependent on the demand running through the system.

  Sustainable paused for a time to  resubmit Requests for Proposals for a new  flat rate going out perhaps one, two, or three years and hired the national leader in energy auctions to find Sustainable a rate that works to keep green energy competitive.

The electric supply companies Sustainable had gone to (apparently on their own not using again Transparent Energy Systems the negotiator of the previous contract), came back with rates that all were higher than last year regardless of the markets they were serving from the very small to the very large.

The pause was still going on , just  when Sustainable Westchester turned over its customers temporarily to Con Edison while it searched for a sustainable Kilowatthour price it could live with (and is still in the process of negotiating).

Meanwhile the cost of Con Edison delivering electricity through its systems soared to 15 cents a kilowatt hour. If you  have an airconditioning system or an window unit, keeping that full house zonal system on will still double your consumption of kilowatt hours in this relentless heat wave, even killing certain zones in your house you do not use.

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WPCNR ALBANY ROUNDS. From The Governor’s Office. April 9, 2022:

Governor Kathy Hochul today announced the issuance of new guidance for counties throughout New York to support the development of Domestic Terrorism Prevention Plans which each county and the City of New York are responsible for developing.

The Governor discussed the importance of devising Domestic Terrorism Prevention Plans during today’s virtual remarks as part of a two-day Threat Assessment and Management Summit hosted by the State Division of Homeland Security and Emergency Services and its Office of Counter Terrorism at the State Emergency Preparedness Center in Oriskany.

“In the wake of the horrific domestic terror attack in my hometown of Buffalo, I committed to New Yorkers that we will confront the scourge of domestic terror head-on,” Governor Hochul said. “New York is providing local governments with the tools they need to address the threat of domestic terror and targeted violence, so we can prevent tragedies before they even occur. I will never stop fighting to keep New Yorkers safe.” 

DHSES is encouraging localities to develop Threat Assessment and Management (TAM) Teams as part of their Domestic Terrorism Prevention Plans. To assist in creating and operating threat assessment management teams, $10 million will be made available to counties. Such teams shall be comprised of law enforcement, mental health professionals, school officials, and other key stakeholders tasked with identifying, assessing, and mitigating the threat of targeted violence.

Executive Order 18 was issued by Governor Hochul in direct response to the white supremacist act of terror at a Buffalo supermarket in May.

The executive order is specifically designed to fight the troubling surge in domestic terrorism and violent extremism frequently inspired by, planned on and posted about on social media platforms and internet forums.

In part, the executive order calls upon:

1. DHSES to establish a new unit within its Office of Counter Terrorism dedicated to the prevention of domestic terrorism.
2. Every county and the City of New York to develop and maintain a plan to address the threat of domestic terrorism, including racially or ethnically motivated violent extremists.
3. New York State Police to establish a new unit within the New York State Intelligence Center (NYSIC) dedicated to tracking domestic violent extremism and increase social media monitoring for investigative leads that may come from the online promotion of violent extremism.

During the two-day summit, state counterterrorism experts are reviewing the newly issued guidance on Domestic Terrorism Prevention plans and state grant funding opportunities, at both the state and federal level, to advance county domestic terrorism planning and TAM team creation efforts. A consultant with expertise in behavioral threat assessment will also provide training on TAM team development.

Division of Homeland Security and Emergency Services Commissioner Jackie Bray said, “Domestic terrorism fueled by white supremacy and bigotry is the number one terrorism threat we currently face. Our team in the Office of Counter Terrorism is working around the clock to ensure counties across New York have everything they need to meet the challenge in front of us. Thanks to Governor Hochul’s leadership, together we are working with our partners to make New York a safer place for everyone.”

The recent spike in domestic terror attacks represents one of the most pressing threats to public safety across the United States. In the last decade, domestic terror attacks and plots have tripled nationally. In 2021, there were 73 terrorist attacks and unearthed plots in the United States, including 38 white supremacist and similarly like-minded terrorist attacks and plots.

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WPCNR QUILL & EYESHADE. From Town of Greenburgh Supervisor Paul Feiner. August 9, 2022:

Governor Kathy Hochul has signed legislation yesterday that the town of Greenburgh lobbied for for many years.

The new law will allow  allow local governments to increase the maximum allowable income eligible for a property tax exemption to $50,000 for people who are 65 and older as well as people with disabilities. The measure will increase the current limit set at $29,000 a year for older New Yorkers who live outside of New York City. 

The Greenburgh Town Board, Assessor Edye McCarthy (Editor’s Note, she is former White Plains Assessor) and I have been pushing for this new law for a number of years.

We felt that it was unfair for NYC seniors to get better tax breaks than seniors of Greenburgh.

Am grateful to State Assemblyman Tom Abinanti who also worked very hard to get this legislation approved over many years and to Senator Andrea Stewart Cousins for her advocacy.  This new law will enable more seniors to continue to live in Greenburgh.

It’s our intention to approve this benefit for seniors.