What do you know about the monkeypox vaccination that could spill over into supplies

In the middle of a new ad monkeypox National public emergency and vaccine shortages, the Food and Drug Administration has announced that it is reviewing a new vaccine approach that could lead to a fivefold increase in the United States’ supply of the Genius monkeypox vaccine.

“Please know that we have been exploring all scientifically possible options, and we believe this could be a promising approach,” Food and Drug Administration Commissioner Dr. Robert Califf said during a Thursday briefing.

The vaccine will be given in a smaller, less-deep syringe under the skin, a method Califf said would still be safe and effective and would allow up to five doses to be drawn from one vial.

The new strategy will still need to be tested in clinical trials – a process that could take weeks or months. But experts say previous studies look promising, and if successful, it could be a safe way to boost limited vaccine supplies.

“This kind of research is exactly what the FDA and the National Institutes of Health should be driving at this moment of a public health emergency,” said Dr. Josh Sharfstein, former commissioner of the Food and Drug Administration and currently deputy dean for public health practices and community engagement and director of Bloomberg American. Health Initiative at Johns Hopkins Bloomberg School of Public Health.

“If a much lower vaccine could be used with intradermal injection, as opposed to intramuscular injection, then the current monkeypox vaccine could be extended to accommodate more people.”

Jynneos monkeypox vaccine is currently FDA approved as a subcutaneous injection given in two doses four weeks apart. The new strategy will still be a two-dose shot, according to the CDC.

The extension of supplies could help “close the gap,” Califf said. The White House has already made 1.1 million doses available to states and expects 6.9 million doses to be delivered by May 2023, according to HHS.

Here’s what you need to know about the new process:

What is intradermal injection?

The dermis is the second layer of skin, under the epidermis, which is the visible layer of skin. Most routine vaccinations are given as an intramuscular or subcutaneous injection that goes deeper into the skin layer.

But the intradermal vaccine would make a tiny bubble under the skin. This is the exact same method actually used for tuberculin skin tests also called a PPD test.

A nurse performs an intradermal injection to test the Mantoux PPD skin on a person’s forearm, March 31, 2015, in London

Corbis via Getty Images, FILE

How will the FDA know if this works?

This smaller dose should be tested like any other vaccine to make sure it is safe and effective.

“It is important to note that the overall safety and efficacy profile will not be sacrificed for the sake of this approach,” Califf said.

But this is not the same as starting a vaccine from scratch, and other vaccines have been shown to work using this method. It was used worldwide against smallpox in the 1970s.

“The smallpox vaccine that has been used globally to eradicate smallpox from the planet requires intradermal vaccination,” Dr. Richard Kuhn, director of the Krenecki family of inflammation, immunology and infectious disease at Purdue University and editor-in-chief of virology, told ABC News.

The intradermal method, “is very effective because there Lots of immune cells just under the skin, and often lower doses are needed compared to intramuscular inoculation.”

More recently, the influenza vaccine against the H1N1 strain that caused the pandemic in 2009 has been tested intradermally in several research studies and shown to be equally effective at one-fifth of the intramuscular dose.

How will the bullets enter the arms?

If the Jynneos monkeypox vaccine passes a clinical trial, there is another barrier to overcome. Baruch also cautions that administering the vaccine in this way may be technically challenging, saying, “Most people are not trained or experienced in intradermal administration of vaccines.”

But experts say it’s a skill that can be learned easily.

“Whoever is an expert in intramuscular management, but you still want to give them training to the dermis. Like I said, they can be taught very quickly, and they can be off duty in a very short period of time,” explains Dr. Robert Frink, Director of the Vaccine Research Center at Cincinnati Children’s Hospital Medical Center, for ABC News.

Frink also says this national public health emergency is a reminder that living in a globalized world means that outbreaks anywhere pose a risk to people everywhere.

“That’s why vaccines are so important. It’s what keeps us healthy,” Frink said.

Dr. Jade A Cobern, Board Qualified in Pediatrics, is a member of the ABC News Medical Unit and resident in General Preventive Medicine at Johns Hopkins.

Cheyenne Haslett contributed to this report.