Israel’s monkeypox vaccines strategy: Stop sexual spread to those most at-risk

The first monkeypox vaccinations headed to Israel will be reserved for men who have sex with other men (MSM) and whose medical records suggest particularly high vulnerability to the virus.

Following Israel’s decision to secure 10,000 monkeypox vaccines, Dr. Tal Brosh, coordinator of Israel’s Epidemic Management Team and chair of its deliberations on the national monkeypox response, briefed The Times of Israel on planned criteria for administering them.

They will arrive in two batches, with 2,000 coming soon, followed by 8,000 more, he said on Tuesday, discussing the Health Ministry’s vaccine announcement a day earlier. 

Brosh said that as almost all cases of monkeypox in Israel so far have been among MSM, this is the focus of all vaccines currently ordered.

“The epidemiology of the outbreak so far is that it’s largely spread among men who have sex with other men, and while criteria still aren’t final, this will guide them,” he said.

Israel reported its first monkeypox case in May — a man who returned from abroad — and communal spread was first detected last month. Cases are raising concerns, as the virus is contagious, and while often mild, can cause serious illness.

As of Monday, 101 men have been infected, the ministry said, though monkeypox usually clears up after two to four weeks, according to the World Health Organization.

Monkeypox is characterized by a rash that can look like pimples or blisters, from which the virus can be transmitted, normally through skin-to-skin contact.

Brosh stressed that sex isn’t the only contact during which monkeypox can be transmitted, and said that other skin-to-skin contact — such as between family members — could potentially account for numerous cases as the virus continues to spread.

Brosh stated that the first 2,000 vaccines will be reserved for MSM who have had a sexually transmitted disease in recent months (the exact range will be between three and six months), and who are either HIV-positive or taking pre-exposure prophylaxis, which are drugs to protect them against HIV.

“The objective here is to locate the people with highest risk of being infected, which is men who have more partners,” Brosh said. “They will be identified mostly via their HMOs according to the criteria being set.”

He added that the criteria may be relaxed slightly for the subsequent 8,000 shots, but will still be strongly focused on MSM.

For all initial vaccine allocation health funds will filter their digital data, as they did for early COVID vaccine drives, to build lists of those who qualify for the vaccines, and then contact them.

Brosh, who heads the infectious disease department at Assuta Medical Center in Ashdod, said a major concern is that if case numbers grow, some of those infected will be people with background health conditions, including those who are immunocompromised, and the virus could have a devastating impact on some. This stands behind the push for early action by way of vaccination.

He commented: “As more and more cases happen there could be a very significant morbidity. “It can be very debilitating. Once it spreads and we have thousands it will infect people who are immunocompromised, pregnant mothers, the young, and others who it could impact badly.”