The ??? ?????? ??????odds are good that you don’tneed to rush out and get the monkeypox vaccine. Assuming you do, I will tell you what you need to know in a minute, but I’d be remiss if I made it sound like this vaccine is something everyone needs right this second.

The situation for the time being is that there are two monkeypox vaccines available in the US. One of the two, JYNNEOS, is a fairly normal series of two injections, administered 28 days apart, but there's not currently enough of that to go around. The more plentifulof the two, ACAM2000, is a rather unpleasant medical procedure not far removed from the old-school smallpox vaccine, and is thought to be too dangerous to give to people with HIV or heart conditions. 

So, long story short, unlike the COVID-19 vaccine, which is for pretty much everyone, this is something you should only get if you’re in a high risk group, particularly while JYNNEOS doses are in short supply. And since these were intended to be smallpox vaccines, much more data will be needed to confirmthat these vaccines truly are effective against monkeypox, to what degree, and whether one is significantly better than the other.

Who needs the monkeypox vaccine?

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With that preamble out of the way, you really needto get vaccinated if you've likely been exposed to monkeypox. In public health this concept is called "post exposure prophylaxis," or PEP. The vaccine is thought to be effective four days after exposure, and can be administered up to 14 days after exposure, because it's also thought to be useful in easing symptoms even if you're infected. Men who have sex with men are the group most targeted with monkeypox awareness messaging, but according to the Centers for Disease Control and Prevention (CDC), you don't have to be in this group to be vaccinated. You qualify if:

• you've been in close contact with someone known to have monkeypox, or

• you've had sex in the past two weeks with someone who has since been diagnosed with monkeypox

So to a large degree, people receiving the vaccine right now are part of so-called "ring vaccination" campaigns, in which the small amount of the JYNNEOS vaccine available is given on an invite-only basis to those determined to be the most likely beneficiaries in the immediate term. It's a "don't call us, we'll call you"-type deal.

But you can theoretically also get vaccinated if you've had sex with multiple people in the past two weeks in an area where monkeypox is known to be spreading, the CDC says. I say "theoretically" because this doesn't necessarily mean you can just go to your primary care physician, tell them you've had sex with multiple people, and get a referral to get the vaccine. Which brings me to…

How do I get the monkeypox vaccine?

It really depends where you are, and honestly, it might not even be practical right now no matter what, unless you find yourself in a ring vaccination campaign.

In New York City, for instance, there's a portal online where you can make an appointment. In Los Angeles, the online appointment portal was, as of this writing, "paused," because it was overrun with people trying to make appointments, but walk-up vaccine clinics seem to pop up more and more. In San Francisco, rather than scheduling online, you're directed to locations accepting drop-in visits, along with numbers you can call for appointments. In Chicago, 100 doses are provided each Monday, in one location, on a first-come-first-served basis. 

You get the idea. If you're concerned about infection, check online with your local health department, call around, and keep trying.  

Is getting a monkeypox vaccination going to get easier?

The rollout of JYNNEOS in particular has been patchy and slow. Even though most US stateshave now had documented cases of monkeypox during this outbreak, not all health departments are making it easy or even possible to get jabbed. That's because for the time being it appears that jabbing everyone would mean widespread use of ACAM2000, and that seems to be exactly what authorities are avoiding. As of early July, the federal government had said only 800 peoplehad been given ACAM2000. 

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About that ACAM2000 vaccine: it may be frustrating to know this vaccine is out there and mostly not being made available, but I should probably remind you that it's, well, nasty. According to the CDC, administering ACAM2000 means 30 punctures in the skin of your shoulder, delivered by quickly jabbing you 15 timeswith a bifurcated steel rod until you bleed. Successful ACAM2000 vaccination produces a lesion that scabs over during the healing process. During your recovery from your 30 needle pokes, you’re infected with, "a live, infectious vaccinia virus that can be transmitted from the vaccine recipient to unvaccinated persons who have close contact with the inoculation site." Afterward, you will have a scar. 

So personally, I think of that vaccine as a last resort. Research couldeventually prove that it's the superior vaccine, and that the virus is so scary that we all need to sign up for ACAM2000. In the meantime, measures of human immune responses and animal research strongly suggest that JYNNEOS is effective against monkeypox.

According to the White House, there are supposed to be 750,000 total JYNNEOS doses up for grabs in the summer, and 500,000 more rolling out through fall. On July 1, the US Department of Health and Human Services ordered 2,500,000 doses, meant to be in arms by early 2023. And bear in mind, JYNNEOS is a two-dose vaccine.  

So if you're a man who has sex with men in a major US city, getting vaccinated is a good idea. But unless you've been exposed, it's not an emergency. Get tested regularly, and try the available portals and phone numbers until it's your turn to get, preferably, a JYNNEOS jab.