Even as Oklahoma sees its first reported cases of monkeypox, public health officials here have ordered a smaller share of the vaccine than any other state and are offering the shots to a narrower set of people than federal authorities recommend.

With a nationwide shortage of the monkeypox vaccine JYNNEOS, The U.S. Centers for Disease Control and Prevention has divided up available doses for states and a few large cities. Most states have asked for their entire allotment, but Oklahoma had ordered just 24% of the vaccine the federal government has offered as of noon Wednesday. That amounts to 736 doses — enough for roughly 1800 people if the state follows new guidelines to stretch supply. 

No jurisdiction has asked for a smaller share of its vaccines, and only one other state has ordered less than 98% of their allotment. 

Oklahoma has confirmed 12 cases of monkeypox as of Wednesday afternoon, a tiny fraction of the nation’s more than 10,000, but more are probably on the way. 

“We have not seen the big rise in cases in Oklahoma yet, although I think all of us are holding our breath,” said Dr. Dale Bratzler, interim dean of the University of Oklahoma’s Hudson College of Public Health. “Take COVID, or any other infectious disease. We often see big outbreaks on the coasts that slowly work their way into the heartland,” he said. 

The actual number of infections in the state is almost certainly higher, as some cases can go undetected, said Josh Michaud, associate director of global health policy for the health care policy group Kaiser Family Foundation.

“There are lots of reasons why there are undiagnosed and unreported cases of monkeypox,” Michaud said. “If you’re just going on the reported numbers, you are underestimating the true size of the outbreak.” 

Current state rules limit eligibility to people who have had prolonged, skin-to-skin contact with someone confirmed to have monkeypox, or similar contact at an event or venue where the virus was present. 

But federal guidelines also recommend vaccination for anyone who has had sex with multiple partners in the last two weeks in an area where monkeypox is circulating. 

The idea is to vaccinate people at high risk of exposure in order to prevent transmission public health would otherwise miss, according to Michaud. Several of Oklahoma’s neighbors, including Missouri, Colorado and much of Texas, have already begun vaccinating people with multiple partners. 

Speed matters. Within four days of exposure – the sooner, the better – JYNNEOS has a good chance of preventing infection. For ten days after that, it can still reduce how long someone is contagious.

State Epidemiologist Jolianne Stone hopes Oklahoma can eventually expand access to the monkeypox vaccine, but there’s a lack of storage capacity outside OSDH. 

 “Hardly any facilities throughout the state even have capacity to store this vaccination,” Stone said, “whether it’s county health departments, or even community partners.” 

JYNNEOS has to be kept around zero degrees Fahrenheit, and can last up to eight weeks in a refrigerator, according to the CDC.

“We’re constantly having conversations with our community partners, internal conversations and external conversations, to help us determine how much of our allocation we should request right now, knowing that this allocation has to provide second doses,” Stone said.

The Oklahoma State Department of Health is using case data to project demand a week or two in advance. If the situation changes suddenly, it can get more vaccines from the national stockpile in about two days.

A CDC spokesperson confirmed there are currently no additional criteria keeping Oklahoma from ordering nearly 2500 more doses of JYNNEOS. Oklahoma can get the rest of its allotted vaccines early if it shows federal officials it gave its doses to eligible populations.