Men who have sex with men are most at-risk of monkeypox, but are they being reached with the vaccine in time?
The fightback against monkeypox has begun with European nations finally taking action to vaccinate at-risk groups against the disease.
The outbreak has seen cases in more than 30 countries in the European region of a disease which was previously localised in Western and Central Africa.
Spreading through close skin contact, contact with clothes or the bedding of someone infected, and through large breath droplets, the disease is mainly circulating amongst men who have sex with men (MSM).
Though it’s believed to currently be mainly transmitted through sexual contact (including kissing and cuddling), it’s not a sexually transmitted infection.
The first case of monkeypox was detected in Europe in early May, but it was July when the EU Commission announced it had ordered 109,090 doses of the Bavarian Nordic vaccine.
A further 54,530 doses were ordered later in the month by the European Centre for Disease Prevention and Control (ECDC), bringing the total to 163,620.
These vaccines have been distributed to affected countries including Spain, Germany, Portugal and Belgium, but are they reaching the people they need to fast enough?
What is the monkeypox vaccine and does it work?
The Bavarian Nordic vaccine is actually a smallpox vaccine which is judged to be effective against monkeypox. Two doses are required four weeks apart with maximum immunity reached two weeks after the second shot.
The vaccine is believed to offer 85 per cent protection to those that receive it but this is currently under review.
Nonetheless, large doses are being ordered around the world with Australia ordering 450,000, while in the US this week, President Joe Biden declared monkeypox a public health emergency.
How is the monkeypox vaccine being rolled out in Europe?
Doses of the Bavarian Nordic vaccine have been distributed within the EU with most going to countries with the highest cases like Spain and Germany.
Italy, Sweden and Ireland have all received doses from the EU’s Health Emergency Preparedness and Response Authority (HERA) in July too.
The same month, the French health minister said that they were expecting a delivery from the ECDC, but already had a small amount of smallpox vaccine which was being made available in clinics.
In the UK, 30,000 doses of vaccine were supplied in June with the government securing a further 100,000.
The vaccine numbers available, however, are considered small; in the UK, an open letter from health groups stated at least 250,000 doses would be needed to stop the spread of monkeypox.
Opinions differ on the likelihood of the epidemic spreading beyond the mainly affected MSM community, and the ECDC guidance is currently to target vaccines at the most at-risk members of the group.
How is the vaccine rollout going in Europe?
The vaccine rollout has begun in affected countries, with efforts concentrated in urban centres.
In Germany, vaccines are available through certain doctors' practices in Berlin and cities in the Brandenburg region, with one employer advising workers to try for surgeries in Potsdam where demand would be lower.
A hotline is also available in Germany for those concerned to get information.
In Ireland, although vaccines have been sent by the ECDC, little has been announced about a vaccine rollout programme attracting criticism of the health minister Stephen Donnelly from opposition parties for his “lack of urgency”.
A lack of central organisation is a common theme across Europe.
In France, walk-in vaccination centres have been set up in Paris, but in the rest of the country, the vaccinations are handled by local sexual health authorities.
“Since June, people I trust have been sounding the alarm,” Pierre, who lives in Lyon, told Euronews Next.
After making attempts over many days, Pierre managed to secure an appointment and received his vaccine; however, the doctor told him they were only administering one dose at this time due to lack of availability.
“I feel protected and that I've done my part to protect others, but I feel more would get vaccinated if the shot was made more available,” he said.
“Santé Publique France [the French health authority] should mobilise to set up walk-in vaccination across the country if they want to prevent the situation in Paris from spreading throughout the country”.
How are monkeypox vaccines being distributed in the UK?
Vaccine response in the UK has been criticised as uncoordinated, with lack of availability outside of London leading to so-called “vaccine treasure hunters” travelling from the regions to access shots.
Some walk-in vaccination centres were set up in the capital but other doses have been given out at the discretion of sexual health providers.
“What I have been doing has been opportunistic. If someone comes into the clinic then we can offer them the vaccine if there is a risk or they fit the criteria,” said Simon, a sexual health doctor in London.
The criteria in question are whether a patient is a member of the MSM community, has had five or more sexual partners, or has had an STI in the last three months.
In places like the northern city of Manchester and Brighton on the south coast, sexual health clinics have approached those known to them who are in the at-risk category by text message - with mixed results.
“I went for my check-up and they said I should go to the pop-up next door and just show my text message,” Patrick, who lives in Manchester, told Euronews Next.
“When I got there it was a big fat no and they couldn’t tell me when the next available walk-in would be, as I’m away on the dates that they offered me”.
Fellow Manchester resident Will has also struggled to access the vaccine.
“To be honest I started and ended knowing that there were 240 doses available in Manchester and they have all been given out already,” he said.
Concerns were raised at a recent panel by charity the LGBT Foundation about the lack of vaccines in Manchester ahead of Manchester Pride, which draws in 170,000 attendees.
“My friend in London got vaccinated. They seem to have been really on it,” said Will.
“The fact that the rise in numbers is happening before Manchester Pride, it doesn’t seem to sit quite right when the vaccines in London.
“There needs to be more transparency with how they make those decisions”.