A pilot is set to begin at three NHS sites to offer eligible patients a smaller dose of the monkeypox vaccine in order the stretch the existing supply. The smaller dose is said to be equally effective.

The approach is known as fractional dosing, is clinically approved and has been used in other worldwide outbreaks when vaccine supplies are low.

The pilot will be introduced in one clinic in Manchester and two in London.

In the pilot, those eligible will  be offered a 0.1ml dose of the smallpox Jynneos vaccine, instead of a 0.5ml dose.

It is believed the approach will enable up to a 5-fold increase in the number of people that can be offered vaccination.

The UK Health Security Agency (UKHSA) said it had reviewed the evidence in detail alongside the Joint Committee on Vaccination and Immunisation (JCVI) and they are working with NHS England to test the feasibility of the approach at pilot clinics.

Dr Mary Ramsay, Head of Immunisation at UKHSA, said: "Global supplies of the smallpox vaccine used to combat monkeypox are limited but we acted early to ensure the UK obtained the maximum number of doses available.

"Adopting this tried and tested technique will help to maximise the reach of our remaining stock, including the 100,000 doses due to arrive in the country next month, potentially enabling us to offer protection for many more thousands of people.

"We will continue to remain agile in our response to the monkeypox outbreak and will adapt our approach as new science and advice becomes available."

Dr Claire Dewsnap, President of the British Association for Sexual Health and HIV (BASHH), said: "BASHH absolutely supports the UKHSA led fractional dosing pilots, assessing feasibility in UK sexual health clinics. If acceptable, this would offer us the opportunity to roll out vaccine to those eligible much faster and would address the issues of short supply of vaccine across the world."

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