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The U.S. government has a large stockpile of vaccines that protect against smallpox and monkeypox—but immunization likely won’t be available (or necessary) for everyone.

As cases of monkeypox continue to spread across the globe, people have shifted their questioning from “What is it?” to “How can I protect myself?” And as it turns out, some older people in the U.S. may still be somewhat protected from the virus due to a prior vaccination: the smallpox vaccine.

“Vaccination against smallpox also protects against monkeypox,” Hannah Newman, MPH, director of epidemiology at Lenox Hill Hospital, told Health. “People who were vaccinated against smallpox years ago may have some immunity, or at least have some protection against milder illness if infected.”

The U.S. officially stopped routine smallpox vaccination in 1972, after the disease was eradicated, but because of concern for bioterrorism, the government has a large stockpile of the smallpox vaccine—enough to vaccinate all Americans who would need protection, should a future outbreak occur.

So what does this all mean for the current uptick in monkeypox cases? How much protection does a previous smallpox vaccination give to older adults at risk of monkeypox? And how does the U.S. plan to distribute these vaccines for the current outbreak? Here’s what to know.

Childhood Smallpox Vaccination and Monkeypox Protection

According to Newman, people who received the smallpox vaccine prior to its discontinuation in 1972 likely still have some protection against the related monkeypox virus and other orthopoxviruses—it’s just not entirely clear how much.

A 2007 study published in the journal Clinical and Vaccine Immunology found that prior childhood smallpox vaccination doesn’t provide complete protection against monkeypox—but it does provide partial protection. Researchers also found that, in those previously vaccinated against smallpox, those who still contracted monkeypox experienced reduced disease severity.

“Clearly protection does wane,” William Schaffner, MD, professor of medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine, told Health. “How much, and certainly how much against monkeypox, we don’t know.”

Current Vaccines Offer Protection Against Smallpox and Monkeypox

There are two different smallpox vaccines that the U.S. has in its stockpile that are either also approved or could be helpful against monkeypox: ACAM2000 and Jynneos. Both have been licensed by the U.S. Food and Drug Administration (FDA)—ACAM2000 in 2007 and Jynneos in 2019.

Neither of those vaccines were the specific ones used when smallpox vaccination was mandatory during the 2oth century, according to Newman. But ACAM2000 replaces Dryvax, which was licensed by the FDA in 1931 and uses the same kind of virus to create an immune response.

The ACAM2000 vaccine doesn’t contain variola virus (the virus that causes smallpox), but it does contain live vaccinia virus, which is in the poxvirus family and is related to variola virus. The vaccine is approved for those who are 18 and older and at high risk for orthopoxviruses (right now, that includes people in laboratories working with orthopoxviruses and military personnel), but can be used in people exposed to monkeypox, if needed.

The vaccine is different from typical vaccines in that it doesn’t include an injection. Instead, the vaccine is administered by a two-pronged (bifurcated) needle dipped in vaccine solution that then pricks the upper arm. A small, red, itchy, sore spot (known as a “pock”) develops at the vaccination site, which indicates a successful vaccination. The spot will then turn into a blister, then a scab, and leaves behind a scar.

Jynneos is the newer vaccine that has been licensed in the U.S. to prevent both monkeypox and smallpox. Like ACAM2000, Jynneos is also made from the vaccinia virus, but in a modified form called “Modified Vaccinia Ankara.” It’s non-replicating, meaning it can’t reproduce in human cells, and it doesn’t cause disease. The vaccine is meant for people ages 18 and older who are at a higher risk of orthopoxviruses, and is given in two doses, four weeks apart.

Vaccine Effectiveness and CDC Recommendations

According to the CDC, the smallpox vaccine is at least 85% effective in preventing monkeypox, according to past data from Africa. Meanwhile, the effectiveness of Jynneos against monkeypox was concluded from the vaccine’s immunogenicity—or its ability to provoke an immune response—and effectiveness based on animal trials.

While there is a large quantity of the ACAM2000 vaccine available—more than 100 million doses—there is significantly less availability of the Jynneos vaccine, with just over 1,000 doses in the stockpile currently, though they’re expected to increase.

In a Morbidity and Mortality Weekly Report (MMWR) published by the CDC on May 27, the agency accepted recommendations by the Advisory Committee on Immunization Practices to make Jynneos available to those at high risk of exposure and infection—that can mean people who study monkeypox in labs, as well as health care workers who, right now, may be dealing with the current outbreak.

The CDC is also beginning to mobilize the vaccine for monkeypox in light of the increase in cases, by focusing on those who have been directly exposed. “Right now, while we are in the early phase of investigating this, we know that those at highest risk for infection are those who had contact with a known monkeypox patient,” Jennifer McQuinston, DVM, MS, a veterinarian and deputy director of the CDC’s Division of High Consequence Pathogens and Pathology, told CNN. “So those are the individuals we’re really focusing on recommending vaccination for right now: post-exposure vaccination.”

This strategy is also known as a “ring vaccination,” in which direct contacts of confirmed monkeypox patients are vaccinated. “At the time, the vaccine is available through public health for people who have had contact with confirmed or suspected cases,” said Newman. “This strategy ensures everyone who has been, or could have been, exposed to a patient with smallpox receives the vaccine.”

Past that, however, the vaccines will not likely be widely used in the general public. “This is not something that everybody needs,” Maria Van Kerkhove, PhD, emerging diseases and zoonoses lead at the World Health Organization, said during a Q&A on social media. “It is a virus that is spreading between people who are coming in close contact with those who are cases.”

Other Monkeypox Prevention Strategies

Even without a nationwide vaccination effort—which, again, is unlikely to happen—there are still ways to minimize your risk of contracting monkeypox.

Because the virus is spread through contact with an infected animal or person, or materials that have been contaminated with infected body fluids, the best prevention strategy is to avoid contact with any animals, people, or materials (bedding, clothing, towels) that could be harboring the virus.

And as with many other viruses, practicing proper hygiene is important, too. That means washing hands with soap and water, or using an alcohol-based hand sanitizer after potential contact, as well as using personal protective equipment.

If you think you may have been exposed to monkeypox—either through travel or close contact with an infected person—you should talk to your doctor as soon as possible and isolate from others to minimize risk of transmission.



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Image by Ivan Gener / Stocksy

How positive is your relationship?

While “relationships are hard” is an oft-repeated refrain, the catchphrase can make it seem like relationships are expected to be constantly full of nonstop challenges, arguments, frustrations, and roller-coaster emotions. The struggle is often romanticized in movies and gushy social media posts, but the truth is, relationships should not feel hard all the time—or even most of the time.

Relationship researchers have actually identified exactly how much time couples in healthy relationships tend to spend struggling versus how much time is spent in a positive state. The ratio is pretty eye-opening.

The magic ratio of healthy relationships.

In the 1970s and ’80s, psychologists John Gottman, Ph.D., and Robert Levenson, Ph.D.conducted research studying the way couples interacted with each other and how their relationships fared over the course of several years. Based on their findings, Gottman identified what he calls the “magic 5:1 ratio” for relationship success: Couples who go on to have happy, long-lasting relationships have about five positive interactions or feelings for every one negative interaction or feeling during times of conflict.

Positive interactions might include showing affection, laughing together, sharing physical touch, and just times when you generally appreciate and like each other. Negative interactions might include the moments of criticism, contempt, tension, resentment, stress about the relationship’s future, and times when things just don’t feel good in the relationship.

“Of course, no one is going to walk around all day calculating their interaction ratio,” licensed couples’ therapist Elizabeth Earnshaw, LMFT, tells mbg. “However, we can use it as a reflective tool—if I wrote down a list of our interactions today, would I be writing about more positive interactions than negative?”

You can also think of this magic 5:1 ratio as a sort of love bank account, as licensed marriage therapist Linda Carroll, LMFT, once told mbg. Positive interactions fill up the bank account, while negative interactions deplete it. “The love bank account should be kept in the black so that when you need to draw a lot out at once, such as a deep misunderstanding, a nasty fight, or a time of distance and moving apart, it doesn’t go into the red,” she writes.

Gottman’s research found couples who had lower than a 5:1 ratio between negative and positive interactions (such as a 1:1 ratio, for example) were more likely to be divorced years down the line. And importantly, that 5:1 ratio was specific to times of conflict. Outside of conflict, the ratio between positive and negative interactions in successful relationships actually goes up to 20:1, according to Gottman. That’s 20 positive interactions for every one negative interaction.

In other words, in healthy relationships, the vast majority of the time is spent in a state of ease and affection.

What does this mean for your relationship?

The magic 5:1 ratio (and the 20:1 ratio!) can be a helpful way to take a pulse check on your relationship—and a good reminder that nonstop struggle, drama, frustration, or pain shouldn’t be the defining feature of your relationship.

If negativity is overly present in your relationship, that’s a dynamic that needs to be addressed—not tolerated or glorified. “With continued negativity, people distance themselves because they no longer feel valued, appreciated, and loved,” Earnshaw notes. They eventually cannot tolerate any more, and the relationship ends—or, perhaps worse, they remain in relationships that bring more stress than pleasure and eat away at their overall well-being over time.

There will always be hard times, but it’s important for couples to be working to improve their dynamic, minimize the behaviors that hurt each other, and maximize all the stuff that makes relationships so great to be in. Because relationships should, more often than not, feel good. 

The takeaway.

Every relationship will definitely have its ups and downs. Navigating life with another human being will always come with challenges to work through because no two humans are perfectly alike, and it’s inevitable that any two people interacting with each other on a daily basis will occasionally hurt and irritate each other.

That said, a healthy relationship is made up of overwhelmingly more positive moments than negative ones. Relationships can be hard at times, but your relationship in general shouldn’t feel hard. It’s a nuanced distinction, but an important one.


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“For everyone, it is possible for events like this to overwhelm our usual abilities to cope in major ways and in small ways.”

In the U.S., more than 200 mass shootings—events during which at least four people are shot and injured or killed—have taken place so far in 2022, according to the Gun Violence Archive.

The most recent incidents in Uvalde, Texas, where 19 children and two teachers were killed during a school day; and Buffalo, New York, where 10 people were killed in a grocery store, have left not only the affected communities but the U.S. as a whole reeling, still trying to process the tragedies.

“When something unfathomable and overwhelming happens like an act of mass violence affecting young children, it affects all of us whether we’re closely related or not,” Rebecca Brendel, MD, JD, president of the American Psychiatric Association and an assistant professor of psychiatry at Harvard Medical School, told Health.

“For everyone, it is possible for events like this to overwhelm our usual abilities to cope in major ways and in small ways,” Dr. Brendel added.

Some people may resort to anger or frustration; others may feel fearful and helpless; while still others may experience feelings of sadness, sorrow, and worry, Arash Javanbakht, MD, a psychiatrist and director of the Stress, Trauma, and Anxiety Research Clinic at Wayne State University, told Health.

Whatever you’re feeling, mental health experts maintain that any reaction is not only typical, but expected. “This kind of trauma or something that happened out of the course of everyday life that’s just so upsetting; it’s normal to feel a reaction,” said Dr. Brendel.

Here are some expert-backed ways to help you start processing any feelings and emotions you may be struggling with.

Communicate Your Feelings

After a mass shooting event, it’s important to recognize, share, express, and communicate any emotions or feelings you may have with trusted people who are willing to talk and listen, Mayra Mendez, PhD, LMFT, a licensed psychotherapist and program coordinator of intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center in Santa Monica, CA, told Health.

“It’s OK to feel outraged and it’s OK to feel powerless, but the way that you best manage those types of feelings is by exploring them, putting them out there, writing about them, and doing something active,” said Dr. Mendez.

Talking with others can be a way to validate your feelings and experiences, too. It can remind you that whatever you’re feeling or thinking is a typical response to traumatic events, according to the National Alliance on Mental Illness (NAMI), while also allowing you to feel more connected to others who may be feeling similarly. Sharing these feelings with others can also provide comfort in knowing that you have support moving forward to get you through the days ahead, said Dr. Brendel.

Stick to a Routine

It’s easy to experience disturbances in your day-to-day life following news of a traumatic event, but according to Dr. Mendez, keeping up with your daily routine can be beneficial to help maintain a sense of normalcy—especially for children and teenagers.

“Routine is really important during times of stress, especially when the stress is something that’s completely unimaginable and unexpected,” said Dr. Mendez. “The way we ground ourselves is by going to our routines, whatever those are, it’s different for everybody.”

Dr. Mendez and Dr. Javanbakht also suggest continuing a practice that helps with emotional relief whether that be prayer, exercise, meditation, reading inspirational material or attending to other forms of self-care.

Limit Your Media Exposure

Staying informed on current events is important—but it’s equally important to know when to step away from the coverage and give yourself and your family a break.

“If you [turn on] the TV, any of the cable news channels for hours and hours are talking about this—the pain and the number of people who got killed,” said Dr. Javanbakht. “Some even show pictures of videos of the chaos, and if you get hours of exposure to this, you will feel much worse.”

In a 2020 commentary published in the journal Nature Human Behavior, researchers explained that media exposure—even just several hours of reading or watching about a mass casualty event like the 2013 Boston Marathon bombings—led to higher reported levels of acute stress. The repeated exposure was also associated with ongoing worry about mass violence and traumatic stress symptoms over time.

Another 2019 study found that repeated media exposure to mass trauma can fuel a “cycle of distress”—ultimately putting individuals at risk of both mental and physical health consequences.

“Although a well-informed public is essential during crisis events, it is also important that viewers understand how they may be putting their long-term mental and physical health at risk by closely following along with collective traumas as they unfold in the news media,” study authors wrote. “That way, consumers will be able to make more mindful and informed choices about how to stay informed about collective traumas across the world.”

Consider Professional Help

Though there’s no “right” way to deal with traumatic events, people not directly affected by a mass casualty event should see their intense sadness and worry begin to fade after about two weeks, said Dr. Brendel.

But if those symptoms of trauma persist—like not being able to sleep or enjoy things you once liked, having recurring worries or fears, or feeling fearful to go about your daily activities—it may be time to seek the help of a licensed mental health professional.

“The most important thing when we face mass trauma such as the [recent] mass shootings…is to find a way to talk about the events and reestablish normalcy and routines, but also not overexpose ourselves in a way that itself can become harmful,” said Dr. Brendel.

If you find yourself overwhelmed and needing to talk with a professional to help sort through your feelings and emotions, the following resources are a good place to start:


The 211 network, powered by the United Way, provides information to callers about local resources. Trained professionals are available to talk to 24 hours a day, seven days a week, and can help people find resources for mental health and substance abuse, as well as COVID-19, food, and housing. For assistance, dial 2-1-1.

American Counseling Association

The American Counseling Association is a nonprofit organization dedicated to the promotion and advocacy of counseling, while ensuring ethical, culturally-inclusive practices of those who seek professional counseling. The group’s website can help you find a licensed professional counselor in your area, and depending on your specific community.

National Alliance on Mental Illness

The National Alliance on Mental Illness (NAMI) is the nation’s largest grassroots mental health organization that provides advocacy, education, support, and public awareness to ensure better lives for the people and families affected by mental illness. The organization’s toll-free NAMI HelpLine provides free information and support to those in need. For assistance, call 1-800-950-NAMI (6264) Monday–Friday from 10 a.m. to 10 p.m. EST.

National Suicide Prevention Lifeline

The National Suicide Prevention Lifeline provides free and confidential support for people in distress, or prevention and crisis services for loved ones of those in need. The Lifeline is available 24 hours a day, seven days a week at 1-800-273-8255. Starting on July 16, 2022, you will be able to access the Lifeline by dialing 9-8-8.

Substance Abuse and Mental Health Services Administration

The Substance Abuse and Mental Health Services Administration (SAMHSA) is an agency within the U.S. Department of Health and Human Services (HHS) that seeks to advance the behavioral health of the nation, and improve the lives of individuals and families living with mental health and substance use disorders. In addition to locating treatment facilities near you, SAMHSA also has a toll-free hotline that can be contacted 24 hours a day, seven days a week: 1-800-662-HELP (4357).

Online Therapy Resources

Online resources including (but not limited to) Psychology TodayBetterHelp, and ZocDoc can help you find a licensed practitioner in your area—or through telehealth—to start your therapy journey. Remember: Therapy isn’t only essential during times of trauma; beginning a regular therapy practice with a trusted professional can improve mental health at all times.


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