OOn July 23, the World Health Organization declared monkeypox a public health emergency of international concern (PHEIC). It was a controversial decision, with WHO Director-General Dr Tedros Adhanom Ghebreyesus making the final call and passing it through the WHO Emergency Committee. Advisory Board of disagreement Reflective debates have been taking place among public officials, on social media and on opinion pages over the past few weeks. Is monkeypox a public health emergency when it “only” spreads between gay and bisexual men and transgender women? To what extent should transgender men, women and children be concerned?
Behind these questions are concerns about stigma and how best to allocate limited resources. But they also reflect an individualist understanding of public health. Instead of asking what monkeypox means to them nowThe general public should question how the monkeypox epidemic might affect them in the future and why and how it can be controlled now.
The longer the transmission of smallpox in monkeys is left unchecked, the more likely it is to spread to other populations. There have been a small number of cases in women and a few cases in children due to family transmission. In healthy people, monkeypox can be extremely painful and disfiguring. But in pregnant women, infants, young children, and immunocompromised people, monkeypox can be deadly. All of these populations would be in jeopardy if monkeypox became entrenched in this country.
Stopping transmission among men who have sex with men will protect them here and now and more vulnerable populations in the future. But with limited supply monkeypox vaccine availability, how can public health officials best target the vaccines equitably for impact?
Just vaccinating close contacts of people with monkeypox is not enough to stop the spread. Public health officials have been unable to trace all chains of transmission, meaning many cases go undiagnosed. Meanwhile, the risk of monkeypox (and other sexually transmitted diseases) is not evenly distributed between gay and bisexual men and transgender women, and targeting they will all outstrip supply. Such a strategy also risks discriminating these groups on the basis of their identities.
CDC recently extended eligibility for monkeypox vaccination includes those who know that a sexual partner in the past 14 days has been diagnosed with monkeypox or who have had multiple sexual partners in the past 14 days in a jurisdiction with cases known monkeypox. But this approach depends on people having access to test. Clinicians in some jurisdictions are testing more than others.
Alternatively, public health officials may target monkeypox vaccination for gay and bisexual men and transgender women who have HIV or are considered at high risk for HIV and are eligible. sue to Pre-exposure prophylaxis (PrEP, which is taking medicine to prevent HIV infection). Overall, there is a lot of overlap between these populations and those at risk for monkeypox. But only 25% PrEP-eligible people in the United States were prescribed it, and that rate dropped to 16% and 9%, respectively, among Hispanics and Blacks. This approach risks missing many at-risk populations and exacerbates existing racial and ethnic disparities.
This is why some LGBTQ activists are advocating for stronger outreach. “We talk about two types of surveillance. Passive tracking, where I go to my doctor’s office,” said Dr. Gregg Gonsalves, an epidemiologist at the Yale School of Public Health and a longtime AIDS activist. “Active surveillance is where we go out and we proactively look for cases by going where people are. There are parties, social places, sex clubs where we can do monkeypox testing,” he said. This will be especially important outside gay-friendly cities, where both patients and service providers may be less informed and gay sex more stigmatized.
In New York City, the epicenter of monkeypox in the United States, disparities in access to monkeypox vaccine emerged. The city’s health department issued appointments for the first doses of monkeypox vaccine through an online portal and advertised them on Twitter. Those initial doses were administered at a sexual health clinic in the affluent neighborhood of Chelsea.
Read more: Why is it so hard to find a smallpox vaccine for monkeys?
According to Gonsalves, “It was in the middle of the day. It’s located in a predominantly white gay gay neighborhood… It’s really targeted at the demographic that would be top for everything. This is the problem with relying on passive surveillance and people looking to you.” According to Dr. Michael Levasseur, an epidemiologist at Drexel University, “The demographics of that population may not really reflect the highest risk group. I’m not even sure we know the highest-risk group in New York City at the moment.”
Granted, three fourths The city’s cases have been reported in Chelsea, a neighborhood known for being home to a large LGBTQ community, but it’s also a reflection of awareness and access to testing. In spite of more labs are providing smallpox testing in monkeys, many clinicians do not yet know or do not want to test patients for monkeypox. You have to be a strong advocate for yourself to be tested, which marginalized populations have been put at a disadvantage.
The NYC Department of Health later opened a second vaccination site in Central Harlem to better reach communities of color, however, most of the people who had access to monkeypox vaccine there were White skin-man. And in the last week, NYC came out three points of mass vaccination in the Bronx, Queens and Brooklyn, only open for one day. To vaccinate monkeys against smallpox, you must know, have a day off, be willing and able to stand in line in public.
How can public health officials do the active surveillance Gonsalves is talking about to target smallpox vaccination of monkeys equitably and for those most at risk? Part of the answer may lie in efforts to map the sexual networks and spread of monkeypox, such as the Rapid Epidemiological Study of Prevalence, Network, and Demographics. study of monkeypox infection (SAVING-MOTHER). Your risk of monkeypox exposure depends on the probability that someone in your sexual network has monkeypox. For example, research could help clarify the relative importance of group sex at parties and large events compared to dating apps in the spread of smallpox online. Dr Joe Osmundson, an analyst, said: “A network map can tell us, because vaccines are so scarce, that the most important demographic of people needs to be vaccinated first, not just to protect ourselves but also really to slow the spread,” said Dr. Joe Osmundson, an analyst. Microbiologist at New York University and Co-Principal Investigator of the RESPND-MI study.
During the early stages of COVID-19 vaccine rollout, when the vaccine was administered at pharmacies and mass vaccination centers, racial gaps emerged in vaccination rates. Public health officials have closed that gap by meeting people where they are, in easily accessible community facilities and through mobile vans, for example. They worked hard with trusted messengers to reach people of color who might be wary of the health care system.
Likewise, sexual health clinics may not be a one-size-fits-all solution for monkeypox testing and vaccination. While some sexual health clinics may feel friendlier to some, others may fear being seen. Others may not be able to go to a sexual health clinic due to limited hours of operation only on weekdays.
Meeting members of the LGBTQ community where they are is not new to public health officials. During the 2013 outbreak of meningitis among gay and bisexual men and transgender women, health departments across the country Forged relationships with LGBTQ community-based organizations to distribute meningitis vaccines. Unlike New York City, Chicago is now leveraging those relationships to vaccinate those most at risk for smallpox.
According to Massimo Pacilli, Chicago’s Deputy Commissioner for Disease Control, “This vaccine is not indicated to the general public nor to any MSM person at this time.” Chicago is distributing smallpox vaccine to monkeys through locations like gay bath and bars to target those most at risk. “We don’t need to screen when people are present because we’re doing it upstream by taking a different approach,” says Pacilli. He said that monkeypox vaccination “is purposefully decentralized. And so the ways in which any individual comes to the vaccine are very diverse.”
Another reason to partner with LGBTQ community organizations is to expand capacity. The New York City Department of Health and Mental Hygiene is one of the largest and best-funded health departments in the country, yet even they are Fight to respond quickly and vigorously to an outbreak of monkeypox. “COVID has overwhelmed many public health authorities, and they could use the help of LGBTQ and HIV/AIDS organizations” in controlling smallpox in monkeys, Gonsalves said.
But even as public health officials try to control the transmission of monkeypox among gay and bisexual men and transgender women in this country, it’s important not to forget that Monkeypox has been spreading in West and Central Africa for many years. Not all of that transmission occurs within the MSM community. Control strategies for monkeypox will need to be informed by the local epidemiological agency. Social and sexual mapping will be even more important but challenging in countries, like Nigeria, where gay sex is illegal. Sadly, wealthier nations are hoarding supplies of monkeypox vaccine as they did the COVID vaccine. If access to monkeypox vaccine remains unequal, it will leave all countries vulnerable to future outbreaks again.
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