People across the country are melting in the summer heat as they wait for access to a vaccine for monkeypox, the nation’s latest health crisis. The monkeypox vaccine shortage is forcing some people to wait more than six hours in line—with many then being turned away when they finally get to the front because the site has run out of supplies—all after spending weeks looking for a vaccine they can get near them.
On July 23, the World Health Organization declared monkeypox a global health emergency. As of Aug. 2, there are more than 5,800 confirmed monkeypox cases in the U.S. Many cities say they are unsure how many doses they still have left or when they’ll get more supplies, all while the number of cases continues to grow.
But while thousands more demand the vaccine or get sick, over 1 million doses of the vaccine owned by the U.S. sat in a warehouse in Denmark. The Food and Drug Administration took months to approve their release, waiting until early July to even begin inspection—when cases were diagnosed as early as May.
California, Illinois, and New York City have declared public health emergencies because of the outbreak, and local governments from Missouri to Washington, D.C., alongside over 50 Congressional representatives are demanding a better response from the federal government, which hasn’t provided local governments with enough resources, like federal funding and distributing enough vaccines, to prevent the problem from escalating.
“The lack of urgency in government response to the outbreak is similar to the early days of AIDS,” said Dr. Oni Blackstock, the founder and executive director of Health Justice who has a background in primary care and HIV and AIDS research. “Both are disproportionately impacting highly stigmatized groups, and there’s challenges in terms of access and prevention, like getting access to vaccination … There’s so many of the same issues because of the way systems work. Inequitable systems mean inequitable outcomes.”
Monkeypox spreads through respiratory droplets, contact with monkeypox rash, scabs, or bodily fluids, and touching shared fabrics like bedding or clothing. As of Aug. 2, there are 23,620 confirmed cases globally with 5,810 of them in the U.S.
A lack of consistent data on demographics of cases means there’s little understanding of how monkeypox is actually spreading and among whom. However, on a recent call, the Centers for Disease Control and Prevention told clinicians that in a sampling of cases the counts were highest amongst people of color, with 32% Latinx, 26% Black, and 38% white.
Vaccine rollout problems
The rollout of the monkeypox vaccine is eerily similar to last year’s rollout of the COVID-19 vaccine. There are two vaccines available, but the primary one, JYNNEOS, can be safely used by more people. As of July 27, fewer than 340,000 doses of this vaccine are available, and the majority have been shipped. Last week, the Department of Health and Human Services finally announced an additional 786,00 doses of the vaccine.
Distribution and criteria for accessing the vaccine vary state by state, and cities like New York were criticized for first focusing on white, wealthy neighborhoods.
“The initial vaccine rollout for monkeypox wasn’t very considerate of Black and brown communities,” said Dorcas Adedoja, MPH, a public health professional who specializes in working with communities that are excluded from mainstream health care.
Monkeypox through a white lens
Media coverage and research on monkeypox have focused on the virus traveling through white men who have sex with men, including a recent New England Journal of Medicine study used for policy that used volunteered confirmed case data primarily from Europe and North America and had a subject population that was 75% white men. Communities of color and other marginalized groups like trans people, sex workers, and homeless people are being ignored in conversations, diagnoses, vaccines, and treatment.
“We don’t know how this is showing up in Black and brown communities because as of now we don’t have much data,” Adedoja explained. “Much like COVID, discussions of the pattern of the spread are mostly through a white lens—how it’s impacting white communities.”
Much of the public health messaging around the outbreak isn’t helping. While research focused on gay white cisgender men, the first images of monkeypox were on Black people’s skin. The limited media focus on mostly gay white men has further stigmatized the virus, leading to homophobic, far-right-led misinformation. “Groomer” trended on Twitter in July when the first monkeypox case was diagnosed in a child, creating more potential harm for communities already at risk as state legislatures pass anti-trans and gay bills.
Testing problems
Monkeypox has been reported in central and west Africa for over 50 years, but this is the first outbreak in the U.S. and Europe. Since smallpox was eradicated in the 1970s in the U.S., the U.S. federal government has kept an allotment of the vaccine in the Strategic National Stockpile.
Because the government had the vaccine and knew an outbreak could be on the horizon, many medical professionals and state and city governments say the response hasn’t matched the intensity of the situation.
“We could have shipped more doses earlier,” Adedoja said. “We have the tools to not be here, but look at where we are.”
The issues with monkeypox response start with testing, which was initially limited and hard to access. Now the spread continues because of few vaccines and the lack of proper geographic distribution. Diagnosing is also a challenge: The patient must have a lesion and get that swabbed at the doctor’s office since there are no at-home testing kits. After a swab, the hospital needs to sanitize the room. For some, getting an appointment for a diagnosis isn’t possible as doctors deal with the latest COVID-19 surge, and hospitals run with limited staff.
Once diagnosed, Blackstock said some patients are not getting the pain medication they need, and the isolation period of multiple weeks necessitates the ability to stay home for weeks, challenging for those with no paid sick leave or federal mandate for paid time off. For unhoused people, returns to congregate shelters means concerns of further spread.
It was only recently that the Biden administration responded with more treatments, less administrative burden for medical professionals, and a commitment for more vaccines. But as the cases grow, many are waiting to see if any of those commitments turn to reality.
“The whole process for getting these vaccinations here from the stockpile needs to be accelerated,” Blackstock said. “We have a window of opportunity so it doesn’t become endemic, but it’s closing quickly.”
With schools reopening, funding for community sexual health clinics and services, more accurate information, testing, treatment, vaccines are vital.
“If this were impacting lots of groups of people—like it’s starting to—it would be a foregone conclusion. But because it’s impacting a group that is marginalized and stimigatized, there seems to be a lack of urgency,” Blackstock said. “We need to push the government to do a lot more.”
