The best way to slow the spread of monkeypox

aOn 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 canceling the WHO’s emergency committee. advisory committees quarrels It reflected the discussions taking place among government officials, on social media, and in opinion pages over the past several weeks. Is monkeypox a public health emergency when it is spread ‘only’ among gay, bisexual men and transgender women? How worried should gender-consistent men, women, and children be?

Behind these questions are concerns about stigma and how best to allocate limited resources. But it also reflects an individual understanding of public health. Instead of asking what the monkeypox outbreak would mean to them CurrentlyThe public at large should ask how an outbreak of monkeypox might affect them in the future, why and how it can be contained now.

The longer monkeypox is transmitted unchecked, the more likely it is that it will be transmitted to other populations. There have already been a few cases among women and two cases in children due to transmission from home. In healthy people, monkeypox can be very painful and disfiguring. But in pregnant women, newborns, young children, and immunocompromised people, monkeypox can be fatal. All of this population would be in danger if monkeypox became entrenched in this country.

Stopping transmission of infection between men who have sex with men will protect them now and more vulnerable populations in the future. But with a limited amount of monkeypox vaccine How can public health officials equitably target vaccines for best effect?

It would not be sufficient to vaccinate close contacts of people with monkeypox to stop the spread of monkeypox. Public health officials have not been able to follow all chains of transmission, which means that many cases go undiagnosed. Meanwhile, the risk of monkeypox (and other sexually transmitted diseases) is not evenly distributed among gay, bisexual and transgender men and women, and the targeting of them all outstrips exposure. Such a strategy also risks stigmatizing these groups on the basis of their identity.

The Center for Disease Control recently Extended Eligibility For monkeypox vaccination to include people who know that a sexual partner in the past 14 days has been diagnosed with monkeypox or who have had multiple sexual partners within the past 14 days in a jurisdiction with known cases of monkeypox. But this approach depends on the people they have Access to the test. Doctors in some jurisdictions test a lot more than others.

Alternatively, public health officials can direct monkeypox vaccines to gay, bisexual and transgender men and transgender women who are HIV-positive or considered to be at high risk of contracting HIV and eligible for pre-exposure prophylaxis (PrEP, i.e. taking medications to prevent HIV infection). After all, there is a lot of overlap between this population and those at risk of developing monkeypox. but only 25% Of people eligible for PrEP in the United States being prescribed it, this percentage drops to 16% and 9% among Hispanics and blacks, respectively. This approach risks losing many vulnerable people and exacerbating existing racial and ethnic disparities.

This is why some LGBT activists are calling for more aggressive outreach. We talk about two types of monitoring. “Negative surveillance, which is where I go to my doctor’s office,” says Dr. Greg Gonsalves, an epidemiologist at the Yale School of Public Health and longtime AIDS activist. “Active surveillance is where we go out and actively look for cases by going to where people are. There are parties and social places and sex clubs where we can do monkeypox testing.” This would be especially critical the outside Gay-friendly cities, where both patients and providers may be less knowledgeable and gay sex is more stigmatized.

In New York City, the epicenter of monkeypox in the United States, disparities in access to the monkeypox vaccine have already emerged. The city’s health department offered dates for the first doses of the monkeypox vaccine through an online portal and promoted them on Twitter. These initial doses were given at a sexual health clinic in the affluent Chelsea neighborhood.

Read more: Why is it so hard to find monkeypox vaccines?

According to Gonçalves, “It was midday. He was in a predominantly white gay neighborhood… He really targeted a demographic that would be the first to go along with everything. That is the problem of relying on passive surveillance and people coming to you.” According to Dr. Michael Levasseur, an epidemiologist at Drexel University, “The demographics of that group may not actually reflect the most at-risk group. I’m not even sure we know the most high-risk group in New York City right now.”

granted, Three-quarters City cases have been reported in Chelsea, a neighborhood known to have a large LGBTQ community, but this is also a reflection of awareness and access to testing. despite More labs They offer monkeypox testing, many doctors They are still unaware or unwilling to test monkeypox patients. You have to be a strong advocate for yourself to get tested, to the detriment of an already marginalized population.

The New York City Department of Health opened a second vaccination site in Central Harlem to better reach communities of color, however, most of those getting the monkeypox vaccines have been there. white men. And last week, New York City launched Three mass vaccination sites in the Bronx, Queens and Brooklyn, which were open for one day only. To get the monkeypox vaccine, you need to be aware, take a day off, and be willing and able to stand in line in public.

How can public health officials do that active surveillance that Gonçalves is talking about in order to equitably target monkeypox vaccinations and those most at risk? Part of the answer may lie in efforts to map sexual networks and the spread of monkeypox, such as the rapid epidemiological study of monkeypox infection prevalence, networks, and demographics (RESPND-MI). Your risk of developing monkeypox depends on the likelihood that someone in your sexual network will contract monkeypox. The study, for example, may help explain the relative importance of group sex at parties and large events versus dating apps in the spread of monkeypox through sexual networks. “The network map can tell us, given the rarity of the vaccine, that the most important demographics of people who need to get the vaccine first, not just to protect themselves, but actually to slow the spread of the vaccine,” says Dr. New York University and co-principal investigator of the RESPND-MI study.

During the initial phase of the COVID-19 vaccine rollout, when the vaccines were administered in pharmacies and mass vaccination centers, an ethnic gap in vaccination rates emerged. Public health officials have filled that gap by meeting people wherever they are, in friendly community settings and through mobile trucks, for example. They have worked hard with trusted messengers to reach people of color who may be wary of the health care system.

Likewise, sexual health clinics may not be a one-size-fits-all solution to monkeypox testing and vaccination. Although sexual health clinics may feel more welcome to some, others may fear seeing them attend one. Others may not be able to go to sexual health clinics because Limited working hours On weekdays only.

It is not new for public health officials to meet members of the LGBTQ community wherever they are. During a 2013 meningitis outbreak among gay, bisexual, and transgender men, health departments across the country fake relationships With community-based LGBTQ organizations to distribute meningitis vaccines. Unlike New York City, Chicago is now taking advantage of those relationships to vaccinate people at risk of developing monkeypox.

According to Massimo Basile, Chicago’s deputy commissioner for disease control, “the vaccine has not been indicated for the general public nor, at this point, for any MSM.” Chicago distributes monkeypox vaccines through places like gay baths and bars to target those most at risk. “We don’t have to scrutinize when people come in because we do it in the early stages by doing outreach in a different way,” says Bachele. The monkeypox vaccination, he says, “is intentionally decentralized. Because of that, the methods by which any individual applies for the vaccine are also very diverse.”

Another reason to partner with LGBTQ community organizations is to expand capabilities. The New York City Department of Health and Mental Hygiene is one of the largest and best funded health departments in the country, yet it is Struggle To respond quickly and forcefully to an outbreak of monkeypox. “The coronavirus has overwhelmed many public health departments, and they could use help, frankly, from LGBTQ organizations and HIV/AIDS” in controlling monkeypox, Gonçalves says.

But even as public health officials try to control the transmission of monkeypox among gay, bisexual and transgender men in this country, it is important not to forget that monkeypox has been spreading in West and Central Africa for years. Not all of this transmission was happening among the MSM community. Monkeypox control strategies will need to be guided by local epidemiology. Social and sexual mapping will be more important but is a challenge in countries, such as Nigeria, where gay sex is illegal. Unfortunately, wealthier nations are already hoarding supplies of monkeypox vaccine as they have done for COVID vaccines. If access to a monkeypox vaccine remains unfair, it will leave all countries vulnerable to a re-emergence in the future.

More must-read stories from TIME

call us in

(Visited 1 times, 1 visits today)

Related posts

Leave a Comment