By Sam Manzella
New data shows that the 2022 monkeypox (MPV) outbreak is disproportionately impacting LGBTQ people of color, yet they are less likely to be vaccinated against the virus.
According to CDC analysis of demographic data on MPV cases, Black and Latinx people are contracting the virus at rates disproportionate to their respective populations in the United States. This is likely linked to racial gaps in distribution of the JYNNEOS vaccine, a post-exposure prophylaxis recommended by the CDC for those at high risk of MPV exposure or infection.
Although Black people account for one-third of the 18,000 documented MPV cases nationwide, they have received just 10.5% of vaccine doses, per the CDC’s vaccine administration tracker. Vaccine distribution data is still limited, but these trends are in line with early reports from select states and jurisdictions.
This outbreak is shedding light on existing racial inequities in the U.S. healthcare system. There are additional layers unique to MPV, too. On August 9, the FDA approved a new protocol for intradermal injection of the JYNNEOS vaccine, meaning one vial can cover up to five doses. Although this emergency authorization will extend the overall vaccine supply, some healthcare providers have expressed concerns about its implementation and public perception.
David Wohl, a professor of infectious disease at the UNC School of Medicine, told Politico that his university hospital is scrambling to train staffers to properly administer intradermal injections. He is also worried the new regimen was not adequately explained to ward off a negative perception from Black and Latinx communities, who might feel like they are getting a less effective version of the vaccine. Given the medical establishment’s fraught history of mistreating people of color, vaccine hesitancy could be at play here, too.
To combat these hurdles, public health officials are bolstering resources for clinicians on how to properly administer the JYNNEOS vaccine intradermally and continuing to make data about vaccine distribution publicly available.
In an August 26 press briefing on the White House’s MPV response, CDC Director Dr. Rochelle Walensky emphasized the “unique” quality of public health data in the U.S., which comes from “a complex, de-centralized landscape of state and local health departments with many points of friction that can keep data from getting from local jurisdictions to CDC.”
“The effort to secure monkeypox vaccine data represents how we at CDC are working hand in glove with our state and local partners and other federal agencies to continually improve our approaches,” Dr. Walensky added. “Our goal is swift, transparent, publicly available, and actionable data.”
The White House also unveiled a pilot program to provide MPV vaccines and community education at upcoming large-scale LGBTQ gatherings, including events expected to attract many LGBTQ people of color, such as Southern Decadence in New Orleans. Anyone can get MPV, yet the vast majority of MPV cases in the U.S. are still among gay men, bi men, and other men who have sex with other men. Additionally, the White House announced August 30 that it will make 10,000 vaccine vials available to local health departments “for use as part of smaller-scale equity interventions,” such as distribution at community clinics or events for Black and Latinx LGBTQ people.
These inequities are just the latest example of racial disparities within the U.S. healthcare infrastructure. As we saw with the COVID-19 pandemic, which has had similarly disproportionate impacts on communities of color, public health initiatives often fail to reach the people who need them most. LGBTQ people of color also experienced disparate economic effects of COVID-19, reporting higher instances of pandemic-related unemployment or reduced work hours.
In a statement to GLAAD, Mardrequs Harris, Director of Community Investments at the Southern AIDS Coalition, emphasized the ongoing need for equity in preventative healthcare as well as responses to public health crises. (Southern AIDS Coalition is a coordinating center for The Gilead COMPASS Initiative®, created to address the HIV/AIDS epidemic in the Southern U.S.)
“The data being reported is all too similar to those of other health disparities that impact Black people, and more specifically in this case, Black same-gender loving men,” Harris said. “These scenarios and reports continue to reinforce why we can’t stop calling out and calling in our decision-makers on equity, intentionality, and the need to create a healthcare infrastructure that is proactive versus reactive. This also lets us know that stigma and shame are still issues that we cannot let up on anytime soon. We cannot afford to keep repeating the same vicious cycles; it must change. Lives depend on it.”
On an individual level, LGBTQ people are taking steps to slow the spread of the virus. A CDC report published August 26 found that roughly one-half of gay and bisexual men reported reducing their number of sex partners, one-time sexual encounters, and dating app hookups to protect themselves and their partners from MPV.
Paired with increased availability of the JYNNEOS vaccine, these behavior changes have made the CDC cautiously optimistic that MPV transmission in the U.S. is finally beginning to slow.