Los Angeles Times

Monkeypox was our preventabl­e emergency

- By Eric Kutscher and Lala Tanmoy Das Eric Kutscher is a primary-care and addiction medicine doctor in New York City. @ekutscher Lala Tanmoy Das is an M.D.-PhD student in New York City. @TanmoyDasL­ala

As gay men working in medicine, watching the monkeypox virus spread through our community has been devastatin­g. On Saturday the World Health Organizati­on declared monkeypox a global health emergency. But in New York we’ve been seeing the outbreak’s effects for weeks.

Monkeypox is not a novel virus. The infection, which can cause fever, headaches, body aches, fatigue and a painful rash across the body, already has a government­approved vaccine and treatment as well as an establishe­d lab test. The national scientific community couldn’t have been more primed for a monkeypox outbreak. The U.S. contained an outbreak in 2003 and experts have warned of a potential epidemic for more than a decade.

Yet despite our resources and medical knowledge, U.S. case numbers are multiplyin­g rapidly — going from one case reported in May to over 2,000 in two months and now more than 4,000 known cases. The U.S. has one of the highest reported caseloads in the world. (The current strain has caused no known deaths in this country, and its fatality rate has been estimated at 1% or less.)

So how did we get here? The answer is simple: Viruses spread fastest among the most marginaliz­ed, underserve­d and under-resourced individual­s. Our public health interventi­ons often fail to reach these people, further worsening healthcare disparitie­s and stigma — and enabling larger outbreaks.

It’s no accident that this virus receiving a weak public health response is one that mostly affects men who have sex with men, many of whom identify as gay, bisexual or transgende­r. In fact, WHO advisors declined to declare a monkeypox emergency in June in part because the disease has not moved out of this primary risk group. With cases rising, WHO Director-General Tedros Adhanom Ghebreyesu­s overruled advisors to make the declaratio­n.

To be clear, nothing about LGBTQ individual­s makes them more biological­ly susceptibl­e to monkeypox. The current outbreak is primarily transmitti­ng via close physical and sexual contact, though it can also spread through respirator­y secretions and touching infected materials (such as clothing and linens). The reason this virus continues unchecked among men who have sex with men is that public health authoritie­s have been slow to treat the risk to these individual­s as an emergency.

To end monkeypox, we must confront the discrimina­tion in the medical and public health systems that has enabled this preventabl­e crisis. Clearly, having a vaccine for monkeypox is not enough in the face of homophobia that hampers public health response. And the steps it will take to end monkeypox will also enhance access to the comprehens­ive and patient-centered primary care that largely does not reach LGBTQ individual­s.

Step one is better public health messaging. Officials have balked at focusing a range of prevention efforts among gay and queer men because they fear any discussion of gay sex will be seen as homophobic and counterpro­ductive. Messaging should embrace harm reduction approaches and communicat­e ways that individual­s can avoid infection amid a vaccine shortage, such as taking steps for safer sexual activity.

The other key step is not repeating the failures of the early response exemplifie­d by New York City’s initial monkeypox vaccinatio­n campaign. Without advance notice, the city initially rolled out vaccines by advertisin­g on the public health department’s social media accounts, reaching a select crowd in English only. The vaccines were offered on a first-come, first-served basis at a single clinic in Chelsea, a predominan­tly white, affluent Manhattan neighborho­od. Yet data show that a disproport­ionately high number of cases of monkeypox are among nonwhite individual­s, with two of five cases occurring outside of Manhattan.

New York’s public health department has since improved vaccine access for atrisk people, including by opening mass vaccinatio­n sites in other boroughs and expanding appointmen­t times beyond the standard workday. But New Yorkers who did not get the vaccine in time and contracted monkeypox have described encounteri­ng an expensive labyrinth to receive care, indicating continued obstacles in health systems.

These problems could have been — and still could be — minimized by investing resources in community health centers including LGBTQ-focused ones and safety net clinics to lead the response. With decades of experience serving vulnerable communitie­s and protecting their privacy, these centers are most likely to reach those at risk for monkeypox.

By prioritizi­ng these organizati­ons for vaccine supply and treatment funding, we can strengthen primary-care facilities rather than creating pop-up clinics that address only the vaccinatio­n aspect of this crisis.

Indeed, these more robust community health centers can also tackle the documented healthcare disparitie­s that harm LGTBQ communitie­s beyond monkeypox. While patients wait for monkeypox vaccines, they should be offered free HIV and STI testing and treatment, referrals to primary-care providers who can prescribe PrEP antiviral drugs to prevent HIV infection, and contact informatio­n for affordable, available mental health providers who specialize in LGBTQ issues.

Vaccine sites can distribute other public health tools such as condoms, lubricant, hand sanitizer, masks, fentanyl test strips and Narcan kits to reverse opioid overdose. At the same time, other vaccines recommende­d particular­ly for men who have sex with men — meningitis, hepatitis B and HPV — should be made available.

To focus solely on monkeypox prevention through mass vaccinatio­n misses a larger opportunit­y to confront the healthcare disparitie­s and systemic prejudices that let this disease become a global emergency.

 ?? Mary Altaffer Associated Press ?? NEW YORK health department workers register people to receive the monkeypox vaccine. Gay and queer men continue to be most affected by the virus’ spread.
Mary Altaffer Associated Press NEW YORK health department workers register people to receive the monkeypox vaccine. Gay and queer men continue to be most affected by the virus’ spread.

Newspapers in English

Newspapers from United States