Late last month, the CDC announced its mass monkeypox vaccination plan. It includes new capacity to conduct 10,000 tests per week and two types of vaccines, though one is in short supply. This week, Labcorp also offered to double testing capacity via its largest facility in the U.S.
Seven weeks since the first monkeypox case was identified in the U.S., around 5,000 cases have been identified in 58 nations around the world. In the U.S., monkeypox is currently primarily spreading within gay communities and men who have sex with men. The CDC’s plan prioritizes for vaccination the men who have sex with men who have had multiple sexual partners in venues where the virus has spread or who live in high-spread areas.
GREGG GONSALVES, gregg.gonsalves@yale.edu
At Yale University, Gonsalves is an expert in policy modeling on infectious diseases and substance use.
Last week, the World Health Organization declined to declare monkeypox a Public Health Emergency of International Concern (PHEIC), although much of the criteria for the category is already met by monkeypox. Some experts expressed surprise, calling it a “missed opportunity.” Eric Fiegl-Ding, an epidemiologist and chief of the Covid Task Force at the New England Complex Systems Institute, told the Institute for Public Accuracy: “I think it’s very unfortunate that the WHO declined to declare a PHEIC over the weekend [of June 25]. I think there are obviously many more cases [of monkeypox] than are currently tested and recognized.” The report from the panel that made the decision notes that it would potentially reevaluate in 21 days, but Gonsalves says a review should come sooner.
The World Health Network––a global coalition formed as a people’s task force in response to the Covid-19 pandemic––had already declared monkeypox a pandemic by June 22, citing the growth of the virus through local community transmission around the world, among other factors. In a press release, Kaitlin Sundling, a physician-scientist with Covid Action Group and World Health Network, stated that “monkeypox can affect anyone. Stigmatization has the potential to hinder timely identification and isolation of all cases.”
Gonsalves began writing about monkeypox more than a month ago for The Nation; now, the U.S. is reporting about 600 cases. “It’s not getting better,” Gonsalves told IPA. “There is the sense that many of the cases are undiagnosed,” he noted. Things are “much worse than they were a week ago.”
The risks of not declaring a PHEIC, Gonsalves says, are that “frankly we won’t be able to contain it. The more cases you have, the harder it is to do cleanup.” This is especially true with a virus like monkeypox, where, because transmission may occur through sexual contact or in crowded social situations like a dance party, “it’s hard to find close contacts… We’re starting with one hand tied behind our back.” Gonsalves warns that inaction may result in monkeypox becoming “a new resident infection in the gay community,” with a “jump-over every once in a while” to other populations.
Coverage of the virus in the U.S., Gonsalves said, must be “frank but not stigmatizing… It’s important to say that [monkeypox] is not a gay disease, particularly in communities in the U.S. and abroad where being gay means someone is under threat of violence––physical, verbal, or legal.” (Monkeypox initially “emerged in heterosexual people in Nigeria.”)
Gonsalves said that the CDC and White House have had “several ad-hoc conference calls” with clinicians, state and local public health officials, and LGBTQ advocates in recent weeks. Anne Rimoin, a longtime prominent monkeypox researcher at UCLA, “reached out to the gay community early on,” Gonsalves said, while Demetre Daskalakis––director of the Division of HIV/AIDS Prevention at the CDC, a gay man, and a member of the leather community––has experience previously steering the community through MRSA and meningitis outbreaks. Daskalakis is well-versed in “the stakes… for the LGBTQ community.”
Still, Gonsalves said that some reporters have told him that it has been hard to get traction for monkeypox stories due to “Covid fatigue” and due to the relatively restricted population that the virus is currently affecting. Reporters are “having trouble getting stories greenlighted.” Gonsalves is also concerned that although gay media is covering the issue, as well as major outlets like the New York Times and Washington Post, “information may not be distributed equally at the moment.” Indeed, when New York City launched its vaccine station in Chelsea, serving primarily white gay men, the clinic quickly reached capacity and had to stop making appointments until it received more vaccines. Meanwhile, on Wednesday, July 6, New Yorkers struggled to book appointments in a “botched roll-out that the health department is blaming on technological glitches,” wrote Politico.
But monkeypox is affecting and will continue to affect other demographics. For one thing, the virus is “already in the South”––which Gonsalves notes is the epicenter of the AIDS epidemic in the U.S. as well as a region with comparatively higher rates of undiagnosed HIV. Undiagnosed HIV may make people more vulnerable to other viruses like monkeypox.
