As the Biden administration scrambles to get a handle on the rapidly spreading monkeypox outbreak, its latest focus is getting vaccines to high-risk events, such as pride parades.
But there has been relatively little messaging on preventing the virus from spreading in the first place — and that’s a mistake, public health experts say.
As it was with the HIV-AIDS crisis in the 1980s, men who have sex with men have borne the brunt of the early stages of the current outbreak. But while public health officials in the past have traditionally preached safer sex rather than abstinence, that message is less resonant in this crisis, where the disease spreads through close skin-to-skin contact, rather than through sexual contact.
Roughly 75 percent of monkeypox cases in the United States were among LGBTQ men who had multiple partners in the last few weeks before symptoms began, according to CDC data.
While the Centers for Disease Control and Prevention has urged LGBTQ men to limit their sexual partners during this outbreak, the preponderance of its public-facing messaging has focused on vaccine acquisitions and where to get the shots, not prevention.
But Jen Kates, senior vice president and director of global health and HIV policy at the Kaiser Family Foundation, said specificity can only help in stemming the outbreak.
“From everything we know about history here of how stigma can play into people’s health needs, as well as the history of the HIV epidemic, it is really important to be explicit,” she said.
The CDC’s response was slow to explicitly call out sexual behaviors for fear of creating stigma, according to multiple sources. Though the first cases were detected in May, it wasn’t until Aug. 5, when the monkeypox case count had already topped 7,000 infections in the United States, that the agency released guidelines encouraging LGBTQ men to limit their sexual partners before getting vaccinated.
About 40 percent of people diagnosed with monkeypox right now also have HIV, noted Kevin Ard, director of the Massachusetts General Hospital Sexual Health Clinic.
“I do worry that based on the current epidemiology of monkeypox, that it kind of sits at the confluence of homophobia and transphobia,” Ard said on a call with reporters.
David Harvey, director of the National Coalition of STD Directors, said his organization is working on building and distributing educational materials in the absence of CDC action, but much of the outreach is happening at the local level.
State and local health departments can now order monkeypox vaccines to distribute at pride events that attract the LGBTQ community through a new Department of Health and Human Services pilot program. The program, launched Thursday, sets aside 50,0000 doses of Jynneos vaccines in the Strategic National Stockpile that jurisdictions can order on top of their existing vaccine allocations and supply.
The Centers for Disease Control and Prevention is offering assistance to jurisdictions to prepare for these events — upcoming ones include the Charlotte Pride Festival and Southern Decadence in New Orleans — and making plans to prepare for educational outreach in addition to setting up vaccination sites.
But public health experts say coupling vaccines with education is crucial because it takes two doses of the shot to protect against the virus. CDC Director Rochelle Walensky cautioned Thursday during a reporter briefing that even though localities will offer vaccines at pride events, receiving the vaccine at the event does not provide protection at the event itself.
Unlike with COVID-19, as far as scientists know there is no asymptomatic monkeypox spread, and respiratory spread is extremely rare, making it easier to prevent transmission.
“You probably can make the biggest impact by trying to get people to change behavior, which is what we did with SARS CoV-2 when it came to this country,” FDA vaccine advisory committee member Paul Offit said, referring to COVID-19. “We had nothing, we didn’t have vaccines. We didn’t have monoclonals. We didn’t have antivirals, we only had sort of behavior changes … That’s all we had. And it mattered.”