Now that San Francisco, California, and the U.S. have emergency declarations for monkeypox in effect, officials at all levels of government must quickly ramp up efforts for testing, vaccinations, and treatment. While there are some positive developments on all fronts, it bears repeating that the overall response, especially at the federal level, which controls vaccine distribution and, until recently, had a lock on testing, has been dismal. If this outbreak had been primarily affecting ANY group other than men who have sex with men, we think that there would have been a vastly different — and quicker — response. And while it's true that the country's public health infrastructure has been woefully underfunded for years, that's no excuse in this case, when the feds had millions of doses of the Jynneos vaccine in the national stockpile, only to allow them to expire, rendering them useless.
As John Oliver said on his "Last Week Tonight" show the other day, the U.S. could have sent those vaccines to countries in Africa where monkeypox has been endemic for years. This country could have been a good neighbor. That's the difference between monkeypox and COVID — the U.S. had all the tools to combat the outbreak from the beginning, yet still fell behind, which allowed the virus to spread. Talking heads wondered during the early months of COVID if the country was ready for the next epidemic. Clearly, the answer is no, it is not.
The recent emergency declarations are a good first step that should have been taken much earlier. For San Francisco, the declaration of a local emergency is a legal action that will mobilize city resources, accelerate emergency planning, streamline staffing, coordinate agencies across the city, allow for future reimbursement by the state and federal governments, and raise awareness about preventing monkeypox in the community, according to health officials and the mayor's office. The Board of Supervisors interrupted its August recess on Monday to ratify the declaration and heard from Health Officer Dr. Susan Philip about how it could help the city get more of the Jynneos vaccine. (The city recently received 10,000 doses, less than is needed but way more than previous shipments.)
Gay District 8 Supervisor Rafael Mandelman, however, had some tough questions for Philip, particularly regarding the long lines of people waiting to get vaccinated outside Zuckerberg San Francisco General Hospital and Trauma Center. He urged the creation of an online appointment system similar to what was used for the COVID vaccines. Philip was able to say that the state, which declared its monkeypox emergency August 1, is in the process of utilizing its MyTurn system, which was put in place for COVID, for monkeypox shots and that it should be completed by the end of the month. But Philip also noted that jurisdictions that have pivoted to online appointments are seeing frustration among people because the slots fill up so quickly.
We think a hybrid system would work the best, with both online appointments and drop-in options. There still remains a class issue in that not everyone can afford to take a day off of work to stand in line for a shot. That needs to change, as several supervisors have pointed out.
It's also worth noting that Philip said medical providers Kaiser Permanente, UCSF, and Sutter Health are all able to provide monkeypox vaccines to people in their networks. These providers need to do a better job of letting their clients know this is available. It would take some of the pressure off SFGH if people can go to other medical centers. Men who have sex with men and trans people who have sex with men if they've had multiple sexual partners and sex workers regardless of sexual orientation or gender identity are eligible for the vaccine, according to DPH. Persons who have had close contact in the last 14 days with someone with suspected or confirmed monkeypox are also eligible.
Public health officials also need to address stigma, since the current monkeypox outbreak is mostly affecting men who have sex with men and their sexual partners. Most officials have been regularly pointing out that anyone can get monkeypox through close personal contact, but there is still this sense of stigmatizing the gay, bi, and trans male communities.
Dr. Demetre Daskalakis, a gay man who's director of HIV prevention for the Centers for Disease Control and Prevention, was just named the deputy director of President Joe Biden's White House National Monkeypox Response. He told reporters last week that the response team is planning to partner with social media influencers to get messages out about monkeypox with non-stigmatizing messages. That's a good idea. We also like what the San Francisco AIDS Foundation has been doing. Ahead of last month's Up Your Alley leather and kink street fair, it released "Douchie's guide to a Dore Alley without fear of monkeypox.". The information remains relevant even after the street fair, and we hope SFAF continues to use Douchie's message ahead of the Folsom Street Fair. It's a good guide for guys going to any parties or get-togethers and written in a sex-positive way that has earned praise.
At gay state Senator Scott Wiener's (D-San Francisco) meeting Tuesday of the select Senate Committee on Monkeypox, Joe Hollendoner, the former SFAF CEO who's now in the same position at the Los Angeles LGBT Center, suggested the state compile a comprehensive list of where and when vaccines will become available. Kristen Hwang of CalMatters was following the hearing and tweeted that this would mitigate the stampede of people searching for the vaccine.
CDC director Dr. Rochelle Walensky said during the feds' announcement of an emergency declaration August 4 that testing capacity has greatly expanded. Local officials have said the same thing, now that more labs are able to run the tests, which can only be done by swabbing the lesions.
We can't say it enough — more must be done to make up for the lost opportunities that allowed the infections to spread because the government's response was so poor.
Help keep the Bay Area Reporter going in these tough times. To support local, independent, LGBTQ journalism, consider becoming a BAR member.