In the wake of the World Health Organization declaring the growing monkeypox outbreak a “public health emergency of international concern” on Saturday, activists in New York —from groups like PrEP4All, ACT UP New York, and VOCAL-NY— are calling on the city and the federal government for more aggressive outreach.
Their slogan, “POX VAX NOW,” refers to Jynneos, a vaccine that has proved to be effective against monkeypox and smallpox, a much deadlier virus related to monkeypox.
As of July 26 there were 18,877 confirmed cases of monkeypox worldwide, up from 230 only two months earlier. Almost 3500 cases have been reported in the U.S. alone.
New York City, which reported its first case of monkeypox on May 19, is now the epicenter of the world outbreak with 1,092 cases, representing a third of all reported cases in the United States. So far, only 46,000 New Yorkers have received the monkeypox vaccine.
The U.S. already owns about 300,000 doses of the vaccine, which have sat at a facility in Denmark awaiting inspection and authorization for release by the Food and Drug Administration.
Anyone can get and transmit monkeypox, but according to the NYC Health Department, current cases are primarily spreading among social networks of gay, bisexual, and other men who have sex with men. About 99 percent of worldwide cases are among men, with at least 95 percent of those cases being among men who have sex with other men, according to the World Health Organization (WHO).
There have been many reports of proctitis, or chronic inflammation of the anus and rectum, which is a common symptom of monkeypox. “Imagine someone poking your rectum with a hot fork, from the inside,” described one suffer quoted in the New Yorker.
“The monkeypox virus is most often spread through direct contact with a rash or sores of someone who has the virus,” the Health Department explains on its website. “It can also spread through contact with clothing, bedding and other items used by a person with monkeypox, or from respiratory droplets that can be passed through prolonged face-to-face contact.”
The department also lists a number of sexual activities that can cause the spread of the virus, including “oral, anal and vaginal sex” and other forms of intimate contact.
“At this time, it is not known if monkeypox can spread through saliva, semen, vaginal fluids or feces,” the department says.
Despite the excruciating stories shared on social media and at gatherings and demonstrations to create awareness about the urgency of the situation, federal authorities still don’t have a date for the vials of Jynneos set to fly out of Denmark.
The 300,000 ready-to-use doses have not been requested yet.
“Rather than quickly transfer those doses back to the United States and begin administering them… the federal government adopted a wait-and-see attitude,” the New York Times reported on Monday. “In the first few weeks after monkeypox was detected in the United States, the government requested only 72,000 of the 372,000 doses.”
The U.S. supply of Jynneos is managed by the Biomedical Advanced Research and Development Authority (BARDA), a federal agency that develops and acquires vaccines to defend against pandemics, bioterrorism, and other threats to public health. “The authority supported development of the vaccine following the terrorist attacks of Sept. 11, 2001, as the federal government worried about the use of weaponized smallpox,” according to the New York Times.
Dr. Gary Disbrow, a senior official at the U.S. Department of Health and Human Services who runs BARDA, told the Times that requesting all of the monkeypox vaccines could affect the stockpile to defend from a possible smallpox bioterrorist attack.
The number of monkeypox cases in New York is likely much higher than reported, as the virus spreads rapidly and easily from one person’s skin to the next. The Department of Health, however, which is one of the biggest and best-funded in the country, has moved at a slow pace to try to control it. Testing has been limited, and providing proper and prompt health care can take weeks of paperwork. Since late June, appointments to get the vaccine have been administered in a small number of slots that are filled in minutes.
Another reason for the delayed response is the fact that advisers at the World Health Organization (WHO) did not recommend the emergency declaration earlier “because the disease had not moved out of the primary risk group, men who have sex with men,” the Times reported.
On Wednesday, WHO chief Tedros Adhanom Ghebreyesus advised “men who have sex with men” to reduce their number of sexual partners and exchange “contact details with any new partners to enable follow up if needed.”
“Men who have sex with men,” or MSM, is the term used by public health authorities to refer to the population at the highest risk of infection and those who are right now the only ones eligible for the first Jynneos dose.
It is important to note that the MSM designation should be revised, as it is used by medical authorities to name gay, bisexual, or other men who have sex with men, plus transgender, gender non-conforming, or gender non-binary people—a very wide range of bodies and experiences beyond the category “men.”
The problem with the term has been discussed for decades. According to the 2005 study “The Trouble With ‘MSM’ and ‘WSW’: Erasure of the Sexual-Minority Person in Public Health Discourse,” the term obscures social dimensions of sexuality. The study recommended that public health professionals adopt more nuanced and culturally relevant language in discussing members of sexual-minority groups.
During a demonstration at Foley Square in Manhattan on July 21, James Krellenstein, founder of PrEP4All, which advocates for the prevention of HVI and the availability of medication for those that need it, blasted public authorities for dragging their feet.
“Every single goddamn case in the United States was preventable, because you [taxpayers] spent $2.5 billion to research, develop, manufacture, and stockpile a goddamn vaccine for exactly this scenario,” Krellenstein told the crowd. “And yet, here we are.”
“Every single goddamn case in the United States was preventable, because you [taxpayers] spent $2.5 billion to research, develop, manufacture, and stockpile a goddamn for EXACTLY this scenario, and yet here we are!!!” — @jbkrell, PrEP4All’s Managing Director of Strategy & Policy pic.twitter.com/w7QMKgBM7s
— PrEP4All (@PrEP4AllNow) July 22, 2022
“Despite the severity of the outbreak, both monkeypox tests and monkeypox vaccines are in short supply,” PrEP4ALL says on its website. “The U.S. Government could solve both these problems immediately.”
The current handling of the monkeypox outbreak by Public health authorities resembles the way they mismanaged COVID-19 in the early days of the pandemic, which is particularly concerning for Latinos.
Latinos were disproportionately affected by the COVID pandemic, particularly in New York City, due to the delay in government intervention, the lack of access to health insurance, and difficulties for those without legal status to even get help.
As of 2020, there were about 504,000 undocumented immigrants living in New York City, and about 45 percent of all undocumented immigrants in the city remain uninsured despite their eligibility.
Juan de Dios Sánchez Jurado is a summer correspondent for Futuro Media. A writer, lawyer, and journalist from Colombia, he is currently studying at the Craig Newmark Graduate School of Journalism at the City University of New York.