On July 23, the World Health Organization declared monkeypox a public health emergency of foreign interest. It was a questionable resolution, with WHO Director-General Dr Tedros Adhanom Ghebreyesus taking the latest appeal and overturning the WHO emergency committee’s resolution. The disagreements reflected the debates that have taken a stand among public servants, on social media and on opinion pages in recent weeks. worry?
Behind those questions are considerations about stigma and the most productive way to allocate scarce resources. But they also reflect an individualistic understanding of public health. in the long term and why and how it can be contained now.
The more the transmission of monkeypox is not controlled, the more likely it is to spread to other populations. There have already been some cases in women and some cases in children due to transmission from the circle of relatives. Otherwise, healthy people, ape pox can be incredibly painful and disfiguring. But in pregnant women, newborns, young people and immunocompromised people, monkeypox can be fatal. All these teams would be in danger if ape smallpox took root in this country.
Stopping transmission between men who have sex with men will protect them here and now and protect the most vulnerable populations in the future. But with a limited source of monkeypox vaccine available, how can public health officials focus on vaccines to make an impact?
Vaccinating close contacts of other people with monkeypox will not be enough to prevent the spread. Public health officials have not been aware of all the chains of transmission, meaning many cases go undiagnosed. Meanwhile, the threat of apepox (and other sexually transmitted diseases) is not lightly distributed among gay and bisexual men and trans women, and attacking them all would exceed supply. Such a strategy also threatens to stigmatize these groups.
The Centers for Disease Control and Prevention recently expanded eligibility for apepox vaccination to include other people who know that a sexual spouse in the past 14 days has been diagnosed with monkeypox or who have had sexual spouses in the past 14 days in a jurisdiction with known cases of monkeypox. But this technique is based on other people’s access to verification. Doctors check much more in some jurisdictions than in others.
Alternatively, public fitness officials may only focus on monkeypox vaccines in gay and bisexual men and trans women who have HIV or are at the highest threat of contracting HIV and are eligible for pre-exposure prophylaxis, or PrEP (a drug to save you from HIV infection). In short, there is a lot of overlap between those populations and those at risk of contracting monkeypox. But only 25% of other people eligible for PrEP in the U. S. UU. la prescribed, and that proportion drops to 16 percent and 9 percent among Hispanics and blacks, respectively. This technique threatens to lose many Americans in danger and exacerbate racial and ethnic disparities.
That’s why some LGBTQ activists advocate for more competitive outreach. “We’re talking about two types of surveillance,” said Gregg Gonsalves, an epidemiologist at the Yale School of Public Health and a longtime AIDS activist. “Passive monitoring, where I go to my doctor’s office. Active surveillance is where we faint and actively seek instances as we pass by where other people are. There are parties, social venues, sex clubs where we can test for monkeypox. “
This will be especially important outside of gay-friendly cities, where patients and providers are likely to be less informed and homosexual sex is more stigmatized.
In New York, the epicenter of monkeypox in the United States, disparities in monkeypox vaccines have already emerged. The city’s fitness arm submitted appointments for the first doses of the vaccine through an online portal and promoted them on Twitter. These initial doses were administered at a sexual fitness clinic in the affluent Chelsea neighborhood.
“It was in the middle of the day,” Gonsalves said. It was in a predominantly white gay neighborhood. . . It was aimed at a demographic that will be on the front lines for everything. That’s the challenge of relying on passive vigilance and other people coming to you. “
Michael LeVasseur, an epidemiologist at Drexel University, said: “The demographics of this population may not reflect the organization at peak risk. I’m not even sure we know the organization at peak risk in New York right now. “
While three-quarters of the city’s cases were reported in Chelsea, a community known for its giant LGBTQ community, it also reflects awareness and control. Don’t want to monitor patients. It has to be a strong advocate for itself to gain control, which puts already marginalized populations at a disadvantage.
The Department of Health opened a momentary vaccination site in Harlem to be more successful in communities of color, but most of those who have access to monkeypox vaccines were white men. And then New York City introduced 3 mass vaccination sites in the Bronx, Queens, and Brooklyn, which only opened one day. To get vaccinated, you had to be vigilant, have a day off and be willing to queue in public.
How can public health officials exercise the active surveillance gonsalves talks about to focus equitably on vaccination against monkeypox and those at maximum threat?Examine the prevalence, networks, and demographics of monkeypox infection, or RESPND-MI. Your risk of exposure to monkeypox is based on the maximum likelihood that your sexual network will have monkeypox. The study could, for example, help explain the relative importance of organized sex at parties and large events compared to dating apps in the spread of monkeypox on sexual networks.
“A network map can tell us, given that the vaccine is so rare, the maximum vital demographics of other people who want to get vaccinated first, not only to protect themselves, but also to slow the spread,” said Joe Osmundson, a molecular microbiologist at New York University and co-principal investigator of the RESPND-MI study.
During the initial phase of the COVID-19 vaccine launch, when vaccines were administered in pharmacies and mass vaccination centers, a racial gap in vaccination rates emerged. Public health officials closed this gap by bringing other people together where they were, in available network environments and through mobile vans, for example. They worked hard with trusted messengers to reach out to other people of color who distrust the health care system.
Similarly, sexual conditioning clinics may not be a one-size-fits-all solution for detection and vaccination against monkeypox. in sexual conditioning clinics due to their limited hours of operation, only on weekdays.
It’s nothing new for public fitness officials to meet with members of the LGBTQ network where they are. During a meningitis epidemic in 2013 among gay, bisexual and trans men, fitness across the country partnered with LGBTQ network organizations to distribute meningitis vaccines. Unlike New York, Chicago is now leveraging those relationships to vaccinate those most at risk of contracting monkeypox.
Massimo Pacilli, Chicago’s assistant commissioner for disease control, said, “The vaccine is not indicated for the general public or, at this stage, for any [man who has sex with men]. “Chicago is distributing monkeypox vaccines in places like public restrooms. and gay bars to target those at maximum risk. “We don’t have to clear ourselves when other people show up because we do it against the tide by creating awareness in another way,” Pacilli said.
Vaccination against monkeypox “is deliberately decentralized,” he said. “And because of that, the tactics in which any individual gets to the vaccine are also very diverse. “
Another explanation for why marry LGBTQ organizations is expanding capacity. The New York City Department of Health and Mental Hygiene is one of the largest and best-funded fitness departments in the country, and is even struggling to respond temporarily and vigorously to the outbreak of monkeypox.
“Covid has beaten many public fitness departments and, frankly, it’s possible for them to use the help of LGBTQ and HIV/AIDS organizations” for monkeypox, Gonsalves said.
But even as public physical health officials verify the transmission of ape pox between gay and bisexual men and trans women in this country, it is important to remember that apepox has been spreading in West and Central Africa for years. those transmissions occurred between men who have sex with men. Monkeypox methods deserve to be reported through local epidemiology. Social and sexual mapping will be even more critical but complicated in countries like Nigeria, where homosexual sex is illegal. Unfortunately, the richest countries already are. accumulating the source of ape pox vaccines as they did with covid vaccines. If access to the monkeypox vaccine remains uneven, all countries will be vulnerable to re-outbreaks in the future.
This article was reprinted from khn. org with permission from henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, an independent fitness policy studies organization not affiliated with Kaiser Permanente.
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