Nowhere near enough vaccine to meet need as monkeypox spreads in Chicago – Hyde Park Herald

The federal government has communicated no strategy to contain the monkeypox outbreak predominantly affecting men who have sex with men as the supply of protective vaccine trickles in to health departments and patients who need it.

As of July 4, there were 73 identified monkeypox cases in Chicago. A majority of them are male Chicagoans who have sex with other men. 

“What we have seen is that spread is really occurring between tight-knit social networks,” said Dr. Janna Kerins, a Chicago Department of Public Health (CDPH) veterinarian who focuses on zoonotic diseases, which spread from animals to people, during a July 5 online Q&A with department Commissioner Dr. Allison Arwady. “People who have intimate contact with one another.”

If people are unwell in any capacity, they should stay home until they are checked by a health care provider. Kerins said people should also avoid sex if they think they have monkeypox. Sores and rashes should be covered up, and people should wear masks around others. The virus is primarily spread through close, intimate, skin-to-skin contact, but it can also spread through shared clothing, bedding, towels, silverware and dishes.

If people are having symptoms — a new rash preceded by fever, swollen lymph nodes, intense headaches, muscle aches, back pain and low energy — they should see a health care provider. People can also call the city’s COVID-19 call line, 312-746-4835, for connection to monkeypox or coronavirus care if people do not have health care providers.

“If you’re seeing your health care provider, and you’re really concerned about MPV, just don’t hesitate to advocate for yourself,” said Kerins, using an initialism for monkeypox virus. “Feel free to remind your provider that MPV is in the community, in Chicago.”

The Centers for Disease Control and Prevention (CDC) reports that there are no treatments specifically for monkeypox infections, but because monkeypox and smallpox viruses are similar, smallpox antivirals can be used to treat monkeypox virus infections and may be recommended for people with weakened immune systems.

Jynneos, one of the vaccines effective against monkeypox, is given in two doses 28 days apart. It can be used as post-exposure prophylaxis after someone is exposed to the disease to prevent contracting it. Jynneos is being allocated to people who are known or presumed contacts of monkeypox patients, sex workers or people who have multiple sexual partners in the past 14 days in places with known monkeypox cases, like Chicago.

Massimo Pacilli, CDPH’s deputy commissioner for disease control, said the city is doing pop-up and mobile vaccination work with partner organizations that work with LGBTQ populations. Vaccines have recently been given at the Steamworks bathhouse, 3246 N. Halsted St. through Project Wish at the University of Illinois at Chicago. Howard Brown Health administered vaccines last Saturday at the Chicago Black Pride celebrations at the DuSable Museum, 740 E. 56th Place.

Dr. Anu Hazra, an infectious diseases specialist at UChicago Medicine who practices at Howard Brown, was at that clinic’s July 2 DuSable pop-up, where hundreds of vaccines were administered.

“I think the strategy should really be to stop transmission,” he said. “This isn’t a virus that’s airborne, that people come into contact with all the time, whereas COVID elimination is a lot more challenging in that regard. We have the tools and the means to get to a ‘monkeypox zero,’ or whatever you want to call it.”

He thinks that the public health response, from a local level to the CDC to the World Health Organization, “has been really frustrating,” particularly with the latter declaring the outbreak a public health emergency of international concern.

He stressed the need for targeted messaging about monkeypox’s spread, specifically through sexual networks of gay and bisexual men.

“Monkeypox doesn’t really give a (expletive) if you’re gay or not, but it cares who you’re having sex with and who your close contacts are,” he said. “That just happens to be tighter sexual networks among gay and bisexual men who have sex with men, particularly those who may be traveling between countries.” (The outbreak first materialized in patients who had been to big gay parties in Berlin, Belgium and the Canary Islands.)

That monkeypox is spreading among gay men who travel a lot to big, expensive parties does not mean that it will not eventually spread to, say, down-low men who have sex with men on the South Side. There have been hundreds of Pride events nationwide since the outbreak began, during which the disease can spread between new people.

“When you think about sexual networks, you think about not only the people you have sex with, but the people they have sex with, because they confers your own risk,” Hazra said. “Let’s keep it to STIs, because that might be easier to understand: You may only have one partner, but if that partner has multiple partners, then your risk of an STI increases exponentially.

“It’s not just about your direct five friends. It’s about who they’re connected to as well. And that all equates to what kind of risk you have.”

Chicago’s sexual networks are typically ZIP code-based — people here have sex with people who live around them — so people who live in neighborhoods with high levels of sexually transmitted diseases tend to relate to a higher risk of contracting an STD, regardless of how many sexual partners a person has.

Both the North Side lakefront neighborhoods that are home to a disproportionate percentage of Chicago’s LGBTQ population and segregated, majority-Black neighborhoods on the South and West sides have the city’s highest rates of STDs. Hazra noted the disproportionate effect of COVID-19 on communities of color versus richer, whiter communities in Chicago as well.

“The communities that were disproportionately impacted were the most vulnerable and marginalized communities that did not have access to health care,” he said. “That is always the concern in any epidemic or pandemic is to figure out who has access and who does not, and those who do not will always share the larger burden of disease and morbidity in general.”

Hazra also noted that there is a testing bottleneck in all major U.S. cities and that the number of confirmed cases is an undercount of the number of actual cases. Major labs are expected to begin processing PCR tests. Hazra said commercially available tests will be much more efficient because clinics will not have to spend valuable time doing cumbersome paperwork for each test.

Arwady said she does not foresee any requirements going into effect around monkeypox vaccines akin to workplace requirements around COVID-19 vaccination.

“There are more people, I would say, in Chicago who might want an MPV vaccine than we have the capacity to give them right now,” she added. Pacilli said that neither the general public nor health care workers will need to get vaccinated.

Arwady contextualized that, because monkeypox is typically rare — an outbreak on this scale has never happened on this scale in the West — there is no vaccine on Chicago pharmacists’ shelves or in local doctors’ offices. The federal government kept some in its Strategic National Stockpile (SNS), the national pharmaceutical repository that infamously buckled under the intense demand for personal protective equipment early in the COVID-19 pandemic.

The city has ordered, received and deployed around 1,200 vaccines so far from the SNS. Arwady said the federal government has put in additional orders.

“We want to make sure every dose, just like at the beginning of COVID, is going where it is needed most,” she said. “And as more vaccine becomes available and we see what happens with this outbreak, we will of course be working to make it available for more people.”

Hazra said there is evidence that Jynneos is around 80% to 85% protective against monkeypox. People may need boosters two years after their second doses.

The initial nationwide allotment of Jynneos vaccine from the SNS is 56,000 doses; in the coming weeks, Hazra said the federal government is trying to get 300,000 doses out. (Hazra noted that “weeks” is a vague term.) There are around 1.6 million doses of the Jynneos vaccine available for U.S. use, but they are stored in Europe, and Hazra said there is a lot of Food and Drug Administration red tape to import them. It could take months to get all those vaccine doses in; Hazra said activists are protesting that timeline, which he called a “worst-case scenario.”

In any situation, many, many more people are going to contract monkeypox in the coming weeks. “Our only ways of tamping down transmission are improving education at the individual level of how to protect yourself, improving testing access and improving vaccine access,” Hazra said. “These are bread-and-butter ways to reduce transmission. And these are the same pains that we had during the COVID-19 pandemic that we are experiencing again right now.”

Right now, Hazra said there are other ways or smarter ways people can think about having sex, particularly if they fall in the monkeypox at-risk categories. People should think about their partners and take a look at them, specifically inspecting their and one’s own genitals for lesions, bumps or abnormalities.

Condom use is not a total fail-safe because they do not cover all parts of the skin where the pox can be, but they can be helpful. Hazra said those who do not want to use condoms could reduce their risk of acquiring monkeypox by changing their sexual practices during this outbreak.

“It’s important to note that the lion’s share, over 80% if not 90%, of cases of monkeypox globally are in gay and bisexual men who have sex with men,” Hazra said. “And we can’t ignore that, that this is spreading primarily intimate close contact, and that this seems to be spreading through sexual networks amongst this population. I think we can talk about it without it being stigmatizing, but it’s ultimately important for a population that’s disproportionately infected by a disease to feel educated and empowered about a disease so that they can make informed choices about how they want to live their lives.”

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