Monkeypox vaccine limits cause frustration and fear in Philly

Even after receiving a shipment of monkeypox vaccine Tuesday, Philadelphia health officials acknowledged vaccine supplies continue to be short of what’s needed.

The latest shipment of 2,420 doses brings the supply allocated to Philadelphia to more than 5,000 doses, but the shots are being used as quickly as they arrive. Before Tuesday’s shipment, the health department had either administered or distributed to LGBTQ-focused health-care providers all but 322 doses out of 2,625 delivered to the city.

“The demand is much, much greater than the supply,” said Jessica Caum, who works in public health preparedness at the health department, during a virtual community meeting hosted Tuesday night by the Mazzoni Center, one of the city health providers also administering doses. “We really need to continue to advocate for more vaccine.”

Monkeypox has so far not led to any deaths, but does cause lesions and rashes that can be extremely painful. The symptoms can last for up to a month, a period during which a person can spread the illness.

The virus has overwhelmingly been reported among bisexual, gay, and trans men who have sex with men, and more specifically people in that population who have recently had multiple sexual partners or had anonymous sex.

Those people are eligible for vaccination, but those with confirmed exposures to the virus are being prioritized, health department staff said. Because of limited supply, the city is not reserving shots for second doses, and it is unlikely people who have received a first shot will receive a second dose within 28 days, which is recommended for JYNNEOS, the vaccine being used. The city has not been able to offer doses to health-care workers who may treat people with the virus.

» READ MORE: Philly’s LGBTQ network has rushed to offer monkeypox information and services amid slow public health response

“We have a few thousand vaccines in the city and a lot of wonderful providers, including the emergency departments that employ hundreds of people,” said Shara Epstein, medical director for the health department’s division of disease control. “We could use every vaccine on those people.”

Health experts are also concerned about how monkeypox could spread on college campuses this fall when classes resume. Dormitory life provides the kind of close contact that could spur infections, and the city health department has been in discussions with colleges and universities about managing the virus, department spokesperson James Kyle said.

Working against Philadelphia’s efforts to advocate for more vaccine, Caum said, is that other big cities, like New York City, have far more cases.

Philadelphia’s case count as of Tuesday was up to 84, a more than 60% increase over a week prior. The city the did not update its case count Wednesday, but its cases as of Tuesday account for almost half of the 173 cases reported in Pennsylvania. New Jersey reported 175 cases as of Wednesday, according to that state’s health department.

In less than two months, the national count of identified monkeypox cases has grown to 6,617 as of Wednesday. California, New York, and Illinois, which collectively account for almost half of the nation’s monkeypox cases, have declared states of emergency. Each of the three states have many times more cases than either Pennsylvania or New Jersey. The White House created a monkeypox task force Tuesday to coordinate response to the virus.

The Mazzoni Center’s virtual meeting offered providers a forum to describe the response to the virus in the LGBTQ community, and answer questions about monkeypox.

“What we see presented at our wellness clinic is panic,” said Sebrina Tate, executive director of Bebashi, a health provider focused on people with HIV. “There’s a lot of fear because there’s a lack of information.”

Dusty Latimer, a physician’s assistant at Mazzoni, described people with the virus experiencing intense pain and isolation while infected with a virus that spreads primarily through physical contact.

“There’s a huge stigma factor,” he said. “People are feeling isolated who are presenting with these symptoms.”

Concerns about stigmatizing the community of men who have sex with men spurred some of the most emotional exchanges in the meeting. The virus is not a sexually transmitted disease and could just as easily spread beyond the LGBTQ community. This outbreak, though, has been largely among gay men, and sex is particularly effective as a means of transmission. Health-care providers and experts face a difficult quandary: focusing vaccination and outreach among the most at-risk people while trying to avoid labeling the virus as an illness limited to the LGBTQ community.

“Targeting a group of people based on who they love and who they sleep with makes it sound like a sexually transmitted infection,” said Jazmyn Henderson, with ACT UP Philadelphia, an HIV and AIDS activism organization. “It’s very frustrating and aggravating and it’s not going to promote any kind of trust in any of the Black and brown communities.”

Henderson argued that people least likely to protect themselves from the virus, like sex workers, should be prioritized for vaccination.

Latimer is concerned about the stigma monkeypox is creating, but said if vaccine doses are limited, they should go to the people most likely to catch the virus.

“That’s where I want those doses to go right now, to protect our community,” he said.

» READ MORE: Pa. got more than 3,000 doses of monkeypox vaccine this week, but access is still limited

There remain unanswered questions about the virus, which isn’t following the patterns of previous outbreaks. Some people are developing the lesions and rashes primarily in their genitals or anus, a change from previously observed cases. And the vaccine being used is new, Epstein said, its efficacy based on limited information.

Determining the exact amount of vaccine needed to corral the virus is also difficult because estimates of the at-risk population are imprecise. Michael LeVasseur, a Drexel University epidemiologist, estimated about four million people in the United States are bisexual, gay, or trans men who have sex with other men. Identifying those most at risk requires more intimate knowledge of people’s habits than is available.

“How do we identity what proportion of the population are really having high volume sex?” LeVasseur said.