Monkeypox vax has disproportionately gone to white Philadelphians. This clinic sought to balance that.

JaBaris Swain paced a gymnasium at a monkeypox vaccination clinic this week, weighing whether he had enough shots to meet the need in a vulnerable community in North Philadelphia.

Forty-seven people already had come in for their first shot of a two-dose vaccine that’s been in short supply in an outbreak that is significantly impacting Black men who have sex with other men.

With at least five more appointments scheduled, Swain would not be able to vaccinate all and guarantee second shots, too. He still decided to tap into supplies intended to be held back for second doses.

“If you look at it from a utilitarian perspective, you make sure that the most people have at least one line of protection,” said Swain, medical director at the Dr. Ala Stanford Center for Health Equity.

More than half of Philadelphia’s monkeypox cases have been reported in Black residents, but they have received just 24% of the vaccine doses. White residents have received 56% of shots, and account for 24% of infections.

Monkeypox can spread through close physical contact. Although the current national outbreak is mostly infecting men who have sex with men, cases also have been reported in women and children. Wednesday’s clinic was among the first in Philadelphia hosted in a predominantly Black neighborhood in response to the current outbreak.

» READ MORE: Black Philadelphians are at higher risk of monkeypox but get just a fraction of vaccine doses

Similar disparities occurred during the COVID-19 pandemic, which took the heaviest toll on Black Philadelphians. But the initial vaccine rollout saw more white residents getting shots. Black residents continue to have lower vaccination rates.

Advocates say outreach has been lacking in the neighborhoods where many at-risk Philadelphians live. Expanded effort is needed, said Elle Lett, who established Philly MPX Action with a small group of health professionals to do outreach around the virus.

“We need to have vaccine clinics in Kensington, North Philly, the Northeast, in Southwest Philadelphia,” said Lett, a medical student and social epidemiologist at the University of Pennsylvania, who is a Black trans woman. “Philly is a very queer-person-of-color city.”

City health officials said their efforts have been hindered by a lack of federal funding that was anticipated when monkeypox was declared a health emergency last month.

The health department said on Thursday it was seeking local applicants for 10 grants of $50,000 or $25,000 to improve access and outreach. The health department is drawing on $375,000 from its budget to fund the grants, hoping to eventually be reimbursed with federal money.

Community partners can play an important role in closing the vaccination equity gap, according to the health department, and the grants are intended to “kick-start” the effort.

Vaccine is currently available at Bebashi -- Transition to Hope, a health provider focused on people with HIV, health officials noted. Black patients have received the majority of their doses, said Nackea Bachman, a physician’s assistant who is involved in the provider’s weekly vaccination clinics held on Thursdays at the center’s building near 13th and Spring Garden Streets.

The health department is also working with Philly Pride to reach gay Black men and has plans for clinics in West Philadelphia through September with Action Wellness, a health center for people with HIV and other chronic illnesses.

Fewer new monkeypox cases have been reported in Philadelphia in recent weeks, according to data maintained by the Philadelphia Department of Public Health, but city officials say it’s too soon to determine whether the outbreak’s spread is coming under control. There have been 327 cases of the virus reported so far in Philadelphia.

About 53% of doses administered at the Ala Stanford health center’s pop-up clinic on Monday and Wednesday went to Black patients, according to the clinic’s medical director.

Staff there is careful to protect the anonymity of the people going there for monkeypox vaccine doses. One factor complicating the monkeypox vaccination effort is that some men who have sex with men may be less likely to identify as gay, experts note, and they could be averse to visiting a clinic established specifically for monkeypox vaccine.

“We are being discreet, " said Doris Cush, director of nursing. “It’s total anonymity.”

The clinic is working to reach deeply into the local LGBTQ community. For example, it is coordinating with a party planner to share vaccination information at an alternative lifestyle party this weekend.

A local resident who was vaccinated this week, Sarah Craig, said getting a shot there added to their comfort.

“They’re very friendly and informative here,” said Craig, who is Black and nonbinary. They wanted to get vaccinated because working as an acupuncturist involves close contact with other people.

» READ MORE: Philly sex workers finally have access to the monkeypox vaccine

But supplies are still tight in Philadelphia. Federal authorities allocating the vaccines had suggested the new strategy could yield up to five doses from each vaccine vial, but Cush said she has struggled to get more than four. The city health department said three to four doses per vial is typical.

By Wednesday afternoon, Swain learned that he could order more vaccine, though he wasn’t sure when, and decided to dip into the second dose supply to give shots to every person with an appointment.

Later Wednesday, he received confirmation that the health center would receive 200 more doses.

If supplies hold up, he plans to host monkeypox vaccination clinics at least weekly at the center. Just this week, shots went to gay men, transgender women, and sex workers, most of them Black.

“We have to keep reminding the city, there are pockets of the city that don’t have access,” he said.