Monkeypox vaccination clinics hosted by San Diego County ran out of appointments in a matter of hours following the event’s announcement late Monday. The county, which had set aside 800 doses for the effort, said Tuesday there are no plans yet to host another event, given the nationwide supply shortage.
With a low vaccination inventory, the growing number of confirmed monkeypox cases is concerning public health experts and advocates, given the disproportionate impact that it has on vulnerable groups, such as the LGBTQ+ community.
“The virus is spreading,” said Dr. David Smith, chief of infectious diseases and global public health at UC San Diego. “And we have a vaccine that should help a lot for preventing monkeypox, but we don't have a lot of vaccine. So, that's part of the problem.”
The clinic beginning tomorrow will be the second vaccination event hosted by the county since the first cases of monkeypox were identified in the region mid-June.
San Diego County did not respond to questions about how many people called 211 to schedule an appointment or the demographics of who was able to obtain one, however, a spokesperson for the Health and Human Services agency said that they were screening those seeking an appointment and prioritizing appointment allocation given specific risk factors, such as pre-existing conditions or risk of potential exposure.
There are currently 3,487 monkeypox infections nationwide, with California seeing the second-highest count compared to other states with 646 cases as of July 26. Twenty confirmed and probable cases of the virus have been identified in San Diego County as of July 22.
Though the virus has the ability to infect anybody, the county says that it is working to focus the limited number of vaccines among those in the LGBTQ+ community, given higher rates of confirmed cases.
A recent study published in the New England Journal of Medicine found that, of 528 infections across 16 countries that were diagnosed between April 27 and June 24, approximately 98 percent of cases were among gay or bisexual men.
Infection with monkeypox most often presents as a rash with pimple-like sores or lesions that starts forming near the genitals before spreading across the body. Additional symptoms of the disease include fever, fatigue, headache, muscle aches and swollen lymph nodes.
The time between infection from exposure to the display of symptoms can be anywhere between five to 21 days, with cases beginning to present symptoms around two weeks after exposure.
Monkeypox is ‘rarely fatal,’ according to the Centers for Disease Control and Prevention, as there are vaccines and treatments that can be used to mitigate the virus, but severe outcomes can occur particularly among individuals who are immunocompromised.
Transmission of the virus, according to experts, is primarily through prolonged, direct exposure, via the passing of respiratory droplets and close skin-to-skin contact. While it is not a sexually transmitted disease, experts have repeatedly cautioned that it can spread through intimate activities.
This connection has created difficulties for public officials between balancing the need for centering those being affected most and furthering historically-rooted stigma, as current testing suggests that the virus has moved more quickly through the LGBTQ+ community compared to other groups — notably singling out gay and bisexual men with multiple partners as being particularly at risk.
This could be for a number of reasons, but experts say that the identified spread among those in this group is an “epidemiological accident” — citing the interpersonal nature of the LGBTQ+ community — combined with a lack of testing across demographics.
“That's how infections spread in general,” Smith said, noting similarities between the current outbreak with the 2017 hepatitis A outbreak among San Diego’s homeless community and concentrations of COVID-19 on cruise ships at the beginning of the pandemic.
“Once it gets into a close-knit community, that's how you can see it happen, but we do expect spillover to occur,” he continued.
Advocates though have expressed frustration surrounding messaging that connects sexual or gender identity with the outbreak, arguing that its connection with the spread perpetuates harmful stereotypes about queer intimacy and the ‘us-versus-them’ dynamic that distracts from necessary, overall public health concern.
“The key is to not take shortcuts and simply name identities because it leads to stigma and also to not effectively distributing resources where they are most needed,” said Kim Fountain, deputy chief executive officer with the San Diego LGBT Community Center. “There are a host of reasons certain populations may not be showing up in public health surveillance data and part of this is because they do not fit categories that are being widely and inappropriately used.”
The monkeypox outbreak, experts say, has more to do with waning immunity to the smallpox virus across the globe, as less widespread vaccination efforts have been made in recent years compared to previous generations.
“The overall rate of people who've been vaccinated for smallpox has greatly decreased,” Smith said. “Like I was not vaccinated for smallpox, but people who are older than me were and the smallpox vaccine protects against monkeypox, so that decrease in that immunity has allowed monkeypox to probably spread from person to person.”
Ahead of the San Diego Pride festival, the county administered its first 600 doses of the two-shot JYNNEOS vaccine, which is a smallpox vaccine that has been authorized to treat monkeypox. According to officials, the county has received 2,200 doses of the vaccine to date.
Despite full-vaccination with the vaccine requiring two shots, the county is prioritizing first doses as they wait for a greater supply.
Steps have been taken to expand availability of the vaccination nationwide, but additional doses might not be available until later this year. According to the U.S. Department of Health and Human Services, an additional 2.5 million doses of the vaccine were ordered, which will be ready for federal distribution by mid-2023.
“People are clearly ready to protect themselves and take the vaccine,” said Fernando Lopez, San Diego Pride executive director. “It is imperative that we work together quickly, thoughtfully, and decisively if we hope to meet the needs of the moment and stop the virus in its tracks."
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