|This is the first of what will be a weekly NMAC newsletter on the latest developments in the monkeypox (MPV) epidemic. Production of this newsletter is supported by a grant from Gilead Sciences to NMAC to serve as the coordinating center for the policy response to MPV.
These newsletters are intended for service providers, people living with or at risk of MPV, and policymakers at the federal, state and local levels. Each newsletter will provide updates on the latest data pertaining to MPV, especially as it relates to public policy. These newsletters will center the individuals and organizations most heavily affected by MPV, profiling people living with or at risk of MPV as well as the organizations that are contributing to the fight against this national health emergency.
Why NMAC is helping lead the fight against MPV
NMAC leads with race in the effort to end the HIV epidemic in the U.S. This focus demands that NMAC become engaged in the fight against MPV. Gay/bisexual men – the population most heavily affected by HIV – account for at least 94% of people with MPV. People living with HIV make up 41% of people diagnosed with MPV.
As in the case of HIV, the communities of color for which NMAC advocates are disproportionately affected by MPV. Black and Latinx people account for about one-third of the U.S. population but for 54% of people with MPV. In Georgia, Black people account for 33% of the state’s population but for 82% of the state’s confirmed MPV cases.
Just as people of color are markedly less likely than white people to obtain PrEP or to achieve HIV viral suppression, Black and Latinx gay/bisexual men are being left behind in early efforts to roll out MPV vaccines. In the case of MPV, leading with race means immediate action to ensure equitable access to the prevention of MPV, timely treatment of MPV, and MPV vaccination.
MPV: The latest developments
MPV is spreading rapidly
The federal government has been slow to respond
- There are shortages of every key tool needed to fight MPV (prevention, testing and treatment) – in large measure because of the federal government’s failure to plan and respond aggressively to protect the health of gay/bisexual men. TPOXX, the only drug available for the treatment of MPV, is in short supply, and doctors who have MPV patients must complete a 27-page application and obtain federal approval before they can administer the drug for their patients who are experiencing severe MPV-related pain.
- The country has an acute shortage of MPV vaccines because the federal government, even though it owned millions of doses of the vaccine, failed to ask the manufacturer to bottle it for distribution. The federal government is now racing to close this gap, but current estimates indicate that the vaccine shortage won’t be resolved before 2023.
- To make the limited supply of vaccines go as far as possible, the federal government has approved administration of a smaller dose between the layers of the skin rather than a full dose under the skin. CDC also recommends that people exposed to monkeypox receive post-exposure vaccination (ideally within four days of exposure).
The Biden Administration has declared MPV a national emergency
- The President named Robert Fenton, an emergency response expert, and Dr. Demetre Daskalakis, of the CDC, to lead efforts to coordinate a national MPX response. It is hoped that the emergency declaration will open new funding for the MPX response and light a fire under the federal bureaucracy to overcome its early fumbles.
Building on the leadership of Black and Latinx gay/bisexual men to fight MPV
Given the disproportionate impact of MPV in communities of color, efforts to address this national emergency must elevate the voices of Black and Latinx gay/bisexual men. To help NMAC serve as the coordinating center for the national MPV policy response, Daniel Driffin has agreed to spearhead advocacy with the White House and other arms of the federal government. A Black gay man living with HIV in Atlanta, Daniel co-founded THRIVE Support Services, an innovative community-centered support and service program that aims to promote the health and well-being of Black gay men.
“Regardless of whether it is cancer, HIV, STIs, housing or other social determinants of health, Black gay men are often the last group for whom solutions are provided,” Daniel says. He has seen this with MPV vaccines in his hometown of Atlanta. “Anytime a local health department stands up a vaccine clinic, within minutes all of the available appointments are gone, and the slots aren’t going to the Black and brown men who are most affected.”
Although the challenge of ensuring vaccine equity is considerable, Daniel knows from his own experience that there are solutions to this problem. “COVID-19 has shown that with the right education and the right messengers, Black and brown people have the same uptake of vaccines as other people. Ensuring that Black and brown people are included in the response from the outset – from Day Zero – is critical if we want to ensure equity.”