Monkeypox is spreading. We must move quickly, avoid past mistakes to protect LGBTQ people.

·5 min read

More than 7,200 cases of monkeypox have been reported this year in dozens of countries, including over 600 cases in the United States, largely but not exclusively in men who have sex with men. While it is not as contagious as COVID-19, monkeypox could easily gain a foothold in communities now suffering from the latest spread of the disease.

If we do not contain this outbreak, the risk of the persistence of monkeypox among gay, bisexual and transgender people is likely. That is, it will dig its roots into these communities, making this a disease LGBTQ communities will have to live with for a long time.

This disease is spread by close physical contact – not sexual contact per se – so other places in which close physical contact is common will be at risk. It's like how a methicillin-resistant Staphylococcus aureus outbreak among gay men can spread to health clubs – think contaminated towels, benches – but this could jump to other settings of high physical contact or contact with contaminated clothing and bedding, such as homeless shelters.

Monkeypox: It's not a matter of whether it will spread widely. We need to focus on when.

We can stop this outbreak in its tracks with vaccination, together with a surge public health response that helps countries quickly test and trace cases. That means all the countries who need the vaccine need access to it now.

Coordinating serves our interests

Some countries, like the United States, have already begun administering vaccines to monkeypox cases and their contacts in a strategy called "ring vaccination." And some have started vaccinating individuals at higher risk.

This 2003 electron microscope image made available by the Centers for Disease Control and Prevention shows mature, oval-shaped monkeypox virions, left, and spherical immature virions, right, obtained from a sample of human skin associated with the 2003 prairie dog outbreak.
This 2003 electron microscope image made available by the Centers for Disease Control and Prevention shows mature, oval-shaped monkeypox virions, left, and spherical immature virions, right, obtained from a sample of human skin associated with the 2003 prairie dog outbreak.

But vaccines aren't as readily available in some other countries, including parts of Central and West Africa where monkeypox outbreaks have been documented in recent years.

Monkeypox is here and spreading: But the US is well prepared to handle the threat.

Promoting equitable access to vaccines is an act of self-interest. Limited vaccine access could allow the virus to establish deeper roots in more countries, increasing the risk of new outbreaks for years to come.

Ring vaccination eradicated smallpox and helped contain Ebola outbreaks. We can move now to help contain monkeypox.

The White House announced a new domestic monkeypox vaccination plan last week. As the United States begins to deploy vaccines to contain another new viral outbreak, it is critical that we ensure they are available to everyone who needs them at home and around the world. We cannot repeat the mistakes we saw with COVID-19.

This photo provided by the Centers for Disease Control and Prevention was taken in 1997 during an investigation into an outbreak of monkeypox, which took place in the Democratic Republic of the Congo. It shows a patient who was displaying the characteristic rash during its recuperative stage.
This photo provided by the Centers for Disease Control and Prevention was taken in 1997 during an investigation into an outbreak of monkeypox, which took place in the Democratic Republic of the Congo. It shows a patient who was displaying the characteristic rash during its recuperative stage.

For many years, monkeypox rarely spread out of regions in which it is endemic, in West and Central Africa. This new, widely dispersed global outbreak is unprecedented. Sharing supply with other countries in the short term will be critical.

Stockpile should be shared

The Food and Drug Administration has approved one vaccine to prevent both smallpox and monkeypox: Jynneos, developed by Bavarian Nordic, which has a longstanding partnership with the U.S. government.

Compared with the other stockpiled smallpox vaccine, Jynneos produces fewer side effects, is easier to administer and can be given to more people. But the world's only factory for producing the bulk of the Jynneos vaccine shut down last year for construction, which means that only stockpiled material can be converted into finished vaccines.

That makes the U.S. stockpile particularly important: The United States owns more than 1 million finished Jynneos vaccine dosesand has placed orders for 3 million more finished doses. Not counting those orders, America owns enough bulk vaccine substance for more than 10 million additional vaccine doses.

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Unless the United States shares its enormous stockpile, the vast majority of the world will have to rely on the bulk vaccine substance owned by the company itself – which amounts to just "several million" doses – until next year.

Notably, America once promised the world it would share stockpiled doses: In 2004, concerned about a smallpox outbreak, Washington pledged to make millions of doses available to the World Health Organization in an emergency. Now, the same kinds of vaccines are needed against monkeypox.

Make more vaccine doses

In addition to sharing doses, ramping up production will also be vital. The most acute need is to convert the stockpiled bulk vaccine substance into finished vaccines. The United States can surge staff and supplies at the Bavarian Nordic site and enlist facilities to convert the bulk vaccine substance into finished vaccines through the Defense Production Act.

As with COVID-19 tools, patents and intellectual property concerns should not stand in the way of responding to this new global health crisis.

'Bursts of sharp jabbing pain': What it's like to have monkeypox – and the fight against stigma

Prudence also demands building and diversifying the capacity for vaccine production. We might be able to contain this outbreak by sharing existing supply, but the need for monkeypox vaccines could also increase.

While public health officials are largely vaccinating exposed individuals and close contacts among men who have sex with men, this could shift if the outbreak drags on and monkeypox makes inroads into new demographic groups around the world, potentially requiring a far larger pool of people to be vaccinated.

Funding a network of distributed vaccine manufacturing and transferring technology can stand up the regional infrastructure needed to respond quickly to new outbreaks. At least one site can be located in Africa, where monkeypox has spread for years but was largely neglected by the global community.

Zain Rizvi is a research director in the Access to Medicines Program at Public Citizen. Gregg Gonsalves is an associate professor of epidemiology at the Yale School of Public Health.
Zain Rizvi is a research director in the Access to Medicines Program at Public Citizen. Gregg Gonsalves is an associate professor of epidemiology at the Yale School of Public Health.

For COVID-19, we failed the test – with America and a handful of countries hoarding vaccines, stumbling in our own quest to get people tested and traced early on.

We can do better this time, making sure that the entire world has the tools to quash this new viral outbreak and fight monkeypox.

Zain Rizvi is a research director in the Access to Medicines Program at Public Citizen. Gregg Gonsalves is an associate professor of epidemiology at the Yale School of Public Health.

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This article originally appeared on USA TODAY: Sluggish monkeypox response would lead to prolonged LGBTQ suffering

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