How NC health officials are fighting ‘huge’ racial disparity in monkeypox treatment

Instead of advertising that it had received doses of Jynneos, a vaccine that protects against monkeypox,the University of North Carolina Infectious Disease Clinic kept the news quiet.

Clinic leaders there wanted to guard against a pattern they observed during the COVID-19 pandemic: “Hand-raisers,” the most highly educated and connected people, found a way to get vaccinated first.

To try to bring more parity to who receives care, the clinic administered its small supply of Jynneos instead to people who came in for routine appointments and met the eligibility criteria, Dr. David Wohl said.

“That was more fair, and that was also more equitable, because then it reflected the population of our clinic, and not the people who are able to surmount barriers, who live further away, who can afford the $4.30 cent gallon of gas price,” Wohl said.

Newly released state data show that all-too-familiar disparities marked the early distribution of Jynneos despite the efforts of Wohl and others pushing for equitable access to medicine.

Black men account for 70% of diagnosed monkeypox cases in North Carolina during the current outbreak. But Black people have received less than a quarter of the vaccine doses administered in the state.

This electron microscope image shows virus particles colored blue inside a cell infected by the monekypox virus.
This electron microscope image shows virus particles colored blue inside a cell infected by the monekypox virus.

State officials are hoping they can capitalize on lessons learned from the COVID-19 pandemic to change that pattern, which has also been identified in other places, especially in the South.

“It’s a huge disparity and certainly one that is a huge priority for us,” said Dr. Susan Kansagra, North Carolina’s state health officer and assistant secretary for public health.

Though data showed significant racial disparities in vaccine uptake when vaccines for COVID-19 first became available at the end of 2020, Black and white vaccination rates in North Carolina are now similar, and vaccination rates among Hispanic people are now higher than among non-Hispanic people, North Carolina Health News has reported.

Infectious disease deja vu

The most recent glaring disparity likely reflects a constellation healthcare access issues for people most affected so far by the outbreak — men of color who have sex with men — experts say.

State officials haven’t yet drilled into the data to find underlying patterns, but history provides a useful guide, experts said.

The barriers for this population have included a lack of trusted and inclusive healthcare providers as well as a lack of insurance, said Rebby Kern, director of education policy at Equality NC, a group that advocates for LGBTQ rights.

Another pair of obstacles almost certainly in play, according to advocates: shame and stigma.

Those are dynamics Terry Munn said he is particularly attuned to as a gay Black man who is CEO of Triangle Empowerment Center, a nonprofit fighting health disparities.

Early messaging about monkeypox from public health officials made him furious. It brought back memories of the response to HIV and AIDS in the 1980s, when, as Munn put it, officials used “scare tactics.”

Like AIDS, “monkeypox is not a gay disease,” Munn emphasized in emails and phone calls with health officials earlier this month.

He felt that the LGBTQ+ community was being unfairly singled out. And when he first sought a dose of the vaccine, he found the battery of questions about his sexual history offensive.

Now Munn is helping state officials fine-tune their response. He was pleased to see the most recent educational materials stress that anyone can contract the virus. That’s true despite it emerging most commonly among one part of our population at the start of the outbreak in the United States.

Monkeypox is commonly spread through skin-to-skin contact, but that contact doesn’t have to be sexual. It can also spread through shared objects, such as linens or towels, or through respiratory droplets during prolonged face-to-face contact.

In past outbreaks in Africa, children have often been affected. There’s no reason to think the virus will stay confined to any one social network, experts say.

Trusted messengers

Munn’s collaboration with health officials reflects a key part of the state’s strategy for bringing vaccines to the people who need them most.

Community organizations like the Triangle Empowerment Center know how to reach people who are not already well connected to the state’s health infrastructure, including Black men who have sex with men.

They have built trusting relationships over time. Munn and his colleagues provide rapid tests for a variety of diseases, including COVID-19, and hand out masks, condoms and clean needles, among other things.

The organization also pays for nearly 200 Black gay men to access PrEP, medicine that reduces the chance of getting HIV from sex or injection drugs, but is effectively out of reach for people without insurance, Munn said.

On Aug. 30, the group will co-host an event at the Food Lion at 3022 Fayetteville Street in Durham where vaccines for both monkeypox and COVID will be provided.

People who chose to receive a vaccine from 12:30 p.m. to 6:30 p.m. will be able to get a free haircut or pizza, Munn said.

Other strategies

State health officials are also working to get reliable information out through an advertising campaign focused on websites, social media platforms and dating apps used by LGBTQ+ communities.

And they are keeping a close eye on the data showing who is contracting monkeypox and who is receiving vaccines. They will release demographic updates weekly, Kansagra said.

As of Aug. 2, more than 10,000 doses of the Jynneos vaccine had arrived in North Carolina, with more than 8,300 expected to follow within weeks.

The state’s increasing supply of vaccines will make it easier to put into action the lessons learned from COVID-19, said Wohl, noting that he’s eager to dust off the clinic’s mobile unit to provide vaccines wherever people need them.

“We have the playbook, we just have to follow it,” he said.