Since the first cases of monkeypox emerged outside western and central Africa in May, more than 12,000 cases have been confirmed globally. Many more are likely to be identified. The World Health Organization hasn’t declared monkeypox an emergency, but public health authorities are watching the spread of the disease with concern.
The US has so far registered about 1,500 cases—the most after Spain, Germany, and the UK—with New York City accounting for a third of them. “Three weeks ago, there were 25 cases,” read a July 12 email shared within the mailing list of ActUp, an international organization working to provide health support to the LGBTQ community. ” Two weeks ago, there were 55. One week ago, there were 111. And at the start of this week, there were 223. If this trend of doubling per week continues (hopefully it won’t, but), it could be over 2,000 cases by mid-August.”
Indeed, the trend isn’t relenting: As of July 15, 461 cases of monkeypox had already been registered in the city, having doubled within just a few days; by July 18, the confirmed cases were 639. The number is now 711.
The increase is expected to continue, said Ashwin Vasan, a New York City Health commissioner, at a July 19 town hall on monkeypox, in part because as more testing becomes available, the numbers will more accurately reflect the true size of the outbreak.
While cases spread, vaccine supplies remain insufficient. New York City has received the largest number of vaccines from the federal government, but it’s nowhere near the supply it would need to cover the eligible population, which at the moment comprises “all gay, bisexual, and other men who have sex with men (cisgender or transgender), aged 18 and older, who have had multiple or anonymous sex partners in the last 14 days,” according to the New York City health department guidelines.
As a result, the city has switched to a one-dose strategy, delaying second shots beyond the recommended 28-day window until demand for the first shot has eased.
So far, the overwhelming majority of cases have been identified among men who have sex with men, which has triggered, in the LGBTQ community, painful memories of the early days of AIDS. And while activists and public health experts are clear that this doesn’t risk becoming a crisis of severity similar to AIDS, they are also pointing out a familiar fear of stigmatization, as well as the relative lack of support from the federal government.
“My fear is that [monkeypox] will become entrenched,” Erik Bottcher, a New York City council member who is part of the LGBTQIA+ caucus, said during the town hall, commenting on the vaccine shortage.
So far, New York City has received about 20,000 vaccine doses, administered through sexual health clinics. A vaccine portal is set up to book appointments, though it was off to a rocky start when it launched, being offline for several hours. Appointments and available doses quickly ran out, including at emergency vaccination sites. The city has urged the federal government to deliver further doses as soon as possible. There are nearly 26,000 more doses allocated to the city, but details about delivery and administration timelines aren’t yet available.
New York City’s government has devoted a special information line to monkeypox updates, and shared information about vaccines and eligibility via their site and through social media channels. Yet many who decided to get a vaccine say information about the disease came primarily via word of mouth, or through LBGT+ organizations. “I didn’t hear much from New York City health [department], all my information came from people within the community making sure others knew,” says Ty, a New York City-based gay man who asked not to divulge his full identity.
Ty decided to get a monkeypox vaccine this past week, after seeing a growing number of social media posts from men in his community saying that they’d had contracted monkeypox and sharing information about their previous days’ whereabouts to warn others of possible exposure. “At first I wasn’t that worried at all, but cut to a week or few weeks after the initial news, a couple of people I actually knew started getting it; I was seeing posts on their Instagram like ‘Hey FYI if anyone was in contact with me, I got the monkeypox virus,'” he said.
It’s through this informal network, mostly of gay and bisexual men, that he discovered the signs and symptoms of monkeypox (including painful and potentially disfiguring sores appearing for two to three weeks) and learned about the modes of transmission (through skin contact, clothing and bedding, and potentially other surfaces and bodily fluids). The same community alerted him to the availability of a vaccine. He was able to get it alongside his boyfriend at a sexual health clinic in Harlem, mainly out of a desire to enjoy his summer without having to alter plans to accommodate a preventable, contagious illness.
“This outbreak, it happens to be concentrated in the gay community and especially men who have sex with men,” said Vasan at the town hall. “It’s not so much about identity as it is about actions, and network,” he added, highlighting the importance of informing the broader population that the disease is just as transmissible outside the LGBTQ community.
Still, the LGBTQ community and its institutions have taken a leading role in sharing information, referring at-risk patients, and pushing for more action has been instrumental. Last week ActUp, dissatisfied with the official response, set up a New York City working group to ensure better preparedness and information.
Getting the vaccine in New York City has turned out to be a matter of luck. Zach Fletcher, a Queens-based gay man who works in healthcare, says he’d signed up for text alerts to know when vaccines would be available. But the first time he tried to register through the portal on July 15, it was down. Then, within an hour, there were no available appointments. “Within six minutes, all the slots were gone,” he said. Finally, on July 19, he received a call from his doctor: There was a shot available for him, part of a supply that had been kept aside for proactive outreach to patients at particular risk of monkeypox exposure.
Those who were able to set up an appointment report having very different experiences. Ty says he was done with the shot within 15 or 20 minutes of reaching the clinic and had no issues registering. But he also reported seeing a man crying because he’d traveled to the clinic on a different day from his scheduled appointment and was denied a shot. Others were able to get the vaccine, but the process took much longer—more than two hours sometimes, making it difficult for hourly workers or employees with little flexibility to take the time for the vaccine.
The city was initially slow in responding to the LGBTQ community’s requests, and delayed intervention including not making vaccines easily available during Pride Month in June. But in recent days, local health authorities have been more responsive to the activists’ demands. Vaccine appointments are now being released in the evening instead of the afternoon, to broaden access. Last week, when doses were available, the city opened three new pop-up vaccination sites to handle the demand, and has now notified the broader population to follow monkeypox updates through the same Excelsior platform used to track covid vaccine status. Even so, with such a limited supply of doses, the city has limited ability to cover the demand. Being able to get appointments might remain the prerogative of those who happen to be able to book them as soon as new slots become available.