Because of the way MPX is transmitted, through close personal and prolonged contact, it was assumed that transmission from person to person would not easily occur. And when the first case of MPX was reported on May 7, 2022 in the United Kingdom, it was not until July 23 when the World Health Organization (WHO) declared MPX an international public health concern. By then, too much time had passed to contain the virus while physicians and scientists continued to debate its transmissibility. One of their initial and most important questions centered around sexual contact as a pathway of transmission. Yet historically, that had not been the case.
When MPX arrived in the US, in mid-May, it wasn’t believed to be a threat, which mirrored similar sentiments to the coronavirus when it first began. While the smallpox vaccine was considered an effective response to preventing MPX, a tangled bureaucratic system tied up in underfunded and understaffed public health systems didn’t readily allow private providers like LabCorp and Quest Diagnosis to respond with the provision of new vaccines to replace much of the country’s current stock, which consisted of expired smallpox vaccinations. And, surprisingly, the U.S. did not declare MPX a public health emergency until August 4.
All the while, the virus continued to spread between social networks of gay, bi, and men who have sex with men. And soon, we learned that Black and Hispanic men were disproportionately affected by MPX.
At the beginning of August, the number of probable and confirmed cases in Clark County was approximately 21. At the end of August the cases had risen to more than 135 probable and confirmed cases.
Initially, there weren’t enough vaccines in Nevada to meet demand. Also, there wasn’t a clear point of entry for someone seeking a diagnosis or the vaccine. Once the vaccines became somewhat available, one had to meet a set of criteria, such as being a gay, bi, or man who has sex with men, thought to have been exposed to someone who was diagnosed wtih MPX, or have symptoms of MPX.
Today, Nevada’s Department of Public and Behavioral Health identified nearly half a dozen sites as vaccination locations – a good start but is it enough coverage to meet the need or demand? During a scheduled Interim Finance Committee meeting in August, the Nevada Department of Public and Behavioral Health ( DPBH) requested $345,000 in American Rescue Plan Act (ARPA) funding to implement a public health campaign to educate Nevadans about MPX.
In many ways, the response to MPX, globally, in the U.S. and in Nevada, may seem lackluster, but we have to understand that local jurisdictions were hamstrung with a lack of information and authority to act upon the public’s need for a vaccine. Vaccine supply chain issues, bureaucratic red tape, expired vaccines, and a dearth of vaccine providers (and in some areas a lack of sexual health clinics) made it difficult for public health authorites to respond.
We must continue to treat MPX as a growing public health concern that has the potential to disrupt our lives. Personal anecdotes, data, and time will tell whether or not Nevada’s response to MPX has been quick and sufficient enough.
Public health programs and LGBTQ+ community advocates must ensure that we include transgender and gender variant folks into the conversation and messaging, as well as sex workers and other communities that can easily be left out.
In the meantime, it is important that everyone take extra precautions against the spread of MPX by having open and honest conversations with sexual partners to mitigate risks. Also, creating small contained pods of sexual partners is helpful. Moreover, it is important to know that the MPX vaccine is most effective after two weeks of the second dose, a wait that is well worth it for your health and safety and for the health and safety of others.
As previously mentioned, Black and Hispanic people are disproportionately affected by MPX. The disparity is closely related to COVID-19, which continues to shed a light on how public health concerns impact minority communities. National data shows that the rate of these populations getting the vaccine is terribly low. Therefore, it’s critical that the State of Nevada’s Department of Behavioral Health and health authorities, such as the Southern Nevada Health District and Washoe County Health District, report out on the cases of MPX and perhaps vaccinations, by race, sexual orientation and gender identity. With increased understanding, we will be better positioned to develop and implement effective and timely strategies to increase vaccination rates.
To find out more about MPX please visit the Silver State Equality website at: http://silverstateequality.org/monkeypox/ or the Southern Nevada Health District website at: https://www.southernnevadahealthdistrict.org/Health-Topics/monkeypox/
André C. Wade
State Director, Silver State Equality