Amid growing concerns over the potential threat of monkeypox, executives from Moderna said Wednesday they have initiated a research program to consider whether the company could create a monkeypox vaccine with mRNA technology. “We’re obviously very aware of the monkeypox concern and obviously very sensitive to recent announcements,” Moderna President Stephen Hoge said during an investor call.
“Our platform is pretty well established and our ability to rapidly scale has been demonstrated. If we were to go after a monkeypox clinical development program, it would be to very quickly progress toward an approvable set of endpoints in a clinical study,” he explained. As seen with the rollout for the COVID-19 vaccines, any new vaccine would still need to go through the regulatory authorization process, which can take weeks to months, even in special circumstances.
CDC Director Rochelle Walensky told reporters on a call Thursday that gay and bisexual men who are HIV positive or who are taking medicines, called PREP, to reduce their chance of contracting HIV face the greatest health risk from monkeypox.
“That’s the population we have been most focused on in terms of vaccination,” Walensky said.
The U.S. has secured 1.1 million doses of the two-dose vaccine Jynneos so far, according to the Health and Human Services Department. The federal government has delivered more than 600,000 doses of the vaccine since May, according to HHS.
The right-leaning group Parents Defending Education (PDE) has sued the Linn-Mar Community School District of Iowa because its policies protect transgender students from transphobic parents and students. PDE supports banning LGBTQ books and curricula about institutional racism from schools. The organization has also previously partnered with the anti-LGBTQ group Moms for Liberty.
The Linn-Mar Community School District allows students (grades seven and up) to create a “gender support plan.” The plan requires school staff, students, and school documents (including ID cards and yearbooks) to address students by their self-assigned name and gender identity. The policy also allows these students to enter the locker room, bathroom facilities, and sports teams matching their gender identities.
PDE’s lawsuit takes particular issue with part of the policy that withholds details of a student’s gender support plan from a student’s parents, even if they specifically request it. The lawsuit also says that because parents are notified by the school about “lesser matters” like “schoolyard tussles, missing homework, and social events,” the school should notify parents about a kid’s gender identity, otherwise parents won’t be able to properly support their kid.
The lawsuit omits the fact that nearly 50 percent of trans people in the U.S. experienced familial rejection for coming out as trans, something which dramatically increases their likelihood of attempting suicide, becoming addicted to drugs, or experiencing homelessness, according to the 2015 U.S. Transgender Survey.
“Parents are completely and purposefully left in the dark. The Policy plainly violates parents’ rights under the Fourteenth Amendment,” the lawsuit states.
The lawsuit also claims that the district’s policies against transphobic speech – like deadnaming and misgendering – are a violation of students’ First Amendment free speech protections because the policies punish them for “expressing their sincerely held beliefs about biological sex.” The lawsuit omits the fact that misgendering is a form of anti-trans harassment banned by most social media platforms.
“Nearly a century of Supreme Court precedent makes two things clear: parents have a constitutional liberty interest in the care, custody, and control of their children, and students do not abandon their First Amendment rights at the schoolhouse gate,” the lawsuit states.
The lawsuit’s true biases become apparent, however, in a section describing the complaining parents being represented by PDE.
One of the parents has a middle-school-aged child on the autism spectrum and worries that their kid’s “difficulty distinguishing between male and female characteristics” will get them placed on a gender support plan, pressuring them to identify as trans or nonbinary even though the child may not have a firm grasp of what these identities entail.
Another parent mentioned in the lawsuit worries that their “extremely impressionable” daughter will follow the lead of LGBTQ-affirming teachers and queer classmates and start identifying as trans or nonbinary.
“Some of Parent B’s daughter’s special-needs classes are held in a classroom that also functions as the meeting location for the LGBT student club,” the lawsuit says. “The teacher in that classroom is the faculty advisor for the club. Thus, the classroom walls contain several posters with information about various gender identities, gender ‘social transitions,’ and ‘referred pronouns.’ Parent B’s daughter is extremely impressionable and often follows the lead of other students.”
The lawsuit mentions “research” showing that more teens are identifying as trans due to peer pressure, but it doesn’t actually mention which research it’s referring to. A recent study suggested that worries like this are completely unfounded.
Two other parents represented by PDE say they basically want their kids to be able to misgender and openly disagree with the gender identities of trans kids without facing any consequences. Yet another parent said they didn’t want their kid to be exposed to the acknowledgment of trans people because it will cause the parent “emotional and psychological suffering.”
The lawsuit seeks to block the district’s Gender Support Plan from going into effect, essentially eliminating the district’s support of trans youth, something that will worsen mental health outcomes for trans students in the name of “free speech” and constitutional freedoms.
As monkeypox continues to spread worldwide, health officials have recommended high-risk individuals get vaccinated as soon as possible—but research is limited on just how effectively the available vaccines prevent infection, Randy Dotinga writes for MedPage Today.
CDC has confirmed 6,326 cases of monkeypox across 48 U.S. states, the District of Columbia, and Puerto Rico. The states most impacted by the outbreak so far are New York with 1,617 cases, California with 826 cases, and Illinois with 533 cases.
To reduce the risk of viral transmission, health officials have recommended high-risk individuals be vaccinated against monkeypox. So far, the United States has purchased 7 million doses of Bavarian Nordic‘s Jynneos vaccine, the preferred vaccine against monkeypox, and the entire supply is expected to be available by mid-2023.
So far, the supply of vaccines has been limited, with many jurisdictions, including San Francisco and New York City, saying that they do not have enough to meet demand. Last week, FDA announced it had cleared an additional 786,000 vaccine doses for use.
How well does the monkeypox vaccine actually work?
While health officials continue to emphasize the value of vaccination, there is limited evidence to show that the monkeypox vaccine is effective at preventing infection from the virus. CDC has acknowledged that “no data are available yet on the effectiveness of these vaccines in the current outbreak.”
According to Jay Varma, director of the Cornell Center for Pandemic Prevention and Response, “It is absolutely critical that public health officials work on messaging this uncertainty to people about being vaccinated.”
So far, much of the data on the monkeypox vaccine is from a retrospective analysis published in 1988, which examined whether a smallpox vaccine could also prevent monkeypox. In the study, researchers followed household contacts of 209 people in Zaire who had been infected with monkeypox and found that those who had scars from prior smallpox vaccination were 85% less likely to be infected.
According to Ira Longini, a biostatistician at the University of Florida, the study’s conclusions are limited, since its statistical analysis has no reported confidence interval and did not adjust for other factors, such as age. In addition, the data was based solely on physical signs of vaccination.
The study “is the only shred of evidence we have (in regard to vaccine effectiveness), which is pretty weak,” he said. “In principle it should work, but we don’t know.”
Richard Kennedy, co-director of the Mayo Vaccine Research Group, agreed, saying that the Jynneos vaccine and an older smallpox vaccine ACAM2000 “have not been tested directly against smallpox or monkeypox” and that “[t]he immune responses they create are very close to first- or second-generation vaccines: A little weaker, but not much.”
However, Kennedy noted that the vaccines have been tested against monkeypox in several animal studies. “These data are also clear and consistent with very good protection against disease with animals showing very few or no symptoms of illness after challenge,” he said. “The animal data was strong enough that the FDA approved Jynneos to be licensed for prevention of monkeypox.”
How can people protect themselves against monkeypox?
In addition to vaccination, health officials have advised those who are most at risk, particularly men who have sex with men (MSM), to take steps to reduce their risk of infection, including adjusting their sexual behavior during the current outbreak.
For example, World Health Organization Director-General Tedros Adhanom Ghebreyesus last week recommended “reducing your number of sexual partners, reconsidering … sex with new partners, and exchanging contact details with any new partners to enable follow up if needed.”
Similarly, CDC offered advice for lowering the potential risk of infection during sex, including not kissing and avoiding sharing towels and other items.
“The prevention messaging should be that vaccinations will be an essential part of getting this outbreak under control, and we need everyone to get vaccinated as soon as possible,” said Michael Donnelly, a data scientist and LGBT health advocate. “But even if you’re vaccinated, you’re still at risk, and unprotected anal sex may be the highest risk.”
“Even after vaccination, you may want to consider reducing the number of your sex partners and using condoms or pursuing other safer sex approaches,” he added. (Dotinga, MedPage Today, 8/1)
Southern Decadence, advertised as the largest LGBTQ+ festival held annually in the Deep South, is scheduled for Labor Day weekend (Sept. 1-5) in New Orleans. It typically attracts 100,000 to 300,000 participants and is a major economic boon to the city in a season when tourism is otherwise sluggish. Health officials at the state and local level say Louisiana’s meager vaccine supply will leave the state vulnerable to a large monkeypox outbreak following such a massive event.
Southern Decadence could also further the virus spread in other parts of the country if visitors become infected while in New Orleans and carry monkeypox back to their hometowns, they said. “This will be a superspreader event without additional vaccine doses ahead of time to get as many people as possible [vaccinated],” said Jennifer Avegno, New Orleans health director and an emergency room physician, in an interview this week.
On Thursday, the Human Rights Campaign filed the lawsuit in federal court on behalf of the child, identified as D.H., and her parents.
Under the 2021 law, which allows cisgender public school students and their families to sue if they’re not given a “reasonable accommodation” by their school if they don’t want to share bathrooms, locker rooms, and other facilities with trans people, D.H. was forced to use single-occupancy restrooms at school.
According to the lawsuit, D.H. stopped using school restrooms entirely and began limiting her food and water intake to minimize her need to use school facilities. She also developed migraines, reflux, and recurring nightmares of school.
“These restroom ‘accommodations’ provided to D.H. by the elementary school are not accommodations at all,” according to the complaint. “They reinforce the differential treatment and trauma associated with living under the [Accommodations for All Children Act], violating D.H.’s constitutional and statutory rights.”
The suit argues that the Tennessee law, signed by Gov. Bill Lee (R) in 2021, violates D.H.’s constitutional rights under the Equal Protection Clause and violates Title IX, which prohibits sex discrimination in education. In June, the Biden Administration announced changes to the legal interpretation of Title IX which would help prohibit discrimination based on sexual orientation and gender identity. Last month, a federal judge blocked the Education Department’s new guidance.
“It is unfortunate that Tennessee lawmakers are using their authority to attack some of our nation’s most vulnerable: our children,” said HRC litigation director Cynthia Cheng-Wun Weaver.
“Years ago, I chose to move to Tennessee because it was known as ‘the Volunteer State,’ whose citizens cared for their neighbors without hesitation – not a state that legalizes discrimination against helpless children,” D.H.’s mother said in a statement. “Now I am embarrassed to say that I live in a state that refuses to see anything beyond my child’s gender.”
“By filing this lawsuit, I am showing my volunteer spirit – because I’m fighting to not only affirm my child’s existence, but also the thousands of transgender and nonbinary children who live in Tennessee.”
This is the second lawsuit the HRC has filed against the Tennessee law on behalf of a transgender child. A previous suit, filed last year, was dismissed after the plaintiffs chose to leave the state.
The study also found that the proportion of adolescents who were assigned female at birth and have come out as transgender also has not increased, which contradicts claims that adolescents whose birth sex is female are more susceptible to this so-called external influence.
“The hypothesis that transgender and gender diverse youth assigned female at birth identify as transgender due to social contagion does not hold up to scrutiny and should not be used to argue against the provision of gender-affirming medical care for adolescents,” study senior author Dr. Alex S. Keuroghlian, director of the National LGBTQIA+ Health Education Center at the Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program, said in a statement.
The “social contagion” theory can be traced back to a 2018 paperpublished in the journal PLOS One. Dr. Lisa Littman, who at the time was a professor of behavioral and social sciences at Brown University, coined the term “rapid onset gender dysphoria,” which she described as adolescents experiencing a conflict between their birth sex and gender identity “suddenly during or after puberty.” These adolescents, she wrote, “would not have met the criteria for gender dysphoria in childhood” and are experiencing dysphoria due to social influence.
Littman also hypothesized that adolescents assigned female at birth are more likely to be affected by social contagion and, as a result, are overrepresented in groups of adolescents experiencing gender dysphoria when compared to those who were assigned male at birth.
After intense debate andcriticism, PLOS One conducted a post-publication reassessment of the article, and issued a correction that included changing the headline to clarify that Littman did not survey transgender or gender-diverse youth themselves, but actually surveyed their parents. The correction also noted that, “Rapid-onset gender dysphoria (ROGD) is not a formal mental health diagnosis at this time.”
To test the social contagion theory, researchers used data from the 2017 and 2019 biennial Youth Risk Behavior Survey conducted by the Centers for Disease Control and Prevention, which collected gender identity data across 16 states from ages 12 to 18. In 2017, 2.4%, or 2,161 of the 91,937 adolescents surveyed, identified as trans or gender diverse. In 2019, that percentage dropped slightly to 1.6%, or 1,640 of 105,437 adolescents surveyed.
Researchers concluded that the decrease in the overall percentage of adolescents identifying as trans or gender diverse “is incongruent with the (rapid-onset gender dysphoria hypothesis) that posits social contagion.”
The study also found that the number of transgender adolescents who were assigned male at birth outnumbered those assigned female at birth in both 2017 and 2019, providing additional evidence against a “notion of social contagion with unique susceptibility” among those assigned female at birth.
The social contagion hypothesis, by assuming that youth are coming out, for example, because their friends are, asserts that there’s some social desirability to being trans. Some supporters of the theory, according to the study, also believe that more youth identify as trans or gender diverse because those identities are less stigmatized than cisgender sexual minority identities, or those who identify with their birth sex and are lesbian, bisexual, gay or queer, among other sexual identities.
To evaluate these claims, researchers examined rates of bullying among adolescents who identified as trans and gender diverse, and those who did not.
They found that, consistent with other surveys, trans and gender-diverse youth were significantly more likely to be victims of school bullying (at 38.7% in 2017 and 45.4% in 2019) compared to cisgender lesbian, gay and bisexual youth (at 30.5% in 2017 and 28.7% in 2019) and cisgender, heterosexual youth (at 17.1% in 2017 and 16.6% in 2019).
“The idea that attempts to flee sexual minority stigma drive teenagers to come out as transgender is absurd, especially to those of us who provide treatment to [transgender and gender diverse] youth,” study lead author Dr. Jack Turban, incoming assistant professor of child and adolescent psychiatry at the University of California, San Francisco, said in a statement. “The damaging effects of these unfounded hypotheses in further stigmatizing transgender and gender diverse youth cannot be understated. We hope that clinicians, policymakers, journalists, and anyone else who contributes to health policy will review these findings.”
They wrote that despite the methodological flaws in Littman’s study, the concept of rapid onset gender dysphoria “has been used in recent legislative debates to argue for and subsequently enact policies that prohibit gender-affirming medical care” for trans and gender diverse adolescents.
An increasing number of states have also tried to ban or restrict trans youths’ access to gender-affirming medical care through legislation. The number of bills seeking to restrict gender-affirming health care for transgender youths has grown from one in 2018 to 36 this year, according to an analysis by NBC News. Governors in three states — Alabama, Arkansas and Tennessee — have successfully signed such restrictions into law, though judges have prevented those measures from taking effect in Alabama and Arkansas.
The study lists several limitations, including that the data were collected through a school-based survey and, as a result, youths who don’t attend school were not represented. It also noted that youths were asked, “What is your sex?” and that response options were limited to female and male. It didn’t ask about respondents’ “sex assigned at birth” and didn’t include an additional question about their “gender identity,” which is an established research method for asking about gender identity. But the researchers creditedseveralstudies that found trans and gender-diverse youths are aware of the differences between their sex assigned at birth and gender identity.
Joseph Ladapo — Florida’s surgeon general appointed by the state’s anti-LGBTQ Republican Gov. Ron DeSantis — is trying to make people distrust the monkeypox vaccine, stating that there is “little data” on it, which is misleading.
Ladapo’s position is hardly surprising considering that he spent years spreading COVID-19 disinformation and echoing DeSantis’ distrust in vaccines.
On Tuesday, DeSantis criticized the Democratic governors of California, Illinois, and New York for declaring states of emergency over monkeypox. The declarations give their governments greater ability to mobilize resources against the virus. (U.S. President Joe Biden declared a national state of emergency for monkeypox on Thursday.)
DeSantis said the governors were using the emergency declarations to stoke fear, control people, and “restrict your freedom.”
Ladapo backed up DeSantis’ words, stating, “It’s just kind of remarkable to see some of the headlines — the headlines that very clearly are trying to make you afraid of monkeypox or fill-in-the-blank. You know, because if you’re not afraid of this there will be something else after that and something else after that.”
“These people are determined to make you afraid and do whatever it is they want you to do. And, um, you know, I hope that more and more people choose not to do that,” he added.
Then after revealing that Florida had distributed 8,500 monkeypox vaccines, Lapado said, “You should know that there’s actually very little data on this vaccine.”
To understand why Lapado’s claim is misleading, a little background is necessary.
As of Tuesday, the U.S. Centers for Disease Control and Prevention (CDC) has reported 6,326 monkeypox cases within the United States. The Florida Department of Health shows 525 monkeypox cases statewide, The Florida Phoenix reported.
The Jynneos vaccine is made from a virus that is closely related to, but less harmful than, monkeypox viruses. It does not cause disease in humans and cannot reproduce in human cells.
A study of 400 individuals found that the Jynneos vaccine was as effective against monkeypox as the ACAM2000 smallpox vaccine, which the FDA approved in 2007. The safety of Jynneos was assessed in more than 7,800 individuals who received at least one dose of the vaccine, the FDA said. Previous studies have shown that smallpox vaccines are 85% likely to provide a high level of immunity against monkeypox for up to two years, according to the MIT Technology Review.
Ladapo’s authority on vaccines is highly questionable at best.
In July 2020, near the start of the COVID-19 pandemic, he appeared in a 43-minute viral video as part of a group called America’s Frontline Doctors. The group, which had no epidemiologists or immunologists qualified to speak on infectious diseases, promoted the anti-malaria medication hydroxychloroquine as a “cure” for COVID-19, even though no studies substantiated that claim. The video also said that face masks do not slow the virus’s spread and that COVID-19 is less deadly than the flu. Both claims are untrue.
The video also featured Dr. Stella Immanuel, a pediatrician and religious minister who gained notoriety in 2020 for her bizarre theories, including that “demonic seed” causes endometriosis and ovarian cysts. Immanuel explained on her church’s website that demons insert sperm into sleeping individuals when they have sex in their dreams.
The doctors’ recorded speech was organized by the Tea Party Patriots, a right-wing group backed by wealthy Republican donors. Lapado has written numerous op-eds repeating the video’s false claims.
The video received millions of views when then-President Donald Trump, his son Donald Trump Jr. and other right-wing media figures shared it on social media. Facebook, YouTube, and Twitter all removed the video for violating their policies on sharing COVID-19 misinformation.
In October 2020, Ladapo signed the Great Barrington Declaration, a statement that called for developing societal herd immunity to COVID-19 through natural infection. In response, 80 medical researchers signed an open letter published in The Lancet, a leading medical journal, calling the declaration’s theory “a dangerous fallacy unsupported by scientific evidence.”
Florida ranks third among U.S. states with the highest numbers of COVID-19 infections and related deaths. DeSantis has signed orders expanding exemptions for people who don’t want to get vaccinated against COVID-19 vaccines and to prevent schools and local governments from instating face mask mandates in Florida.
A new draft report from the California Attorney General’s office indicates transgender people in the state are stopped by police at vastly different rates than cisgender men and women.
The report is based on data reported from 58 of the state’s largest law enforcement agencies and shows transgender people were stopped because of “reasonable suspicion” alone —instead of a specific violation or clearly unlawful behavior — in nearly half the stops.
For transgender people, the proportion of “reasonable suspicion” stops was 44%, or four times the ratio for cisgender people.
The data includes all people stopped by police, regardless of whether the officers were responding to a potential offense they observed or to a call for service.
California requires police departments to report the demographic data of every driver, bicyclist, or pedestrian they stop, including perceived race, gender, and approximate age.
The new state data shows that transgender women are stopped due to an officer’s “reasonable suspicion” in more than 45% of encounters when they were stopped in 2021. Trans men were stopped for the same reason 43% of the time.
Interactions with police officers were also more likely to lead to more drastic outcomes – with transgender people more likely to be searched, handcuffed, and arrested – and to have lethal and non-lethal force used against them.
Reasonable suspicion is a legal standard that requires officers to articulate why they believe a person is likely engaged in a crime. Probable cause, the standard required to arrest someone, has a higher bar.
Under the 2015 Racial and Identity Profiling Act, or RIPA, law enforcement agencies with 334 or more officers were required to report data to the state for 2021. The reporting requirement expands to all police agencies for data collected this year.
Alex Binsfeld, legal director at the Transgender Gender-Variant & Intersex Justice Project, an advocacy group in San Francisco, told the San Francisco Chronicle that gender biases result in officers focusing on transgender people because they don’t fit their notions of how a woman or man ought to look.
“It’s in effect a way to enforce Western gender binary norms on appearance, that you will be punished if you are not gender binary in your appearance,” they said. “Policing of trans folks at these disparate rates has led advocates to argue it’s a status crime.”
Cisgender people, who made up the overwhelming majority of the total number of stops statewide, were stopped for traffic violations the majority of the time. Cisgender women were stopped because of an officer’s “reasonable suspicion” in less than nine percent of encounters; cisgender men were stopped because of an officer’s suspicion in 11% of encounters.
Out of 3.2 million total stops, transgender people accounted for 4,740.
Transgender advocates scored a major victory in July when Gov. Gavin Newsom (D) signed S.B. 357, a bill repealing a notorious “walking while trans” law. Effective January 1, the bill repeals a 1995 law that prohibits loitering in public places with the “intent to commit prostitution.” The voided statute allows police to cite people they find suspicious due to factors like how they dress or where they stand on the street.
State Sen. Scott Wiener, the San Francisco Democrat who sponsored S.B. 357, said the sweeping loitering law causes innocent people to get swept up in the criminal justice system and makes sex workers less safe because they fear seeking out law enforcement.
“Even one arrest can have such profound implications for someone’s life,” Wiener said. “It’s one step; there’s certainly more work to do.”
The Biden administration declaredmonkeypox a public health emergency on Thursday as cases topped 6,600 nationwide.
The declaration could facilitate access to emergency funds, allow health agencies to collect more data about cases and vaccinations, accelerate vaccine distribution and make it easier for doctors to prescribe treatment.
“We’re prepared to take our response to the next level in addressing this virus and we urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus,” Department of Health and Human Services Secretary Xavier Becerra said in a Thursday briefing about the emergency declaration.
A quarter of U.S. cases are in New York state, which declared a state of emergency last week. California and Illinois followed suit with emergency declarations Monday.
The World Health Organization declared monkeypox a public health emergency of international concern last month, a designation reserved for the most serious global disease outbreaks. It has previously been used for Covid-19, Zika, H1N1 flu, polio and Ebola. At least 26,200 monkeypox cases have been confirmed worldwide this year, according to the Centers for Disease Control and Prevention.
The WHO recently advised men who have sex with men to reduce their number of sexual partners and reconsider sex with new partners while the outbreak is ongoing.
The average U.S. monkeypox patient is around 35 years old, but people of all ages can be infected. The CDC has recorded five cases in children: two in California, two in Indiana and an infant who is not a U.S. resident who tested positive in Washington, D.C.
The California and Indiana health departments declined to provide details about their pediatric cases, but Jennifer Rice Epstein, the public affairs officer at the Long Beach Department of Health and Human Services, said the patient in her city was exposed via a close contact.
As of last week, white people represented 37% of U.S. monkeypox cases, followed by Hispanic or Latino people (31%), Black people (27%) and Asian people (4%), according to HHS.
U.S. officials still think the outbreak can be contained
HHS officials still hope to prevent monkeypox from becoming endemic in the U.S.
“We continue to marshal forward the tools that we need to make sure that we can take on monkeypox and keep it from spreading to the point of becoming endemic,” Becerra said Thursday.
“There should be no reason why we can’t stay ahead of this if we all work together,” he added.
That work relies primarily on testing, targeted vaccinations and treatment.
As of Thursday, the U.S. had distributed 600,000 of the 1.1 million available doses of the Jynneos vaccine, which is administered as a two-shot regimen. In total, the country has ordered 6.9 million doses. HHS said a shipment of 150,000 doses will arrive in the U.S. in September to then be distributed.
The shot can prevent monkeypox if given before or within four days of exposure. If given within 14 days after exposure, it can ease symptoms.
U.S. testing capacity has also increased, from 6,000 weekly tests in May to 80,000 now.
“Right now we’re really only testing at about 10% of the capacity we have. We are encouraging anyone who has a rash that could be monkeypox to present for testing,” CDC Director Rochelle Walensky said Thursday.
Around 14,000 people in the U.S. have received TPOXX, an antiviral drug that is authorized for use against smallpox but can also be used to treat monkeypox. The Strategic National Stockpile contains 1.7 million of the treatments, HHS said. But the drug’s use is for now limited to people with severe disease or a high risk of becoming severely ill. Physicians must also complete extensive paperwork to prescribe it for monkeypox.
Expanded access to TPOXX was among the many reasons that sexual health providers called on HHS to declare a public health emergency.
“It’s unconscionable not to further make changes to make TPOXX accessible to all that need it,” David Harvey, executive director of the National Coalition of STD Directors, said Tuesday on a news call.
Most U.S. monkeypox patients have reported a rash
The most common monkeypox symptoms include a rash — reported in 99% of U.S. cases so far — malaise, fever and swollen lymph nodes. Some patients have also reported chills, headache and muscle pain.
Some people with monkeypox develop just one or two lesions in their rash, while others can develop several thousand, according to the WHO.
A study published last month, which examined monkeypox cases in 16 countries from April to June, found that nearly 65% of people had fewer than 10 lesions. The lesions were most commonly found in the anus or genital area, followed by the torso, arms or legs. A smaller number of people saw lesions on their face, palms or soles of the feet.
Symptoms usually appeared within a week of exposure, the study found. Around 13% of people studied were hospitalized, mostly for pain management.
As cases of monkeypox surge around the globe, four pioneers of the AIDS activist movement watch in awe and with a sense of nostalgia.
Some of the similarities between the two viruses speak for themselves. Like the HIV strain that started the AIDS pandemic in the late 1970s, the current monkeypox outbreak has emerged from sub-Saharan Africa and has been found overwhelmingly in men who have sex with men who live in the world’s metropolises. And while epidemiologists have not reached a complete understanding of how the current outbreak of monkeypox spreads, recent research points to sexual transmission.
Four pioneering AIDS activists of the 1980s and ‘90s contend that there are other, consequential yet less obvious parallels playing out in real-time.
People hold up signs representing the number of AIDS victims in a demonstration in Central Park in New York City on Aug. 8, 1983. Allan Tannenbaum / Getty Images file
As in the early days of the AIDS crisis, they argue, government messaging around the outbreak has been flawed, gay men have been blindsided and public health officials have failed to defeat a severe disease plaguing the LGBTQ community.
“It feels like déjà vu,” said gay rights activist Peter Tatchell, who was a leading member of the Gay Liberation Front in the United Kingdom. “The lessons from the AIDS crisis and Covid have clearly not been learned.”
Public health officials around the world were slow to combat AIDS when it first began to emerge in men who have sex with men during the late 1970s. It wasn’t until June 5, 1981, that the United States released the world’s first government report on the infectious disease in the Morbidity and Mortality Weekly Report, a government bulletin on perplexing disease cases.
“In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California,” the report read. “Two of the patients died.”
Three years later, the U.S. government announced the development of an AIDS test, in addition to a vaccine, which never came to fruition. By 1985, an estimated 12,000 Americans had died of the disease.
Similarly, activists argue that the global response to tame monkeypox has been too slow to curb ballooning case numbers — more than 20,500 cases of the current monkeypox outbreak have been reported globally across 77 countries and territories since the start of May, according to the Centers for Disease Control and Prevention.
No one has died from monkeypox outside the 11 African nations where the infectious disease has become endemic since it was discovered in 1970. However, a substantial proportion of patients infected with monkeypox have been hospitalized for severe pain caused by pimple-like sores that commonly develop.
Since the first cases were discovered in May, the United States has distributed nearly 200,000 Jynneos vaccines — a two-dose vaccine to prevent smallpox and monkeypox — to the most at-risk population, which falls far short of its roughly 3.8 million gay men. In France, only an estimated 6,000 people have been vaccinated across more than 100 vaccine centers in recent weeks, French Minister of Social Affairs and Health François Braun said on Monday. And in the United Kingdom, health officials ordered an additional 100,000 vaccine doses last week to keep up with burgeoning demand.
Last Saturday, the World Health Organization declared monkeypox a public health emergency of international concern, a designation reserved for the most threatening global disease outbreaks, after initially forgoing to do so last month. More than two months after the first U.S. case of monkeypox was detected in mid-May, on Thursday public health officials in New York City issued a declaration that the infectious disease posed an imminent threat to public health, and officials in San Francisco declared a state of emergency.
“What’s interesting is that many of the scientists and clinicians who were trained during the AIDS epidemic or were there at the beginning, people like Tony Fauci, know this history, but the response to monkeypox has been alarmingly slow and chaotic,” said Gregg Gonsalves, who joined Act Up — the leading group that fought for action to combat AIDS — in 1990 and is now a professor of epidemiology at the Yale School of Public Health. “As an individual, it’s like, ‘Three strikes you’re out, man.’ HIV, Covid and now monkeypox? How many times can you make the same mistakes over and over again?”
Representatives from the National Institute of Allergy and Infectious Diseases, which Dr. Anthony Fauci has directed since 1984, and officials from the White House, where Fauci serves as the chief medical adviser to the president, did not immediately respond to NBC News’ requests for comment.
Images of men waiting in long lines outside clinics around the world to get vaccinated, technical issues with online vaccine portals and reports that accused the U.S. government of developing a “wait-and-see” response to the outbreak — reportedly calling for shipments of vaccines only as cases surged in the last handful of weeks — have piled on to activists’ fears that the public health response to monkeypox is shaping up to be a repeat of its flawed strategy to combat AIDS.
People lined up outside a Department of Health and Mental Hygiene clinic on June 23, in New York.Tayfun Coskun / Anadolu Agency via Getty Images
Although the virus started spreading in May, the U.S. didn’t order more doses of the monkeypox vaccine to add to its stockpile until June. Regulators also had not finished inspecting a key Denmark facility manufacturing monkeypox vaccines until July, leaving 1.1 million ready-to-distribute doses stuck in Europe.
“Just like during the AIDS pandemic, it seems that some governments care very little so long as monkeypox is just affecting men who have sex with men,” said Tatchell, who was turned away from a hospital in London that had run out of monkeypox vaccine last Sunday. “What other explanation can there be? Governments should have been rolling out emergency vaccination programs for gay and bisexual men two or three weeks ago.”
Some veteran AIDS activists also argue that as during the AIDS crisis, the messaging to combat monkeypox has not been tailored enough to reach the LGBTQ community.
Ron Goldberg, an early AIDS activist who joined Act Up in 1987, points to the “America Responds to AIDS” public service announcement campaign, which the government launched at the height of the crisis in the late 1980s. Many of the commercials featured heterosexual couples and displayed messages including “AIDS Is Everyone’s Problem.”
“At that time, they were so afraid of talking about gay sex, or anything like that, they had to bland out the message when they were trying to give some information,” Goldberg said. “If it’s happening within a certain population, you have to direct your messaging to that certain population.”
Activists have largely applauded public health officials’ efforts to not link monkeypox directly to the LGBTQ community — as many believe they did with AIDS — and thereby create stigma. However, some argue that repeated statements from public health officials that “anyone can get monkeypox” mirrors AIDS messaging that “anyone can get the AIDS virus” and also circumvents efforts to alert the demographic most at risk.
Research overwhelmingly suggests that the current outbreak of monkeypox is being driven overwhelmingly by men who have sex with men. A study in the New England Journal of Medicine published last week found that of the 528 cases of monkeypox researchers analyzed, 98% were found in men who identified as gay or bisexual. Another recent report by the the British Health Security Agency finding that of the 699 monkeypox cases for which there was available information, 97% were in gay, bisexual or other men who have sex with men.
“The numbers are there,” said Didier Lastrade, who founded the first French chapter of Act Up in 1989. “We shouldn’t shy away from this. … We’re big people, we’re grown-ups, we can take it. The stigmatization is happening either way.”
On Thursday, the WHO recommended that gay and bisexual men limit their number of sexual partners to protect themselves from monkeypox and contain its spread.
But compiled with two years of pandemic isolation and big summer events, such as last weekend’s annual Pines Party on Fire Island, some activists fear it will be difficult to get gay and bisexual men to curtail their sexual behaviors.
“You want to be able to reach people in their 20s and 30s and say, ‘Look, this is no joke. You’ve all seen the pictures. You’ve all had friends who have had monkeypox. You don’t want it,’” Gonsalves said.
More broadly speaking, Lastrade argued, the advent of pre-exposure prophylaxis, the HIV prevention pill (also known as PrEP), along with scientific proof over the past decade that treating HIV can prevent transmission, have caused gay and bisexual men to fall asleep at the wheel when it comes to their sexual health.
“The new generation totally forgot about the story of AIDS. I keep on writing books about AIDS but nobody reads them,” said Lastrade. “When s— happens, they forget their reflexes that we used to have because it was a question of life or death.”
Regardless of the messaging, with a lackluster global vaccine rollout, the activists fear the virus will become an infectious disease the LGBTQ community has to permanently live with, as it did with AIDS decades ago.
“Many people are saying we’re past the point of containment, that we already missed our chance,” Gonsalves said. “If that’s true, that is incredibly serious because this disease doesn’t necessarily kill, but the enormous suffering and expense of all of this is going to put a burden on many, many people, many, many health systems and many, many communities who have been already plagued.”
