Much like with COVID-19, the monkeypox health crisis in the U.S. is hitting Black and Hispanic Americans hard. Yet those groups are so far lagging in vaccination rates, early data obtained by Bloomberg News shows.
The U.S., which last Thursday declared monkeypox a public health emergency, is the epicenter of the global outbreak. The majority of cases so far have been concentrated among men who have recently had sex with other men. Demographic data from the U.S. Centers for Disease Control, though incomplete, suggests that most cases are also among people of color. As of the end of July, Black people made up 26% of cases with known race and ethnicity information and Hispanic people made up 32% of all cases.
In some major U.S. cities with outbreaks, white people are getting the majority of vaccinations, data collected by Bloomberg shows. In Chicago, 55% of vaccines have gone to white people. In Washington, D.C., 63.5% of vaccine recipients identify as white. And in the Atlanta metro area, where the overwhelming majority of cases have been among Black people, at least 54% of doses have gone to white people. The data are all as of last month.
The national picture on vaccine disparities remains incomplete. The CDC doesn’t independently collect demographic data on uptake, relying on state and local health departments, many of which aren’t reporting or collecting it. When Bloomberg reached out to 10 big U.S. cities, only Washington, D.C., shared any data. The other city health departments either didn’t respond or said they weren’t releasing that information; Bloomberg obtained other city data via Freedom of Information Act requests to state and local health departments.
Not two years after the nationwide vaccination campaign against COVID-19, the data suggest the country’s public health apparatus is once again struggling to reach the most vulnerable populations, undermining efforts to contain the virus. Even a year after COVID shots first went in arms, Black and Hispanic vaccination rates lagged by 10 percentage points or more in half of U.S. states. The U.S. monkeypox vaccination drive has just begun, but early unforced errors have troubled some public health experts.
“Why are we in this situation once again? The magnitude is not as overwhelming as COVID, but public health is all about prevention,” said Stephen Thomas, the director of the Center for Health Equity at University of Maryland’s School of Public Health.
The Georgia Department of Public Health told Bloomberg that since receiving more shots, it has enrolled more community-based organizations as providers; it’s also working with the organizers of Atlanta Black Pride to distribute vaccines during Labor Day weekend events. The Washington, D.C., health department sent Bloomberg a livestream of a July 18 news conference in which the former director of health, Dr. LaQuandra Nesbitt, said, “we have a lot that we have learned from COVID.” The city limited some vaccine appointments to residents who lived in certain neighborhoods, she said. Chicago’s public health department did not respond to requests for comment.
Many of the problems that plagued the U.S. COVID vaccination campaign are preventing those most at risk of contracting monkeypox from getting the vaccine, too. While efforts to reach minorities have ramped up relatively quickly, the early roll out suggests few lessons about health equity have been learned over the last two years, public health experts say.
“My concern is that we’ve got a big problem here that goes beyond these two pandemics,” Thomas said. “It has to do with trust in our health systems and with the history of marginalizing groups because of their sexual orientation, the color of their skin or their ZIP code.”
At first, monkeypox vaccines were only available in whiter and wealthier neighborhoods. In New York City, for more than a week, the only vaccination site was in the Chelsea neighborhood of Manhattan, which has a large LGBTQ population, but is majority white. Its hours were also limited to between 11:30 a.m. and 6 p.m. Similarly, Washington, D.C.’s first two monkeypox clinics were in its more affluent Northwest corridor. In Georgia, it took a full month to get testing and vaccine sites up and running in all counties.
When sites did ultimately open in other neighborhoods, appointments for the limited supply of shots quickly booked up, sometimes within minutes. Both New York City and Washington, D.C., entirely ran out of their first batch of shots within a day.
“Folks that didn’t have access to the internet or couldn’t sit on the internet for hours were left out,” said Sean Coleman, founder and executive director of Destination Tomorrow, an LGBTQ center in South Bronx. Some who tried to call to make appointments were told they could only book online, said Jawanza James Williams, the director of organizing at the Brooklyn-based health justice organization Vocal-NY, who is helping people without internet get access to shots.
A lack of comprehensive data on virus cases and vaccine uptake is also preventing public health official from best deploying scarce resources. Identifying at-risk communities would better help with messaging, too.
“If monkeypox is totally framed as an LGBTQ issue, then those individuals who do not see themselves part of the LGBTQ cultural community will not hear the message,” said Thomas, adding that the U.S. made a similar mistake during the HIV/AIDS epidemic in the 1980s.
Over the last few weeks some efforts have opened up shots to more people. For one, vaccine supply has increased. The U.S. Health and Human Services has distributed more than 600,000 doses of Bavarian Nordic’s two-dose Jynneos vaccine, with another 2.5 million on the way. New York City, Washington, D.C., and Chicago all recently announced thousands more shots will be available to residents soon. The U.S. Food and Drug Administration on Tuesday approved a “dose sparing” technique designed to extend the current supply of the vaccine.
Clinics have also started targeting Black and Hispanic communities. Howard Brown Health, an LGBTQ organization in Chicago, has opened two of its four vaccination sites in the city’s predominantly Black south side. The clinics reserve a portion of vaccination appointments for residents who live in the ZIP code.
Howard Brown Health also set up pop-up sites at Pride South Side, a Black queer festival, and Club Escape, which describes itself as a “Black gay alternative club.” This month, Washington, D.C., opened a clinic in one of the poorest, predominantly Black neighborhoods in the city. The city’s clinics have also started allowing walk-up appointments
Minority groups are less likely to have a positive view of the health care system. A 2020 survey conducted by the Pew Research Center found only around a third of Black and Hispanic Americans had a great deal of confidence in medical scientists, compared with 43% of white respondents.
Early on in the COVID vaccination campaign, Black Americans were less likely than white Americans to say they planned to get vaccinated — in part because of feelings of distrust. That gap has closed over the course of the pandemic, but experts worry that missteps throughout both health crises have only further fueled mistrust, preventing people from getting care.