Today, Explained - Monkeypox is a queer emergency

Episode Date: August 4, 2022

Gay men, queer people, and their partners represent an overwhelming majority of monkeypox cases. But even though the WHO just declared the disease a global health emergency, resources like vaccines, testing, and treatment remain largely out of reach. Health reporter Keren Landman and virologist Joseph Osmundson explain. This episode was produced by Victoria Dominguez, edited by Matt Collette, fact-checked by Laura Bullard, engineered by Paul Mounsey, and hosted by Noel King. Transcript at vox.com/todayexplained   Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

My friends are sick with this, and it is not nice. It is not a nice virus to have. Two U.S. cities, New York and San Francisco, have declared monkeypox a health emergency. And three states, New York, Illinois, and California, have declared states of emergency, too. Likely because they've confirmed higher numbers of cases than most other states. Nationwide, we are at about 6,600 cases of monkeypox, says the CDC. But coming up, two doctors tell us there is a difference between taking this virus seriously and everyone just losing their ish over it.

Sex is fun. Sex is natural. I don't want to tell people not to have sex. We don't need alarmism that makes the world seem even more full of despair than it actually is. On Today Explained, what you need to know about monkeypox. Bet MGM, authorized gaming partner of the NBA, has your back all season long. From tip-off to the final buzzer, you're always taken care of with a sportsbook born in Vegas. That's a feeling you can only get with Bet MGM. And no matter your team, your favorite player, or your style, there's something every NBA fan will love about Bet MGM. Download the app today and discover why Bet MGM is your basketball home for the season.

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If that's not your thing or if you're listening with young kids, we will see you back here tomorrow, same place, same time. Karen Landman, medical doctor, senior health reporter at Vox. The WHO says monkeypox is a public health emergency, which means what exactly? So what it means is that as the WHO has been following this outbreak and gathering information about it, they have seen that it is, it's changing and it's continuing to spread and it continues to exist outside the borders of places where we normally see this virus exist. And that it's sort of meeting their criteria for qualifying as a public health emergency of international concern. And those criteria include being unusual or unexpected, which this definitely is.

You know, we did not see monkeypox spreading outside the African continent previously. And we also didn't see it spreading among sexual networks previously. So that's a real change for this virus. It has potential for international spread. That's another of their criteria. And that clearly is the case. This is in more than 70 countries right now. And also the third criteria is that it requires an immediate international response.

And I wonder if that is really the criteria where some people may have differed on it. On Saturday, I declared a public health emergency of international concern over the global monkeypox outbreak. Ultimately, the determination whether to call something a public health emergency of international concern is really up to the director general. More than 18,000 cases of monkeypox have now been reported to WHO from 78 countries, with more than 70% of cases reported from the European region and 25% from the region of the Americas. So what this means is that, in his view, this met the criteria and would benefit from the WHO's attention to this matter in this way. This is an outbreak that can be stopped if countries, communities, and

individuals inform themselves, take the risks seriously, and take the steps needed to stop transmission and protect vulnerable groups. What does their attention involve? Once something becomes a public health emergency, what does it get that it wouldn't normally get? One of the most important things that declaring this global emergency does is it encourages and sort of signifies to countries that they need to think about donating vaccines and perhaps even treatment to countries that have lower resources to access those means of stopping transmission and treating infection. So higher resource countries, this helps mobilize them to start thinking about donating or otherwise getting vaccines to countries that have lower access to those things.

And so when something's declared a public health emergency, that's different than declaring it a pandemic, which is what COVID is. Where do the main differences lie? Yeah, you know, it's tough because even though the definition of a public health emergency is pretty clear, there's a little bit of fuzziness there and how much the criteria actually lead to a declaration. But also the definition of a pandemic is pretty squishy. It just kind of means that there's an epidemic that's reached worldwide and that has affected a large number of people. But those are really relative terms, right? We know that COVID is a pandemic. We know that HIV affected a large number of people. But those are really relative terms, right? We know that COVID is a pandemic.

We know that HIV is a pandemic. What actually qualifies as a pandemic is a lot less clear than what qualifies as an emergency. I think, you know, you could say that a pandemic is basically an outbreak that has spread worldwide and that is out of control, whereas there is still a window of opportunity open when you declare something an emergency. What's the situation with vaccines in this country?

All of the vaccine that's being distributed right now in the United States, almost all of the vaccine, is called JYNNEOS. The vaccine called JYNNEOS right now is only available for someone with direct exposure to a confirmed monkeypox case. And it is sourced from a company called Bavarian Nordic. It's headquartered in Denmark, and that is where their main production facility is. The U.S. ordered this vaccine before this monkeypox outbreak even started, just to have in the strategic national stockpile. And it's intended to be there as protection against smallpox, actually. It does look like if you've had the smallpox vaccine before,

you're pretty well protected. Smallpox has been sort of thought of as a potential bioterrorism threat, even though that has never actually happened. It's considered a threat uh because it is such a fatal disease you know it kills 30 of the people that it infects and it's been eliminated worldwide you know we haven't seen cases worldwide since very early 1980s so there is a relationship between the u.s government and this bavarian nordic company for a long time the genius vaccineYNNEOS vaccine was approved by the FDA in 2019

for use for both smallpox and monkeypox prevention. But I don't think anybody anticipated that they would need to use it the way we're talking about using it now. The state now recommends people who have been exposed to someone with monkeypox get the vaccine. This includes people whose sexual partner was diagnosed with monkeypox in the past 14 days. I've been waiting for hours. Four hours. You'd think that we would have more of a structured process for vaccine rollout, and there just wasn't really anything.

Until now, there had been several hundred thousand doses of vaccines distributed and allocated to states for use. There was a press release out of HHS, the Department of Health and Human Services, indicating that an additional 786,000 doses of vaccine are now available for use in the U.S. So hopefully we'll see another big flood of vaccines hitting states and locals soon. Governor Hochul announced today New York City will receive 32,000 doses of the vaccine and the first of three additional installments in the coming weeks. New York State will get nearly 12,000 vaccines. So the rest of those vaccines, it sounds like are going to come, at least for now, it seems like they're going to come more slowly.

The date given by the secretary of HHS, Javier Becerra, sounds like it's going to be mid-2023. So that's a lot later than I think most of us would really want to see those doses arrive. I want to say, and I know you didn't ask this, but I want to say that vaccines aren't the only tools we have to prevent the spread of monkeypox among the highest risk folks here, right? The people who should be getting monkeypox vaccines are sexually active men who have sex with men, whether basis, meaning people who are having basically group sex with multiple partners that they don't really know very well. So this is a smaller group of people than just all gay and bi and MSM, men who have sex with men in the United States. There are ways to make sex and sex like this a lot safer.

You know, you can talk to people. You can ask people what's going on down there, whether they've been feeling safe and healthy. A lot of guys that I've talked to who've had these infections say, you know, they wouldn't have even really known that they had monkeypox if they didn't know to look for it because the lesions can be really hard to detect and sometimes really not particularly symptomatic. I realize that that introduces some awkwardness into sexual encounters that people may not really want to have. But this is a tool, and we should acknowledge that we have it in addition to vaccines to help prevent the spread of this. I know this is a hard question for someone with a lot of experience to

answer, but I also know that it's something that an average listener is going to want to know. Are we now in a place with monkeypox where we should start being really concerned? I mean, how should we be feeling about all of this? The folks that I am most worried about are the people who do not have the resources to know how to get vaccine. You know, how to line up for it, who don't get the messaging on this, whether that's because they have sort of low incomes and low resources and low access to health information, health messaging, or because they're not in the out community of gay and bi men, you know, they're closeted or they're just not open about their sexuality. And so they kind of stay away from faces or from messaging

sources that might help them understand what they need to do to keep themselves safe or get themselves treatment if they do get sick. The thing that is most likely to perpetuate spread of this disease is stigma, whether it comes from people's communities or from inside themselves. So I'm really worried about how homophobia could play a role in making this disease go on a lot longer than it really should and cause a lot more suffering going forward. explain comes from Ramp. Ramp is the corporate card and spend management software designed to help you save time and put money back in your pocket. Ramp says they give finance teams unprecedented control and insight into company spend. With Ramp, you're able to issue cards to every employee with limits and restrictions and automate expense reporting so you can stop wasting time at the end of every month. ramp.com slash explained, r-a-m-p.com slash explained, cards issued by Sutton Bank, member FDIC, terms and conditions apply.

Today Explained, we are back this time with Dr. Joseph Osmundson. My day job is as a clinical assistant professor at NYU, where I teach all of the biology. My background is in microbiology, molecular microbiology, studying bacteria and the viruses that infect them. I've trained my whole life to think really hard about microbes and their impact on people. I'm a public health homosexual. Okay. And as a public health homosexual, you've presumably seen the evolution of how we're talking about monkeypox and who is talking about monkeypox? I think there's been a shift over the last two weeks as this has gone from something in May that was rarely even talked about in the queer community to May and June where like literally most of the people I know in the queer community knows someone directly impacted. I probably have a dozen people in my life who have gone through the experience of getting monkeypox.

So the queer community had a lot of awareness coming up because it was just so impacting our social and sexual networks. And now it's sort of, oh no, the straights have gotten a hold of this. A lot of the alarmism that has come up through the COVID crisis is now those same kind of alarmist actors are moving into monkeypox. And I think they're doing a huge disservice, the alarmism that it's going to be as bad as COVID, that it's already endemic, that it's going to be as bad as COVID, that it's already endemic, that it's going to be impacting kids in schools in ways that aren't matching with what we know about the epidemiology of this disease.

I think, number one, it's scaring people, and fear and panic do not help you make good risk decisions in a time of actual crisis. And then number two, it really is going to do a lot of harm to queer people. What we saw with COVID is a huge rise of anti-Asian violence that was misplaced against Asian folks in the wake of the COVID crisis. And I'm really worried that if this is viewed as sort of the gays infiltrating wastewater in San Francisco with our disgusting monkey pox, and then everyone's going to get it, that we're going to see the same wave of anti-queer violence in the wake of sort of alarmism and misinformation about monkey pox. So something is clearly going wrong with the messaging. This is 2022. It's not unheard of.

What should the messaging be? and who should it be coming from that maybe it currently isn't? You know, this conversation is a great one, right? Like you're talking to someone here who has a PhD in molecular microbiology and my friends are dealing with this, like I can speak to the actual feeling of being pretty sure you have monkeypox, but being denied testing for seven days. And that was in June. Another friend of mine tested positive for monkeypox, had lesions that should have given him access to treatment, and waited 10 days from his swab to get the drug T-pox, tecovirimat, that may help him recover more quickly. And that was this week, right? So we can speak to the real painful experience, the real lived experience.

And also, you know, our queer community is most affected. It's like 95 to 90% of cases right now are in queer people, gay men, and our larger sexual network, which of course includes non-binary and trans people. We have experts in our community, right? I'm working with clinicians, epidemiologists, other scientists, community health people who have been doing this work our whole lives and who have built in relationships both to, well, the federal, city, and state governments where there's been a lot of frustration. But more importantly, we are directly the community being most affected. And have the expertise ourselves to do the messaging around risk reduction, what the disease looks like, and how to best get care. I mean, this has been our frustration. Look, my colleagues and

I, queer health advocates with relationships to policymakers at city, state, and federal level have been trying to get tests, treatment, and vaccine activated since May. Our colleague at Vox, Karen Landman, says the U.S. government has smallpox vaccines in case there's a bioterror attack, And those vaccines do work for monkeypox. Why aren't we using them? We knew something was wrong, right? Because there's a huge need for vaccine. The community is really desperate for it,

and yet no one can get vaccinated. We're supposed to have this, you know, 1.1 million doses, which would be a game changer. A group of U.S. senators is calling on the Biden administration to invoke the Defense Production Act to boost access to the monkeypox vaccine. It comes as officials in San Francisco warn a shortage of the vaccine will force its main clinic to close on Thursday. Do you know people who can't get the vaccine, who want it but can't get it?

Uh, yeah. Like everyone I know. Oh my God. I will say, I had a person reach out to me today who had a very high-risk exposure. They shared a bed on a vacation with someone who was getting kind of a rash, they thought, maybe like an allergic reaction to poison ivy or something, came home and tested positive for monkeypox, and they have not been able to access the post-exposure shot yet,

which is, you know, city and state governments say we hold a number of doses for this specific reason, but the people are just so overworked and overwhelmed and there's so much need that some of these essential healthcare points of access are falling through the cracks. It's really, really frustrating. You know, the New York Times reported yesterday that one reason we have this shortage of vaccines is that the Department of Health and Human Services failed to ask the vaccine maker, Bavarian Nordic, to put vaccines that the U.S. had already bought into the bottles that are needed to distribute them. And in the meantime, Bavarian Nordic went and got other clients who wanted the vaccine. This seems very sloppy, Joe. I've read op-eds by very smart people who compare the government's

response to monkeypox to the government's response to HIV and AIDS in the 1980s. Do you think that comparison is fair? You know, again, New York and San Francisco were American epicenters of HIV AIDS. New York and San Francisco Francisco were American epicenters of HIV-AIDS. New York and San Francisco are the American epicenters of monkeypox now. The two viruses could not be more different, right? They are very different viruses. We do not want to flatten and say this is so reminiscent of HIV-AIDS. This is a much faster-moving crisis, but we also have much better biomedicine.

We know this virus. We've studied it for decades. The reason we don't know it better epidemiologically and virologically is that it, until now, has only affected people in Congo and Nigeria and countries where, frankly, we don't study the viruses that harm people there because of biomedical racism. I did a call with the head of the CDC in Nigeria. They have zero countermeasures. They have zero vaccine and zero medication to help people when they get ill or to prevent spread of illness within households or within close contacts. Now, the real question is, what is driving the incredibly slow response to this outbreak in the American context? You know, a bunch of my colleagues and I, all queer folk, have been trying to figure out,

is it ineptitude or is it homophobia? And I think early on, everyone was just kind of saying, these people are not homophobic. They're just slow-moving federal bureaucrats. There's a little bit of ineptitude. They're just not responding to the scale of the crisis. But look, I don't understand how this got this out of hand with a virus where there are tests, treatment, and vaccines. So I do think there is some, you know, the WHO, when they were trying to decide whether or not to name this a public health crisis of international concern, the committee actually voted against that, literally saying that it's not a public health emergency of international concern because it was only impacting men who have sex with men and our sexual networks, as if our health is not an emergency. Look, Joe, to me, as a reporter who reads a lot of news, it's also pretty clear that some groups are using monkeypox to push homophobic narratives about queer men, about the way they behave, about the way the disease is transmitted. How should public health officials handle a topic that has been politicized and try to dispel

the politicization? Is that even possible? I've been having some of these conversations about how we give good risk-aware advice to queer folks and the people we have sex with without sort of making us a target to fascist backlash. And I'm sorry, fascists are going to hate fags no matter what we say about ourselves, no matter what we call it. We cannot capitulate to the anti-queer mafia in this country that is on a march to roll back our rights and to do harm to our personhoods. We do harm to our own personhoods if we do not speak frankly with one another in a sex positive way in an honest way about what risks are and what risks aren't and how to keep yourself and your community safe so no i'm just like we cannot have the conversation on those terms we cannot care for ourselves and

our community if we don't say hey sex is awesome group sex can be incredibly fun for people who like it and people who like it should absolutely be able to do whatever type of sex that they want to do. Group sex or places where people meet for anonymous sex are basically the highest risk places for monkeypox transmission, and we need to talk very frankly about that. So we need to be able to talk about sex, what people like to do, how people find pleasure in it. And if those are risky behaviors for viral transmission, how people might want to think about minimizing that risk. Can I ask you for our listeners out there who might be at risk, a personal question? Have you changed your behavior at all?

I have. And I started actually in May. One of my friends was a pretty early case in June. So I had personal experience with exactly what this feels like. I love a bathhouse, even just to relax and hang out. I avoided places where men meet for sex and our sexual networks meet for sex, because that's a lot of the epidemiology has been traced back to those types of places. As someone who loves the community that goes there, it is the community that goes there. It's just been my call that until we get vaccine out at scale, it's too risky for me personally to go to those places. And me and public health professionals published Safer Sex in Monkeypox Guidance just a week and a half ago where we did recommend avoiding places where

people meet for sex and anonymous hookups, maybe sex potting, right? So, you know, you have a few friends, you're all kind of hookup buddies, maybe have a conversation around, let's wait a few days, monitor for symptoms, and then kind of keep our sex within our bubble until, you know, I coined the term anal autumn. I really hope we all get to have a very fun anal autumn, but it is not the safest thing right now in terms of monkeypox risk to have anonymous sex at this time. Dr. Joe Osmunson wrote a book, It's called Virology, Essays for the Living, the Dead, and the Small Things in Between. Today's show was produced by Troy Dominguez. It was edited by Matthew Collette. It was fact-checked by Laura Bullard, and it was engineered by Paul Mouncey.

We're working on an episode about long COVID. If you have questions about long COVID that you would like to hear answered, or if you have a personal story about how it's affected your life, please email us at todayexplainedatvox.com. Or you can call us at 202-688-5944, 202-688-5944, and leave us a voicemail. Please make sure you leave us your name, where you are located at, and how we can get in touch with you. All right, thanks so much. you