Both locally and nationally, health care and medical officials are allowing themselves to feel something they haven't enjoyed in a while: cautious optimism.
Monkeypox infection rates are declining across the country and, after weeks of steady progress in administering vaccinations to more than 800,000 people nationwide, including more than 30,000 in San Francisco, officials are cautiously optimistic that the vaccinations are working.
As a result, San Francisco — like many other large cities around the United States — has seen its MPX infection rates drop. As of October 2, the city reported 807 cumulative cases but, as of late, those case numbers have been climbing at a very slow pace. Compared with July 27, when the city recorded a record high of 31 reported infections during a week, San Francisco now goes a few days at a time without reporting a single new case.
At a White House teleconference on September 30, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, told reporters, "This progress is a result of our comprehensive effort to get shots into arms, bring vaccines directly to the impacted, and work closely with community groups and health departments to help reduce risk behaviors.
"But let me be clear: We are not done with this fight," she added. "There is still a lot of work to do. We must continue to reach more of the highest-risk communities, especially Black and Brown communities."
In San Francisco, local health officials observed that the decline does seem to be a trend, something they weren't quite ready to commit to a couple of weeks ago.
"I would say that the decline is real," said Dr. Susan Philip, San Francisco's health officer. "We always like to see repeated trends over time."
The Jynneos vaccine, of course, has played a huge role in that decrease, despite the difficulty local health officials have had in acquiring quantities sufficient to beat back the outbreak due to a lethargic federal response, but more is at play, Philip said. And much of that was because of the response from the local LGBTQ community.
"I think it really has been behavioral," Philip said in an interview with the Bay Area Reporter. In addition to the large numbers of people turning out to get vaccinated — more than 31,000 first vaccinations have been completed in San Francisco so far — people have been changing their behaviors, as well. (Two doses of the Jynneos vaccine are required, usually given a month apart.)
"The second thing is that people are making decisions about harm reductions," Philip said, which included reducing the numbers of sexual partners they might have.
Tyler TerMeer, Ph.D., CEO of the San Francisco AIDS Foundation, agreed.
"It really was community in that moment that created support for one another in a difficult and painful time and created systems of communications and access because the federal system abandoned them," said TerMeer, a gay man who described himself as "cautiously optimistic in these times."
"We've had as successful a response as we could have hoped for, especially considering the federal response," he said.
Funding issues
In early September, the Biden administration requested $4.5 billion for the nation's response to MPX, part of a larger $47 billion package which included additional money for COVID, as well as aid to Ukraine to help in its fight against invading Russian forces. Last week, however, Congressional Republicans nixed the additional funding for both COVID and MPX. The funding would have included $1.6 billion for vaccine manufacturing, and hundreds of millions more to support state and local testing efforts as well as vaccination and treatment efforts.
LGBTQ officials were critical.
"The failure of Congress to respond with the urgency and funding necessary to prevent the physical and emotional suffering felt by the LGBTQ+ community is beyond disappointing. Despite the declaration of human monkeypox as a federal public health emergency, there are still too many members of Congress who do not care about our communities," stated Los Angeles LGBT Center CEO Joe Hollendoner. "What's most appalling is that the COVID response has provided us with lessons on how to properly manage a public health crisis. Still, the lessons learned to prevent an outbreak from becoming a pandemic are not being used for the LGBTQ+ community."
Last month, the Human Rights Campaign, the nation's largest LGBTQ rights organization, and San Francisco-based National Center for Lesbian Rights wrote a letter to elected leaders requesting the funding be restored. PrEP4All, an advocacy group, and the National Coalition of STD Directors, were among the more than 100 agencies that signed on to the letter.
Still, despite the high numbers of San Franciscans who have gotten the vaccine so far — particularly men who have sex with men — as of September 30, only a little more than 9,000 have actually gotten their second shot, which the CDC says is vital to being fully vaccinated against the MPX virus.
Nationally, of 802,993 cumulative vaccinations in arms as of September 17, only 226,613 are second doses, according to figures from the CDC. That drew criticism from some national activists.
"The CDC prominently touts on its website that 803,596 vaccines have been administered between May 22 and September 24, but that number doesn't distinguish between first and second doses," stated Dennis Jaffe of Washington, D.C., and a member of the PrEP4All MPX Working Group. "Data on second doses is almost buried. The total number of people who have received two shots has not been reported until now."
Locally, officials are also worried that not everyone is getting the second dose.
"I have some level of concern as I look at this lower uptake of people getting the second dose," said TerMeer. "I worry about the possibilities of reinfection. We have not seen much around the country, but there have been cases of people being symptomatic."
The city will continue its work to get as many people vaccinated as possible, said Philip. Much of that effort lies in offering vaccinations at events where target populations are expected to gather.
"We are working with the community and asking the community what events we can get first doses to," Philip said. "We're really trying to say, what smaller events can we go to? So we have nighttime events, weekend events."
As part of that effort, DPH began offering vaccinations at various street fairs and bars around the city, most notably at Folsom Street Fair, which took place September 25, and the Castro Street Fair on October 2. The vaccinations for both those events and others came from a special 10,000 vaccination allotment distributed by the federal government specifically to reach the thousands expected to attend those events.
More than four months after MPX began to appear in San Francisco, men who have sex with men are still by far the largest group affected by the outbreak. As a result, said Philip, "We're still not at a place where we're saying everyone should get an MPX vaccine."
According to September 28 figures compiled by DPH, of the 807 cumulative cases of MPX in the city, 95% have been men, with less than 1% of cases being trans men. The largest number of infections — some 88.9% — have been found in people ages 25-54, with the largest share of those infections — 38.6% — occurring among people ages 35-44. Thirty-one percent of infections were among 25-35 year olds, and the rest — 19.3% — occurred among 45-54 year olds. Those over the age of 55 on up accounted for 7.6% of infections and 3.5% occurred in people aged 18-24. There were no cases among those 17 and under.
Among the city's various ethnic and racial groups, whites still make up the largest percentage of cases at 45.8%. Caucasians make up 51% of the city's population, according to U.S. Census estimates for 2021. However, Latinx and Black individuals are being particularly hard hit with Latinx people accounting for 28% of cases, despite the fact they comprise only 15.7% of the population, while Blacks, at 5.7% of the city's population, comprised 6.1% of cases, as the B.A.R. previously reported. Asians, who account for 37.2% of San Franciscans, made up only 8.9% of MPX cases.
Gay, lesbian, or same-gender-loving individuals account for the lion's share of cases overall: 68.9%. People who identify as bisexual comprise 3.8%, and those who declined to identify their sexual orientation comprise 28% of infections. Heterosexuals accounted for 2.5%.
While health officials are feeling hopeful, they are still quite worried about those who haven't gotten the second shot, which the CDC says should be given 28 days after the initial vaccination. In the earliest days of the outbreak, places such as Zuckerberg San Francisco General Hospital and Trauma Center were giving out only first doses because of the very small amount of vaccines available. Now, however, they're all about that second jab.
"Numbers could go up," noted Philip, referring to MPX cases. There are still plenty of people who are susceptible and have not had even the first shot, she said. "Please come get your second shot."
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