SF health officials come under criticism over monkeypox response

  • by Cynthia Laird, News Editor
  • Thursday July 21, 2022
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Dr. Stephanie Cohen, medical director at City Clinic, speaks during a July 21 Board of Supervisors hearing on the monkeypox outbreak. Photo: Screengrab
Dr. Stephanie Cohen, medical director at City Clinic, speaks during a July 21 Board of Supervisors hearing on the monkeypox outbreak. Photo: Screengrab

Even as the San Francisco Department of Public Health unveiled expanded monkeypox vaccine eligibility, it came under criticism from a Board of Supervisors committee for communications failures and its drop-in vaccine clinic that has left people waiting in line for hours.

Gay District 8 Supervisor Rafael Mandelman led the 90-minute hearing Thursday at the board's government audit and oversight committee.

"We have the unfairness of this sort of cattle call approach," Mandelman said at one point during a presentation by Dr. Stephanie Cohen, the medical director of City Clinic and an infectious disease specialist. "Is DPH going to change?"

He was referring to the fact that people are often getting more information about vaccine availability on "gay Twitter" than from public health officials. One gay man, his former aide Tom Temprano, now political director at the statewide LGBTQ organization Equality California, called every number that the health department's website directs people to contact and never received a response, Mandelman said.

"He was alerted by gay Twitter where he could get a vaccine," Mandelman said. "Sadly, not with a lot of help from the health department." And Temprano is someone who has access to much information, the supervisor continued. "I can only imagine the feelings of powerlessness by other folks," Mandelman said.

It was widely acknowledged that the federal government has failed to provide enough monkeypox vaccine to states around the country, but Mandelman said local health officials must do better.

"Even here locally there is room for improvement, and we need to improve quickly," he said.

However, Mandelman praised DPH for releasing expanded vaccine guidelines that now include sex workers as well as gay, bi, and other men who have sex with men who have had multiple sex partners in the last 14 days. Cohen said this would provide an equitable pathway for those communities most highly impacted by the virus.

"We're building on the lessons learned from COVID and HIV," Cohen explained.

While anyone can get monkeypox, the current outbreak is mostly affecting gay, bi, and men who have sex with men. Slides shown by Cohen, which were also presented at the July 19 meeting of the San Francisco Health Commission, showed that nearly all cases (97.7%) are cisgender men, with the rest identifying as trans men. Most (88.4%) identify as gay or same-gender-loving, 1.2% as bisexual, and 1.2% as heterosexual or straight; this information is missing for about 9%.

Cohen said that while monkeypox is not a new disease, this is the first time it has spread in so many countries at once. Total confirmed cases worldwide stand at 13,340, according to a slide she presented. In the U.S., there are 1,814 confirmed cases. Of those, 266 are in California and of that number, 141 are in San Francisco.

On the vaccination issue, Cohen said that the city has received 7,743 doses and, of those, 7,692 were distributed to clinics.

"We've had 3,400 to arms as of 3 p.m. July 20," she said.

The new Jynneos vaccine involves two injections given a month apart. And Cohen acknowledged that the second dose required might not be available when it's time for someone to return for that shot.

"We do intend for everyone to get the second dose," she said. "But we are prioritizing first doses." She said that was because the first dose provides a level of protection that people without any vaccine wouldn't have.

"So that second appointment might not be real?" Mandelman asked.

"Correct," Cohen replied.

On the issue of the drop-in vaccination clinic at Zuckerberg San Francisco General Hospital and Trauma Center, Cohen said that DPH "is working everyday to improve the process." She also noted that vaccines are now being distributed to Kaiser, where people — whether members or not — can make appointments.

"Every vaccinator wants more doses," Cohen said.

She defended the SFGH site, saying that it "was set up overnight and they didn't know the number of doses there would be."

Vaccines are allocated by the federal government to the states, which then distribute them to counties, in California's case. Cohen said that the state's allocation formula is based on monkeypox case rates and the rate of early syphilis among men, which she said is high in San Francisco.

"And also that it can be administered quickly," she said, as the state won't send vaccines if they're not promptly administered. "We have the highest rate among Bay Area counties currently."

District 5 Supervisor Dean Preston, who chairs the committee, noted that equity is missing from the current process in that those who can afford to can take a day off of work to wait in line for hours, "while many others cannot."

Preston also pushed Cohen regarding demographic data, which she said DPH updates twice a week. That wasn't good enough, the supervisor said.

"I don't understand why DPH doesn't have that data on a daily basis," he said.


On the communications issue, Cohen said the health department is working to improve.

"City Clinic had 600 voicemails — we want to fix that," she said.

Countered Mandelman, "I think communications has been poor — making things worse by telling people to call these numbers" and then getting no call back.

"The inability to return phone calls ... is unforgivable, and DPH needs to fix it," Mandelman added.

Committee Vice Chair Supervisor Connie Chan of District 1 stressed that those with language challenges "are always left behind in these situations." She urged the health department to have a strategy to reach out to those for whom English is not their primary language.

Cohen said that the department has reached out to various groups such as Black Brothers Esteem, a program of the San Francisco AIDS Foundation, the Leathermen's Discussion Group, San Francisco Pride, the Trans March, and the UCSF Latinx Center for Excellence. She said the department relies on community-based organizations to do outreach with their clients.

The committee also heard from gay SFAF CEO Tyler TerMeer, Ph.D., who presented more specific demographic data on the clients his agency has seen. He said employees have been pulled from their regular duties to staff its monkeypox hotline that gets one to two calls per minute. SFAF also held a virtual town hall July 12 that was attended by some 600 people, as the Bay Area Reporter previously reported.

SFAF has tested 52 people since June 27, TerMeer said. Of those, 20 tested positive for monkeypox, six tested negative, and 26 are pending a result. Additionally, the foundation has vaccinated 761 people, including 460 at a clinic July 17 for people on its waiting list that was by appointment only.

"We have 127 vaccines on hand that we're filling from the waitlist," he said. That list now has 5,300 people on it as of Thursday morning just before the supervisors hearing.

TerMeer said the foundation was vaccinating people at high risk, including multi-racial, 29%; Latinx, 17%; white, 17%; Asian/Pacific Islander, 15%; Black, 5%; and unknown/decline to state, 15%.

TerMeer said the foundation is "proud" to partner with DPH and was glad it has broadened vaccine eligibility. The foundation needs 200 doses a week, TerMeer said, with more for large events that are upcoming like the Dore Alley leather and kink street fair set for July 31. He would also like to see more equity outreach by the health department and a dashboard that has demographic information on testing, diagnoses, and vaccinations.

He said that dialogue needs to be framed in sex-positive ways with accurate messaging. He also acknowledged that coordination has been an issue.

"We do have some concerns about allocations coming from the state," TerMeer said.

Mandelman said that he could not sign up for the foundation's waitlist under the expanded eligibility.

"We're changing that today," TerMeer said.

During public comment, Gary McCoy, a gay man who is co-chair of the Alice B. Toklas LGBTQ Democratic Club, said a dashboard is greatly needed.

"We need an appointment system. We have a COVID playbook. Use it," he said, referring to how appointments were set up for those vaccines.

Temprano also addressed the committee. He expressed frustration that he doesn't have a second appointment after hearing Cohen's remarks.

At the hearing's conclusion, Mandelman asked — and the committee unanimously voted — for the possibility of another meeting in the future.

"I think we're all united that DPH needs to get its act together," Mandelman said.

Health officials urge anyone with a rash or other possible monkeypox symptoms to seek medical care and get tested. Those who don't have a regular provider can contact City Clinic on Seventh Street or SFAF's Magnet sexual health clinic in the Castro. Refrain from sex and other close physical contact until the results are known. People who test positive should avoid close contact until their sores heal completely, which takes about three weeks.

For the latest updates on vaccine eligibility and locations, click here.

To contact City Clinic, click here or call its new phone number, 628-217-6600. To contact SFAF's Magnet clinic at Strut, click here or call 415-581-1600.

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