Black Philadelphians are at higher risk of monkeypox but get just a fraction of vaccine doses
City health officials acknowledged they have failed to reach a population that accounts for 55% of the city’s 203 reported cases.
Black Philadelphians account for more than half of Philadelphia’s monkeypox cases, data released Thursday showed, but received less than a quarter of the city’s vaccine doses, an alarming disparity in the midst of a fast-spreading virus.
Despite outreach to the Black community, city health officials acknowledged they have failed to reach a population that accounts for 55% of the city’s 203 reported cases.
“You hate to say something hasn’t worked, but these numbers aren’t where we want them,” said Cheryl Bettigole, the city health commissioner.
The poor vaccination rates could stem from factors such as fear of stigmatization among the Black LGBTQ community, poor access to doses, and the same distrust and skepticism of health-care systems that hampered efforts to persuade more Black Philadelphians to get fully vaccinated against COVID-19.
“The fact that they made [monkeypox] look like a gay disease is just generating more distrust toward that system, because it’s ultimately not,” said Jazmyn Henderson, an activist with ACT UP, an HIV and AIDS advocacy group. “People know that it’s not a STI [sexually transmitted infection].”
Sex has proven to be the most common way the virus is transmitted, which is why health officials are focusing on men who have had sexual contact with numerous or anonymous male partners. But although more rare, it is possible to spread monkeypox through any kind of extended contact with the painful rashes and lesions it can cause.
The data released Thursday by the Philadelphia Department of Public Health offer the first detailed look at who in the city has been infected by monkeypox, and who has been vaccinated for it. The data show 87% of cases have been reported in cisgender men. Three-fourths of infections have been in people ages 20 to 39. The racial disparities, though, are the most concerning indicators.
White Philadelphians account for 27% of cases but have received 57% of the vaccine doses, virtually the inverse of the Black infection and vaccination rates.
Latinos accounted for 14% of Philadelphia cases and received 11% of vaccine doses.
The Centers for Disease Control and Prevention reported similar national trends: 26% of monkeypox cases have been reported among Black Americans, who are less than 14% of the U.S. population. In New Jersey, Black residents received 13% of vaccine doses but reported 20% of cases, according to the state Health Department. White residents got 41% of vaccine doses, though they had only a quarter of the state’s cases. New Jersey Latinos accounted for 35% of cases and received 23% of vaccine doses. Pennsylvania has not yet released demographic data on cases and vaccinations, the state Health Department said.
White residents in cities like Chicago and Washington have also received a majority of vaccine doses, Bloomberg reported.
So far in Philadelphia, vaccines have primarily been made available through the city’s monkeypox hotline and to patients of several LGBTQ clinics, giving an advantage to those who manage to seek out doses in an overwhelmed system.
Sultan Shakir, president of the Mazzoni Center, an LGBTQ-focused health center, said he has heard it can take much of the day to confirm a vaccine appointment.
“There’s a lot that’s built into the system that allows folks who have more flexibility, who have more time, to get access,” he said.
The city wants to team with businesses like the city’s two bathhouses and pharmacies, and health centers to host vaccination clinics, Bettigole said. They need money, though, she said, explaining the federal declaration that monkeypox is a health emergency has not yet led to additional funding.
The city has struggled to get enough vaccine for the estimated 12,000 people who are considered at high risk of exposure to monkeypox. The federal government announced Thursday it would make 1.8 million doses of the vaccine JYNNEOS available to order by Monday, which would ease the scarcity, but it won’t solve the problem of persuading people to get the shots.
Unique Greene, 43, lives in Reading and recently recovered from a monkeypox infection he may have caught at a Philadelphia bathhouse that caters to gay men. He didn’t try to get vaccinated, he said, because he didn’t believe he was at risk, an attitude many others share.
“It’s very painful,” said Greene, a Black gay man who has been encouraging friends to get vaccinated. “I can only tell them about it and warn them.”
As with COVID, distrust of health-care providers and the government has made some Black residents cautious of seeking out vaccine. Additional discrimination LGBTQ people can encounter from health providers makes the situation even worse, said Henderson.
Henderson, a trans Black woman, said Black men who have sex with men may still identify as heterosexual.
“Identifying as gay, identifying as trans, all of that is very stigmatized,” she said. “I didn’t realize how stigmatized trans women are until I became one.”
For this reason, Henderson has urged public health officials to stop emphasizing that monkeypox is a virus that primarily afflicts gay men, she said. She felt it would discourage gay, bisexual, and trans Black men from seeking out the vaccine. Being seen walking into an LGBTQ-focused health center could damage a man’s reputation in his community, she said.
“If it’s someone who knows you and knows where you hang out,” she said, “that business is going to be everywhere.”
Health officials acknowledge the quandary. Vaccines are available only to people considered at high risk, which in Philadelphia includes men over 18 who have recently had multiple or anonymous sexual encounters with other men, some transgender and nonbinary people as well as sex workers. But those categories may drive away people who should get vaccinated.
“This is very much a work in progress,” Bettigole said. “We’re talking to community groups, community activists on this to learn how best to frame things.”