Monkeypox is a major health threat. Government response has been abysmal.

Haven't we been been here before?

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There’s a lot about monkeypox, and the response to it, that is eerily similar to the early HIV epidemic. And there’s a lot that’s not. It’s important to underscore both at this critical moment.

Let’s start with what is similar, such as the fact that, currently, the vast majority of cases in this outbreak around the world and in the U.S. are among men who have sex with men.

And the fact that governments at all levels in the U.S. have responded abysmally.

The federal government, seemingly not learning from the Covid pandemic, has been slow to distribute stockpiles of vaccines, with demand now far outpacing supply —and the millions of vaccines necessary won’t be available until next year — though it’s been several months since the first cases of the current outbreak in the U.S. were reported.

Hundreds of thousands of doses for weeks were sitting in Denmark waiting for clearance from the FDA — which hadn’t inspected them, though European Union health officials had cleared them — as the U.S. saw cases climb to over 1400, a number considered an undercount. Worldwide there are now over 12,000 cases.

New York City has been the epicenter of monkeypox infection in the current outbreak in the U.S., with the state of New York accounting for over 50% of cases. The city saw cases doubling in five days last week — from 238 to 461. Yet the city’s Department of Health has been pathetically incompetent. A rollout of the precious few vaccines that were distributed to the city by the federal government to vaccinate those most at risk has been marked by the online appointment site crashing. Appointments for the few thousand vaccines offered each time (vaccines were offered only online, three times over recent weeks), have been gobbled up in a matter of minutes.

Anyone without access to the internet — and high speed, at that — is doomed in getting an appointment. Mayor Eric Adams wrote a letter to President Biden asking for many more doses of the vaccine, and the federal government has in recent days cleared 800,000 vaccines to be distributed nationally, though they won’t be here until the end of July. But if the city can’t get the vaccines to LGBTQ people at risk in an efficient and equitable way, what does that matter?

Doctors and patients around the country have complained of slow testing, bureaucracy and the inability to get drugs to treat the illness, which can cause excruciating pain:

Although he was covered with lesions, it took four hours of phone calls, and then five hours in a Harlem emergency room, for Gabriel Morales to be tested for the monkeypox virus earlier this month. And that was just the beginning of his wait.

Mr. Morales was sent home and told the Department of Health would call with his results in less than a week. The call never came.

An FDA-approved drug minimizes the miserable flu-like symptoms and painful lesions, and lowers the risk of death (there have thankfully been no reported deaths in the U.S.). And yet, most monkeypox patients do not have access to the drug, called tecovirimat. This, even though the U.S.developed the drug and — you guessed it — has stockpiles of it.

Epidemiologists and health authorities are sounding the alarm, but fear they aren’t being beard:

“Monkeypox is clearly a global health emergency,” Lawrence Gostin, a Georgetown University global-health expert, told The Daily Beast. “It has simmered in small pockets in Central and West Africa for decades, but until now there have been no cases unrelated to travel in the rest of the world. Now it is in virtually every region of the world and spreading rapidly.”

Prof Peter Hotez MD PhD @PeterHotez

We’ll soon exceed 2,000 reported monkeypox cases in US. I said few wks ago this could become an important emerging pathogen here. Now is the window to vaccinate our population at greatest risk before it might spread and generalize in both humans/animals

cdc.govMonkeypox in the U.S.Learn more about monkeypox in the United States.

All of this is outrageous. Once again we’re seeing the richest country in the world drop the ball, as if the people being affected right now don’t matter.

In a time when “Don’t say gay” laws are being passed across the country and at least one of the Supreme Court’s conservatives is pining for banning sodomy again — while Ted Cruz is giving interviews calling for overturning the Obergefell marriage equality ruling — many of us are jolted back to those horrific early years of AIDS. We remember the rise of the evangelical right, and the promotion of the Christian nationalists within the GOP. We remember HIV being used to scapegoat and demonize gay men by the right, often via a sensationalistic national media.

All of that being said, there is a lot that differentiates the current monkeypox outbreak from the early HIV pandemic, both positively and negatively, and it’s equally important to focus on.

Start with the fact that there is a vaccine — a way to prevent this virus from spreading, and a way for each individual to prevent illness.

And there’s the fact that even for those who do become infected, monkeypox, even left untreated, isn’t causing mass fatalities, while almost everyone with HIV faced certain death until the mid-90s when drug therapies saved lives. Monkeypox certainly isn’t causing near the amount of death and long-term illness as Covid-19. In fact, monkeypox, in this current outbreak, isn’t even causing the amount of death it has caused in its own past:

The death rate, mercifully, is still low. As of July 4, the most recent date for which figures are available, the World Health Organization had recorded just three deaths in the current outbreak.

Three out of 9,647—or .03 percent—is a much lower death rate than West and Central African countries apparently suffered in their own pox outbreaks in recent decades. The worst African outbreaks, involving a strain of the virus that’s endemic to the Congo River Basin in Central Africa, have resulted in official death rates as high as 10 percent.

That could change as the virus spreads and mutates. But so far, while some patients have severe pain and debilitation, almost everyone recovers after a couple of weeks.

A difference that is more concerning on a broad scale, however, is that, unlike HIV, which is solely transmitted by bodily fluids, including semen and blood, monkeypox is transmitted by skin-to-skin contact and even via bedding, clothing and furniture (even as it may also transmit via bodily fluids). It made its way into gay social networks outside Africa, where it is endemic, but could conceivably affect any other population.

Some public health experts believe that it in fact has spread into the broader public, and that we’re seeing a vast undercount of cases. We could see outbreaks in nursing homes, homeless shelters, fitness centers, and other locales:

This disease is spread by close physical contact – not sexual contact per se – so other places in which close physical contact is common will be at risk. It's like how a methicillin-resistant Staphylococcus aureus outbreak among gay men can spread to health clubs – think contaminated towels, benches – but this could jump to other settings of high physical contact or contact with contaminated clothing and bedding, such as homeless shelters.

The LGBTQ community, and certainly those affected, have been outspoken about monnkeypox, and should be applauded for shining a light on it. And the media has covered it in a way that isn’t overly-sensational. This is another difference from the early HIV epidemic, when many in the gay community were in denial, seeing AIDS as a PR crisis for the cause of furthering rights — and seeing media fear-mongering and scapegoating — or believing those raising the alarm were overblowing it, pushing “anti-sex” ideologies.

In fact, the demand for monkeypox vaccines in LGBTQ communities shows that people are embracing the reality and the science and want to deal with this head on. LGBTQ health centers have been holding seminars on it, and activists have been demanding more attention be paid to this outbreak, which could soon be deemed a pandemic.

That brings us back to the government response. Whether or not monkeypox spreads rapidly into other populations, it’s a health threat right now in the LGBTQ community — and could remain a persistent one if vaccines and treatments aren’t rushed to health clinics and medical providers rapidly. No marginalized group should be treated so dismissively — which would be a repeat of history.

And monkeypox is a threat to everyone, because it’s likely made its way into other groups and settings, and it could mutate to become both more transmissible and more deadly.

We can’t take that chance, and, after Covid, we should know better. And so should our government and the Biden White House, which rapidly responded to the Covid pandemic and saved many lives after a horrendous, murderous initial response by Donald Trump.

We need the same swift and decisive action now.