‘A lack of care’: Monkeypox response echoes homophobia of past crises

Burdened with slow federal action, King County health officials are scrambling to get a limited supply of vaccines to the estimated 40,000 people who are at risk.

Physician Assistant Susan Eng-Na prepares a syringe with the monkeypox vaccine

Physician Assistant Susan Eng-Na prepares a syringe with the monkeypox vaccine before inoculating a patient during a vaccination clinic at the OASIS Wellness Center, Friday, Aug. 19, 2022, in New York. (AP Photo/Mary Altaffer)

Editor's note: On Nov. 28, 2022, the World Health Organization announced that the disease previously called "Monkeypox" will be renamed "mpox" so as not to employ "racist and stigmatizing language." To avoid altering the context of quotes and information published before this development, we are leaving references to the disease "Monkeypox" in this article.

Seattle novelist Mattilda Bernstein Sycamore, who edited an anthology of writing about the AIDS crisis, believes the federal response to the monkeypox outbreak demonstrates how little it learned from HIV and COVID.

“Unlike both COVID and HIV, we have a vaccine,” Sycamore said, referring to the Jynneos vaccine, which remains in short supply in the U.S. “We have a treatment: an antiviral medication. And we have a pre-approved test. And yet there still isn't enough access. I really believe this lack of access is because of a lack of care.”

Yet despite the federal government’s slow response, public health officials in King County have scrambled to vaccinate the highest risk populations – men who have sex with men, and especially those who have multiple partners – while also trying to avoid stigmatizing those most likely to get the disease. It’s been a delicate balance to strike.

Although monkeypox cases in King County spiked in late July at 61 cases in one week, the disease, which spreads from skin-to-skin contact or from contact with unwashed clothes or bedding, has in the past two weeks begun to level off.

According to Public Health Seattle & King County, there have been a total of 323 confirmed monkeypox cases in King County. At a press conference on Aug. 9, county health officer Jeffrey Duchin said that about 75% of those cases have been in Seattle, and the majority of cases are among men between the ages of 18 and 49.

Seattle architect Andrew Grant Houston, who ran for mayor in 2021, was one of the lucky few to get vaccinated in early August at the sexual health clinic at Harborview Medical Center.

“I find this entire situation frustrating and disappointing,” Houston said. “They're working with the materials that they have, but it doesn't feel as strong of a response as you would like for something that’s very concerning.”

Monkeypox, first identified in 1958, was for decades generally confined to tropical rainforests of central and west Africa. The origin of the current global outbreak, which began in April, hasn’t been determined. But as of Aug. 26, the World Health Organization reported that more than 46,000 cases have been confirmed worldwide outside of the endemic regions in Africa. According to the CDC, as of Aug. 25, nearly 17,000 cases have been documented in the U.S., with no fatalities yet recorded.

Although related to smallpox, monkeypox is much less dangerous, with a historical fatality rate of about 3%. Nevertheless, it’s a painful, unpleasant and serious disease. Monkeypox generally begins with a rash, and then a series of blisters and lesions that can develop all over the body. When those lesions occur in sensitive areas such as the genitals or anus, they can be excruciatingly painful. The disease usually lasts two to four weeks, and quarantining for that length of time can be an immense burden, especially for people with limited sick leave or personal time.

According to a report in The New York Times, the U.S. once had a stockpile of 20 million doses of Jynneos smallpox vaccine, which is also effective in preventing monkeypox. But by May of this year the country had let those doses expire and had a mere 2,400 doses on hand. The U.S. was slow to address that shortage, and it wasn’t until early August that the Biden administration finally declared monkeypox a public health emergency, after the World Health Organization declared monkeypox a global health emergency on July 22. By then there was an overwhelming global demand for the vaccine. In response, the CDC issued guidelines aimed at preventing transmission, which advised against anonymous sex, attending dances and raves in which skin-to-skin contact was likely and reducing the number of sexual partners.

“The echoes to the AIDS crisis are so direct,” said Sycamore, who edited “Between Certain Death and a Possible Future,” a collection of queer writing on the legacy of HIV published in 2021. “You see these images of gay men covered in sores. And then this resurgence of sexual moralism that's blaming people for their actions rather than blaming the government, or our structural racism and homophobia.”

Locally, availability of the vaccine has been severely limited – though in the past two weeks, the situation seems to be improving. At the Aug. 9 press conference, Duchin said Public Health estimated there are about 40,000 people at risk of contracting monkeypox in the county who would benefit from the vaccine. But Duchin said that by Aug. 9 the county had only received enough Jynneos to vaccinate 4,400 people.

Early pop-up clinics were crowded and overwhelmed. Grant Houston said several of his friends went to a vaccine pop-up clinic at Seattle Central College on Capitol Hill in early August and faced a three- to four-hour wait. “They went and then gave up because the line was longer than the number of shots available,” Houston said.

Sam Chapman, who performs in drag as Jane Don’t at Queerbar on Capitol Hill, was frustrated by this lack of access. When a friend came down with monkeypox in July, Chapman decided to travel to British Columbia to get the vaccine.

“The process was actually much easier and less stressful than I anticipated,” Chapman said. Border patrol didn’t ask questions and the clinic didn’t seem to mind if patients were from the U.S. Chapman received the vaccine in Abbotsford at a rural clinic, which they said also seemed to be a horse clinic. “There’s a ketamine joke in there somewhere,” Chapman quipped.

Jonny Cruz also traveled to British Columbia and got the monkeypox vaccine at Fraser Health in Vancouver. At the clinic, Cruz was asked a few questions to determine if he was in the higher-risk category and within 20 minutes he got his first dose of the vaccine (Jynneos is a two-dose vaccine).

In response to his frustration from trying to find accurate information, Cruz created an online resource guide to help other queer men access information about the disease. He feels the lackluster national response is directly related to homophobia.

“If it was more straight people who were getting it,” Cruz said, “I can guarantee you the vaccine rollout would have been a lot quicker.”

Sycamore, who was able to get a vaccine after receiving a tip about open appointments, believes the fact that queer men have to travel three hours north of the border to get the vaccine speaks volumes. “You know this country is doing something wrong when people are leaving the country to get their health care,” she said.

The scarcity created by the slow national response evokes the long, terrible history of the AIDS crisis, Sycamore says. “When we have this homophobic lack of response, there's no way for trauma not to reemerge. That trauma has never been dealt with. There has never been accountability for the government's neglect.”

Sycamore has been advocating for months on Twitter for a more care-centered response to the outbreak. “The way to reach people most in need is not to make people stand in line. It’s to go to where they are,” she said.

To that end, Public Health Seattle & King County has been making a concerted effort in the past several weeks to expand outreach to queer spaces and places where people of color feel more comfortable getting the vaccine.

Nathan Adams, owner of the White Center bar Lumberyard, hosted and promoted a free Monkeypok vaccination clinic at the soon-to-reopen bar in mid-August where more than 560 people were vaccinated. Neighborhood favorite Lumberyard burned down in 2021 and has been rebuilt across the street from its former location. (Genna Martin for Crosscut)

On Aug. 14, public health officials worked in collaboration with the Lumberyard, a queer bar in White Center, to set up a free monkeypox vaccine clinic. More than 560 people, many of them Latino and people of color, were vaccinated, said owner Nathan Adams, who helped promote the pop-up clinic through social media channels.

“The response from the community for the vaccination clinic was super,” Adams said. “I was stunned. [Public Health] was very, very efficient. The speed at which they were moving people through here was exceptional.”

Also exceptional is the effort to rebuild the Lumberyard, a beloved fixture of White Center’s LGBTQ community, after it burned down in 2021. An online fundraising effort led by White Center Pride raised $100,000 in a matter of days after the fire. Adams says the bar is nearly ready for a reopening in September. Public health officials reached out to him, looked at the state of the construction, and were convinced the Lumberyard was the perfect spot for a pop-up clinic. 

“They're doing a better job than I thought they would,” Adams said of public health’s efforts. “They're really targeting Spanish-speaking and African American communities, because those are usually communities who don't have health care or aren’t as proactive with health care because of the stigma that goes with it.”

Steven Sawyer, president of Pacific Northwest Black Pride, reached out to public health officials in August to urge them to set up a monkeypox vaccine clinic at the organization’s annual Cultural Health and Wellness Festival at Jimi Hendrix Park in the Central District. “We insisted, and we held their feet to the fire,” Sawyer said in an interview at the festival on Aug. 21 amid thumping music and an array of booths dedicated to health information.

“It’s horrible that in Atlanta, nearly 90% of cases are among Black men who have sex with men. How could we not see this coming?” Sawyer said. He believes the festival was an ideal spot for a vaccine clinic because it was aimed at creating a “space that’s comfortable, where people can find connection.”

The clinic had enough doses for 200 people to get vaccinated, said Michael Young-Hall, an official with Public Health Seattle - King County. Young-Hall noted that a newly approved injection technique for getting more doses from each Jynneos vaccine vial – which has effectively tripled or quadrupled the number of doses available – is being employed by medical professionals at pop-ups such as this one. “It required some training for some of the nurses,” he said, “but many were already familiar with it.”

He noted that public health has future plans to work at sites including UW Medicine in Kent, Sea-Mar health centers in South King County and gay bathhouses such as SteamWorks on Capitol Hill in order to reach out to those higher risk communities.

Unlike previous events like the one at Seattle Central College, the pop-up clinic at the Black Pride wellness festival was a calm, quiet scene with almost no line. Many people who walked up had time to casually chat with public health staff and learn more about the vaccine. Dwayne King, a board member with the multicultural health nonprofit POCAAN, another event sponsor, said this sort of environment is critical for people of color, many of whom have valid reasons for being skeptical of the health care establishment.

“It allows people to go ask questions about the side effects, talk about the effectiveness of it, and then see people that look like us,” King said.

“Does someone really want to go to an STI clinic and wait three hours?” King said. He told the story of one person he observed at the festival who was shocked to see a clinic there, asked a few questions and then got the vaccine. “They were very grateful because they work a 9 to 5 job and they’d been trying to set up appointments, and it was not working,” he said.

Sycamore believes this sort of approach is a better takeaway from the traumatic experiences the country went through trying to survive HIV and COVID. “The legacy of crisis should be communal care. Where is that lesson, that legacy? Or do we just keep having too little too late?”

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About the Authors & Contributors

Andrew Engelson

Andrew Engelson

Andrew Engelson is a freelance journalist and editor based in Seattle.