There has been some debate about the name of monkeypox, and WHO has started a process to change its name. Why is language important here?
We have to change the name of this virus. It is verifiably incorrect that this virus came from monkeys in the Congo; the monkeys were in a laboratory in Europe. The virus was then found in rodents and humans in Central Africa. The name evokes a lot heart of darkness Images of Central and West Africa that do a lot of damage.
We need a more neutral language. I’ve seen MPV and MPX and both are a significant improvement (I’ll call it MPV). When HIV/AIDS was named GRID (Gay-Related Immune Deficiency), the name of the virus and the disease became associated with queer identity, thus harming gay people who were sick by equating their identity or behavior with a disease like people with HIV. who were not homosexual who were associated with that identity through the virus. Viruses have no identity! They are just little packets of genetic information!
In the US, monkeypox is spread primarily among gay and bisexual men and their sexual networks, a community shaped by the AIDS epidemic. Are there lessons that can be applied to monkeypox?
Of course. It is essential, as this epidemic continues, to maintain that MPV can infect anyone. Any place where there is a lot of contact (sports like wrestling comes to mind) or small shared spaces, like bedrooms, can spread the virus. And we cannot blame this outbreak on gay men, even though we are one of the groups where the virus is spreading.
There are essential lessons from HIV that must be applied in this crisis. With MPV, we are very lucky: we have FDA-approved tests, treatments, and vaccines in stock. People need these tools! This was a great lesson from HIV: After the drugs that worked were developed, it took a decade to ensure those drugs were available in South Africa. Still today, less than 25 percent of people who qualify for HIV PrEP [a medication taken to prevent HIV] have access to the drug. The number for black people is 8 percent, while 63 percent of eligible white people have access to PrEP. Biomedicine is necessary but not sufficient. People must have access to biomedicine and trust that it is designed with them in mind.
Early in the COVID-19 pandemic, the CDC infamously failed tests distributing faulty tests, making it difficult to identify early cases and stop the spread of the virus. It appears that the monkeypox tests also got off to a slow start.
I co-wrote a New York Times opinion piece in late May demanding an increase in MPV testing and setting out a framework to develop that capability immediately. But, as in the response to COVID-19, the urgency to make those changes was absent. Between June and mid-July, testing capacity in New York City, a city home to a million queer Gay Pride hosts and attended by hundreds of thousands more, was limited to fewer than 20 MPV tests per month. day.
This was a choice. The lack of evidence meant that we were underestimating cases. The fact that we were underestimating cases led the federal government to delay shipping vaccines until after Pride.
Speaking of vaccines, how does the monkeypox vaccination work?
MPV should have been an easy virus to contain in the United States. We have millions of doses of two effective vaccines in stock. And yet, in late summer, it seems that this virus is more likely to remain in our communities for some time, if not forever.
In 1980, the WHO announced that smallpox had been eradicated from the planet. In this context, it became unethical to vaccinate widely against smallpox; However, this decision also affected MPV immunity, as smallpox is closely related to MPV. From 1980 to 2010, immunity to MPV in the region of Africa where MPV is endemic went from almost universal to almost non-existent. MPV outbreaks increased. In Nigeria, from 2017 to today, there has been a community spread of MPV in urban centers. We could have been vaccinating in the endemic region to prevent this spread, and if we had, we probably wouldn’t have seen the spread of the virus globally.
One of the frustrating things about viruses is that they are all vastly different from each other. All living organisms, from bacteria to bears, write their genetic information in DNA. Not so with viruses. And each virus will infect a different type of cell with different types of results. All of these differences make some viruses relatively prone to strong vaccine immunity, such as measles, where a vaccine is over 95 percent effective, and some viruses resist vaccine-based immunity altogether, such as HIV. .
Access to vaccines is also reminiscent of early COVID-19 vaccinations, when scheduling an appointment was like winning the lottery. You saying cabling, “When there is so much scarcity, equity is impossible.” What needs to be done to improve vaccination efforts?
Global infectious diseases need global solutions. There are short, medium and long term answers. For now, the vaccines need to get under way. The new CDC/FDA strategy of using a fifth of the dose intradermally may help here, but it throws another variable into the question of how effective this vaccine will be in this epidemic.
In the medium and long term, the world will need more MPV vaccines. Some colleagues and I argued in January 2021 that the world deserved COVID-19 vaccines. We had momentum to get it done in the Biden administration, using the PEPFAR model that funded HIV medicines for all globally. Ultimately, this did not happen, and SARS-CoV-2 continued to evolve and mutate, which global vaccination with the most effective vaccines could have helped prevent.
HIV, COVID and MPV show us that infectious diseases are global in nature. MPV vaccination everywhere the virus is found, and especially in the endemic region, will help prevent more painful infections and loss of life. We need to make more vaccines and we must act urgently.
Harm reduction is used in public health efforts to reduce negative consequences without requiring abstinence, for example, the use of supervised injection sites to prevent drug overdose and encouraging”pandemic pods” during the first waves of COVID to allow socialization in small groups. Is there a role for harm reduction with monkeypox?
Damage reduction is the name of the game! The calls to change sexual behavior actually came first from the queer community. Public health officials are terrified by this, but I was working and talking to some people who throw big parties, and a lot of people in their friend groups had MPV. They voluntarily closed and I am proud of them.
So from the people most affected by MPV, we’re starting to hear that maybe we should all modify our sexual behaviors until more vaccines are available: talk to your connections, wear more clothes to the party, avoid skin contact with groups large. Only after the community began this work did the CDC and the New York City Department of Health issue the same guidance.
Look, it can’t and won’t stop people from meeting or having sex, especially long-term. It just won’t work. HIV research showed us this. It should offer people information about the risk of various infections, prevention through biomedicine when we have it, and knowledge about what infection looks like, how to get tested, and how to get treatment.
Are there other lessons from COVID that can be applied to monkeypox?
We should talk more about how miserable it is to isolate yourself when you’re infected with MPV. For even the mildest courses of infection, people are being asked to completely isolate themselves at home for weeks.
COVID taught us how painful just five to 10 days of isolation can be. Here, people have to isolate twice as much or more. And we haven’t built in any support, be it financial, practical or emotional. We need to support people during and after infection, and work to reduce stigma for people who have recovered.
You are a co-investigator on RESPND-MI, a survey constructed by the LGBTQ+ community on monkeypox prevalence and networks. What do you hope to learn?
RESPND-MI is designed and led by my dear friend Keletso Makofane, a Harvard-trained epidemiologist who studies how social media leads to different health care outcomes. It’s a web-based survey that we’re trying to get every queer person in New York City to take. He asks questions about MPV symptoms, if he’s been vaccinated, who he’s friends with, and who he has sex with. Ultimately, this will provide information on how widespread the virus has been in our city and who is most likely to have had it. We will also build a map of social and sexual networks, anonymously of course. This map can be used to target vaccines to people at higher risk and/or where vaccine uptake is lagging. [People administering vaccines] it can appear, for example, in a gay bar, a gym or even a coffee shop, if that place overlaps with the people you need to find.
In New York, we know that Black people are disproportionately sick with MPV compared to their access to vaccines: While Black people make up 31% of the queer community, only 12% of eligible Black queer people have received a single dose of the vaccine. RESPND-MI, led by a Black epidemiologist along with co-investigators who are mostly queer and trans people of color, is one of many essential ways to end this horrible disparity.
Source: www.nyu.edu