December 6, 2022

Do vaccines reach those most at risk?

Read Time:5 Minute, 45 Second


(CNN) — Three months after the current monkeypox outbreak began, the United States already has more than 12,000 cases… and counting.

And despite a growing supply of the Jynneos vaccine—as well as a new strategy for delivering it that could increase its current availability fivefold—there is still no evidence that this protection is reaching those most at risk.

“If you think about the fact that there is a limited number of vaccines available, you really want to know which groups you should be targeting first,” said Dr. Stella Safo, an HIV primary care physician and founder of advocacy group Just Equity for Health.

“That’s the perspective of equity: that we don’t all experience disease and social determinants of health equally. Therefore, available treatments and resources should also be targeted to those who need them most,” he added.

A detailed analysis of the registry of monkeypox cases published this month by the US Centers for Disease Control and Prevention (CDC) revealed a new perspective on the populations that the outbreak has hit disproportionately, including black and Hispanic people.

The lack of information throughout the country on vaccination against monkeypox

But there is still no national picture of who has received the vaccine. Additionally, the limited state-level data that is available is not promising.

According to CDC records, more than half of monkeypox cases nationwide are among Hispanics (28%) or blacks (26%), who make up just about a third of the general population.

In North Carolina, the disparity is even worse. More than 70% of cases are among black people, but only about a quarter (26%) of vaccines have been given to blacks in the state, according to data posted on the North Carolina Department of Health website. North.

And in Colorado, less than 15% of monkeypox vaccines have gone to black or Hispanic people, according to data the state health department shared with CNN last week.

“It’s not surprising that there are inequities in who is getting vaccinated versus who is diagnosed with monkeypox,” said Dr. Oni Blackstock, an HIV and primary care physician and founder of the consulting firm Health Justice. “So we can assume that these are not isolated cases. These inequities likely exist across the US and really need to be addressed, especially if we want to control this current outbreak,” he added.

More help from local authorities

Does a lower dose of monkeypox vaccine work? 1:52

The public health response to the monkeypox outbreak in the US has drawn criticism as blame bounces back and forth between the federal government and the states.

Health and Human Services Secretary Xavier Becerra said last month that the federal government is prepared to respond. However, he added that he needs more help from local authorities.

“We need the states, the local public health directors to provide us with data so that we have information. Not only to get an idea of ​​how, and what kind of volume, but also to know how to concentrate the help that we can deliver,” he said. “We need more cooperation from the locals to get the information we need,” she insisted.

The CDC is about to complete a data use agreement with states, which would function as a “mutual agreement” to funnel monkeypox vaccination information to the agency from “various sources.” It is an adjustment to the data use agreement on covid-19 and would have the same “requirements and provisions”. A draft of the agreement states that its purpose is “to further the federal government’s efforts to develop a comprehensive picture of monkeypox vaccine distribution nationwide.”

As of last week, 54 of 61 jurisdictions had signed the agreement.

Book with demographics

However, when CNN contacted all 50 states for demographic details on who had received the monkeypox vaccine, most did not respond. Of those who did, most said the data was not yet ready for publication, due to privacy concerns about the small number of people who have been vaccinated or a delay in processing demographic data.

The lack of data on people who have received the vaccine has also caught the attention of political leaders.

Last week, Rep. Ritchie Torres sent letters to local leaders in his home state of New York, as well as the Department of Health and the CDC, calling for demographic data on monkeypox vaccination to be publicly released.

“History tells us that we cannot trust the public health system to automatically meet the needs of the underserved: there should and must be transparency and accountability. And public disclosure of demographic data is critical to both,” he wrote.

They wait up to two hours for the monkeypox vaccine 3:38

On Monday, eight Washington city councilors sent a letter to the local health department requesting more information about the vaccines to ensure equitable distribution. They specifically request more information to show how the district is “applying lessons learned during COVID-19 on communication and vaccine distribution to the monkeypox situation.”

Vaccination against monkeypox “repeats” what happened with covid-19

For Blackstock, monkeypox “repeats” what happened with covid-19, but worse.

“Again, marginalized and vulnerable groups are affected. And there is very little sense of urgency in terms of getting resources to the communities that need them most,” he said. “Monkeypox has even greater stigma for gay, bisexual and other men who have sex with men. And then the intersections of that with Black and Latino men being the most affected.”

In a statement Monday touting the additional vaccine supply available to states, Becerra emphasized the need for coordination and collaboration.

“We will continue to work with our state partners to ensure equitable and fair distribution of these vaccine doses to protect those most at risk and limit the spread of the virus,” he said.

Experts say that, especially with the sensitive nature of the current monkeypox outbreak, working closely with the most affected communities is critical.

The Washington city health department told CNN there was an “increase in high-risk people getting the vaccine, especially in the black community, by reducing the specificity of the data collected.”

Distrust aggravated by ruling in Roe v. Wade

That speaks to a historical mistrust of health care, but also to a “contemporary mistrust” made worse by the reversal of the abortion ruling in Roe vs. Wade that the Supreme Court made, Sappho said.

“People don’t trust that this data that is collected will not be used in a way that negatively affects them. However, from a public health perspective, we need this data so we can understand how to target resources,” he said.

“It goes back to the reality that we need people in these communities to be at the drawing board when we think about how we collect data, how we roll out vaccines, how we talk about these conditions. ”



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