Racial disparities marked the rollout of monkeypox vaccine

New York City released new data on Thursday showing stark disparities in monkey pox vaccine access, with a much lower proportion of blacks receiving the vaccine than members of other racial groups.

White New Yorkers represent about 45 percent of those at high risk for monkeypox infection, and have received 46 percent of the vaccine dose. Black New Yorkers, who make up 31% of the population at risk, have received only 12% of the doses used so far, according to data from the city’s Health Department.

Hispanic residents make up the majority of vaccine recipients. They make up 16 percent of the population at risk, but have received 23 percent of vaccinations. Hispanic men by far represent the largest proportion of monkeypox patients.

Racial and ethnic disparities in vaccine distribution are also occurring elsewhere, as the very limited supply of monkeypox vaccine is often reserved for those with better access. with the healthcare system and have more time to figure out when the dose will be released. There are also concerns among advocates that a new method of vaccine administration favored by the federal government, using only a fraction of current doses, could inadvertently deepen disparities.

To date, New York City has vaccinated more people with smallpox than any other jurisdiction. About 64,000 of the roughly 130,000 people it considers most at risk received the first of two doses. New York City estimates that about 134,000 people — mostly men who have sex with men — are at higher risk of infection, based on a 2020 city health survey.

Racial disparities have frustrated public health experts and activists because the lessons from the Covid-19 response have yet to be learned. Black and Hispanic New Yorkers were more likely to contract Covid than white New Yorkers, hospitalized and die in the first deadly wave in spring 2020. They also suffered less likely to receive the vaccine soon, and less likely to get early treatmentsuch as monoclonal antibodies.

Public health experts and activists are particularly frustrated that monkeypox vaccination appointments have been made primarily on a first-come, first-served basis, just as if they were in the early stages. the first phase of the Covid vaccination series. Public health experts say that means vaccine recipients tend to be whiter and wealthier than other eligible New Yorkers. because they are more likely for a flexible schedule, allowing them to spend as many hours as possible finding a vaccination appointment.

Matthew Rose, a Black HIV and Social Justice Activist. “This is a foreseeable problem. We ran the same play that we had run before. “

In New York City, the first batch of the vaccine was given with little advance notice, midday Thursday, at a sexual health clinic in Chelsea, Manhattan, to a predominantly white crowd. . Subsequent vaccine services are based on a internet appointment system malfunction.

A dispensary was established in Harlem, but those who came were mostly white and lived elsewhere. Neighboring residents were unable to step in and take pictures, a decision that was met with deep criticism from community members who felt excluded. Some Black men said the city wasn’t doing enough to warn them about the disease or how to protect themselves.

“I think there should be more information about the monkeypox vaccine not only in the LGBT community, but also among us blacks and browns,” said Dominic Faison, 35, a Bronx resident. suffering from monkeypox in early July said even heard of the vaccine.

In recent weeks, the city’s health department has changed tack, prioritizing high-risk patients and providing direct doses of doses to public health organizations. But the effort has not been able to completely correct the imbalance. This vaccine is called Jynneos and is given as a two-dose regimen.

Ashwin Vasan, the city’s health commissioner, said in an interview on Thursday: “Black men in particular are under-represented in our vaccination effort relative to their risk. .

Dr. Vasan added: “I think we have a lot of work to do to raise equity. “And sometimes there are trade-offs in terms of speed and the ability to drill down, build relationships, work with trusted partners, and bring the people who need the vaccinations most accessible.”

There are signs that the spread of monkeypox is slowing in New York City. After a sharp two-month spike, cases of monkeypox spiked at between 60 and 70 new cases per day at the end of July. Recently, they have reduced an average of 54 cases per day, according to city ​​data.

City health officials remain concerned that many cases go unreported, especially among those in communities of color with little access to health care. On Thursday, the city said it plans to give $5 million in grants to community organizations in low-income neighborhoods to help advance immunization efforts.

Follow federal data – about 20 percent of cases nationwide.

While some jurisdictions have released racial data on recipients, those have revealed disturbing trends.

For example, in North Carolina, 70% of monkeypox cases occurred in Black men and 19% in white men, but 24% of vaccines went to blacks and 67% to humans. White skin, According to a report dated August 10 from the North Carolina Department of Health. (Because the virus is primarily spread through networks of men who have sex with men, the focus of national vaccination campaigns is on that demographic.)

A similar trend is emerging nationwide in terms of people having access to the antiviral drug Tpoxx, an effective treatment for monkeypox: Blacks make up just 17% of the 233 patients treated. as of July 22, although they accounted for 26% of all patients at the time, according to the CDC

Tpoxx is not particularly scarce – the federal government has a stockpile out of more than 1.7 million courses – but there are barriers to accessing itincluding cumbersome paperwork.

The dosage of Jynneos, the vaccine, was scarce since the outbreak began, partly a federal mistake. To expand supply further, the federal government recently approved a new way of administering vaccines, allowing providers to use only one-fifth of the current dose. Vaccines can now be used in the skinor between layers of skin, but not in subcutaneous fat.

The strategy allows federal officials to assert that they have resolved the supply problem and that there is now enough vaccine to provide all 1.6 million people they believe are most at risk.

But some advocates in the gay community worry that the new dosing strategy could complicate the equity issue rather than solve it.

Intradermal vaccines can be safe and effective. But only research tested the safety and efficacy of intradermal injection of Jynneos vaccine. The manufacturer does not note significant safety concerns or reduced effectiveness, but there is a high chance of side effects at the injection site, such as redness, swelling, and firmness.

Switching to fractional doses also requires training. Most providers do not have much experience with subcutaneous injection. If injected too deeply, fractional doses will not be effective. The need for training can also limit the number of small community clinics that reach disadvantaged groups can provide.

Dr. Vasan, the city’s health commissioner, said that while New York and other localities are feeling pressure from the federal government to make a rapid transition to the new approach, the city has planned to do so. is changing gradually. Pressure mounted on Thursday, when the White House announced that the next phase of distribution of 1.8 million doses of the vaccine – calculated by multiplying 360,000 full doses by five – would distributed to jurisdictions only adopt a new approach.

“I think every jurisdiction feels like this is a quick transition,” he said. “We need time to get this right. The last thing I want to do is roll out something that hasn’t been accepted by the community yet.”

Some gay rights advocates have spoken with city and state health officials about a hybrid plan: All recipients will receive the full dose of their first vaccine and every people will be given fractional injections for the second dose, to ensure fairness.

City and state officials have been receptive to the idea, they said, which could also allow doctors to collect data on side effects and effectiveness during the trial period. Vasan says all options are still on the table.

Joseph Osmundson, a virologist at New York University, said he was concerned that the federal government’s approach would push jurisdictions to switch to the new method quickly even if they had concerns. Health advocates say it can also be difficult to sell Black men in particular under the new approach, which could raise suspicions that they are being treated lower.

As the city saw in its Covid vaccine campaign, many black New Yorkers trust in government and medical facilities warranted because of the long history of racism in medicine, as well as previous medical trials on Blacks.

“So now that a significant number of white gay men in the biggest US cities have been able to take risks, they’re just reckless,” said Kenyon Farrow, executive director of advocacy at PrEP4All. need to do – anything – with us,” Kenyon Farrow, executive director of advocacy at PrEP4All, an HIV advocacy group, describes the sentiment he’s heard from black gay men. on social networks.

“If that happens in any way that a large number of people feel that way, then you really undermine the whole point of having to switch to this strategy in the first place,” he said.