WASHINGTON – Racial disparities persisted in response to the monkeypox outbreak as the numbers of black and Latino men now infected with the disease are disproportionately high, but that disparity is receiving new attention as overall cases decline.
Although overall new cases in monkeypox outbreaks are steadily declining after numbers peaked in the summer, a growing proportion of the persistent numbers are due to men who have sex with men from ethnic minorities.
The most recent figures show the racial disparity significantly. In the week of September 4, blacks made up 41% of cases and Hispanics were 27%, while 26% were white and 3% were Asian, according to data from the Centers for Disease Control.
Among the new cases of monkeypox, black people were far fewer when the numbers were first reported earlier in the summer. For example, it was 18 on June 22 and 8 percent on June 8. The percentage of Hispanics, as with whites, has been declining, although they are still overrepresented in new cases in the context of their demographics in the US population at large.
The disproportionate impact of new monkeypox cases on ethnic minorities has not gone unnoticed. As a result, health officials are trying to shift the focus of the monkeypox outbreak away from gay, bisexual and other men who have sex with men on a larger scale, and more toward men of color from sexual minorities.
Racial disparities in monkeypox outbreaks are largely due to the fact that black and Latino men are “less likely to get vaccinated than their proportion of the population,” Shaun Cahill, director of health policy research at the Boston-based Fenway Institute, said in an interview with the Washington Blade.
“So they’re more likely to get monkeypox, and they’re less likely to get vaccinated,” Cahill said. “So this is a real problem, and it’s really important to know that federal, state and local partners come together and really focus on fairness in the response and trying to reduce the burden on black and Latino gay men, but also increase access to a vaccine to make sure that people can protect themselves.”
Last week, the Fenway Institute released a blueprint calling for a more effective federal response to monkeypox, accusing the US government of failing to effectively mobilize existing public health infrastructure to help communities affected by the virus. The document outlines a range of possible actions, but also concludes that marginalized communities have difficulty accessing vaccines and treatments, which are concentrated in well-resourced institutions and hard to reach for communities of color.
Asked to describe whether the numbers showing racial variance have changed over time or have remained stagnant, Cahill said that any trends are hard to pin down because data on racial demographics were only recently available and “it’s very imperfect data.”
“I don’t know if the disproportionate racial impact is getting worse or better,” Cahill said. “But it’s definitely there, and it doesn’t look like it’s going to go away.”
The Biden administration, while touting the 20 percent decline in total cases in the monkeypox outbreak, is beginning to recognize the continuing disproportionate impact of monkeypox on black and Latino men who have sex with men.
Rochelle Wallinsky, director of the Centers for Disease Control and Prevention, said during a conference call with reporters that the US government is approaching the decline with “cautious optimism.”
“Over the past several weeks, we’ve also seen the racial and ethnic makeup of this outbreak evolve,” Walinsky said. “While monkeypox cases were first seen mostly in non-Hispanic white men, in the past week, among the cases we had data on race and ethnicity, non-Hispanic black men represented 38 percent of cases, and Hispanic or Hispanic men represented 25 percent of cases, Non-Hispanic white men account for 26 percent of cases.”
Among the efforts the Biden administration has made is a trial program of vaccines intended for big events and equality. Monkeypox vaccines have been given to more than 10,000 people, including at Southern Decadence in New Orleans, Atlanta Black Gay Pride, Charlotte Pride, Boise Pride Festival, and Oakland Pride and Pridefest.
Dr. Demeter Daskalakis, the LGBTI director of outreach to the Biden administration in anti-monkeypox efforts and deputy director of the White House Monkeypox Task Force, was among those who promoted the pilot in equity efforts during a conference call with reporters.
“Health departments will use their local expertise and community outreach to identify local strategies to improve vaccine access to communities of color, specifically those that have been overrepresented in this outbreak,” Daskalakis said.
Racial disparities in monkeypox outbreaks are consistent with other trends in public health, said David Jones, executive director of the National Alliance for Black Justice.
“There was a lot of opportunity to learn ways to address health inequality before it grew,” Jones said. “Blacks continue to be disproportionately affected by this latest health epidemic is further evidence of how white supremacy works and the importance of democratic responses to crises.”
Biden health officials, who were asked by Washington Blade during the virtual meeting why the administration’s stated goal of fairness in managing monkeypox outbreaks does not lead to racial equality among new cases, reiterated their efforts and spoke of the difficulty of achieving that goal.
Walinsky, who has also had a leadership role in the Biden administration in the fight against the coronavirus pandemic, said racial disparities in monkeypox outbreaks “are not uncommon for many infectious diseases, unfortunately,” and defended the US government’s approach to monkeypox.
“It is precisely for these reasons that we started on these pilot projects even before we saw shifts in the data, as is often the case in infectious diseases where we have more vulnerable populations — racial and ethnic minorities — that are affected more later on,” Walinsky added. “So, we anticipated this. We have embarked on these activities to address this at this exact moment.”
Continuing to defend the Biden administration’s efforts on equity, Daskalakis said he “spoke to providers on the ground and also promoters at these events who have noted that this effort is truly unprecedented in terms of reaching deeply into these communities.”
I think all of our commitment in management is to really focus efforts on fairness to solve the problems we see. “It’s a hard and challenging effort,” Daskalakis added. “And I think the way fairness is addressed is on purpose, and this is an example of intentional action to address equity.”
As racial disparities persist in the outbreak of monkeypox, health monitors say additional efforts are needed to reach marginalized communities to ensure they have access to public messaging and vaccines.
Cahill said that although people of color in urban areas go to LGBTQ centers for health care, many also get care through other non-LGBTQ facilities, such as emergency rooms and urgent care clinics.
“I think providing some training and technical assistance to these healthcare organizations on how to provide affirmative care to intersex men could be an important approach and could make them more likely to disclose homosexual behavior in those contexts,” Cahill said.
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