By Eli Walsh. Bay City News
San Francisco supervisors on Thursday criticized the public health response to the ongoing global outbreak of "monkey "pox, calling for better communication with at-risk groups and an influx of vaccine doses.
San Francisco currently has 141 confirmed cases, more than half of the 266 confirmed statewide as of Tuesday.
The vast majority of the city's cases have been confirmed in gay or bisexual men between the ages of 25 and 54, and about 42 percent of the confirmed cases have been in Asian, African-descent or Hispanic residents.
Stephanie Cohen, M.D., medical director of the City of San Francisco Clinic and director of HIV and STI prevention within the city's Department of Public Health, said the city requested a conservative estimate of 35,000 doses of simian smallpox vaccine, but only received approximately 7,700 doses.
"Vaccines are the most effective tool in our toolkit to combat this virus and the best way to protect people," Cohen told the San Francisco Board of Supervisors' Governmental Oversight and Audit Committee of the Board of Supervisors during a hearing on the response to simianpox.
"Unfortunately, the federal response has been slow and hampered, and supply is extremely limited and far in excess of need and demand," he stressed.
The virus is generally transmitted through skin-to-skin contact or bodily fluids through kissing, close breathing, sexual activity and sharing bedding or clothing. Local, state and federal health officials have emphasized that the virus is not airborne like COVID-19 or the flu.
Symptoms may include a rash or skin sores anywhere on the patient's body. Contraction of the virus often also begins with flu-like symptoms.
The virus has been confirmed worldwide in many men who identify as gay or bisexual, but public health officials have emphasized that the virus is not exclusive to men who are attracted to men, and anyone can contract monkeypox through close contact with an infected person.
Supervisor Rafael Mandelman, one of two LGBTQ members of the board and the supervisor who convened the hearing, compared the response to the simian pox outbreak to the HIV/AIDS epidemic of the 1980s, calling it "eerily familiar" to those who remember the early days of the epidemic.
Mandelman also called the federal effort to provide more doses of the two-dose Jynneos vaccine for monkeypox and smallpox "totally inadequate" for the scope of the current outbreak, and pointed to the rapid and successful effort to vaccinate some 40 million people against COVID-19 in the first three months after the vaccines became available in late 2020.
Federal health officials have stated that they plan to fully vaccinate some 3.5 million people against monkeypox by mid-2023, a goal Mandelman called "abysmal."
"We have almost 6 million, maybe more, men who have sex with men and trans people living in the United States," he explained. "This is all assuming that this monkeypox outbreak remains within the queer community. There is no reason to believe that at some point it won't spread, so this is a farce."
Some 6,100 people in the city had received at least one dose of the simian smallpox vaccine as of Wednesday, according to the SFDPH, but Cohen said the shortage of vaccine doses will require the city to postpone administering second doses for most people. even if they are given a date and time to return for their second shot.
"We intend for everyone to receive a second dose, but the guidance right now from the state is to prioritize the first doses to ensure that we get the first dose for as many people as possible, and as soon as we have the supply to administer those second doses, they will be administered," Cohen stressed.
State officials have also called for an influx of Jynneos vaccine doses as soon as possible.
In a letter sent Tuesday to the U.S. Centers for Disease Control and Prevention, Dr. Mark Ghaly, the state's secretary of Health and Human Services, and Dr. Tomas Aragon, director of the California Department of Public Health, said the state needs at least 600,000 to 800,000 doses, and said that was a conservative estimate.
Even with the lack of doses, the city expanded its eligibility for the vaccine to all men who have sex with men who have had multiple sexual partners in the previous 14 days, as well as sex workers of any sexual orientation or gender.
Mandelman told an anecdote of Hans How, a member of the city's Housing Stability Fund Oversight Board, who sought a dose of vaccine and was forced to wait in hours-long lines at Zuckerberg San Francisco General Hospital, only to be turned away twice because the hospital had run out of doses.
He also said that former Equality California assistant and current political director Tom Temprano had sought information from SFDPH on how to get vaccinated, but ultimately learned how to access a vaccine through Twitter because department officials did not answer his calls.
Mandelman called the logistical problems "quite unforgivable" and called on Cohen and other SFDPH officials to resolve them.
"These are two people with extraordinary access who have been involved in city government. We're talking about upper percentiles of ability to access public services," he referenced. "So I can only imagine how great the frustration and feelings of helplessness are for thousands, if not tens of thousands of other people who should be getting this vaccine."
San Francisco AIDS Foundation executive director Tyler TerMeer said that while his organization has vaccinated 761 people as of Wednesday, the foundation has only 127 doses of vaccine available and about 5,300 people on its vaccination waiting list.
TerMeer also noted that the foundation recently launched a hotline for information about monkeypox that receives approximately one to two calls per minute, which pointed to the need to educate the public about the virus and how to prevent its spread.
"We've just seen an incredible demand for access to information, for people to talk about their concerns and fears as monkeypox continues to spread in our community," he said.
Cohen said the Department of Public Health has also been inundated with calls and voicemails from people seeking information about the virus, but the department's communications team has had trouble keeping up.
"I think not only have we been giving out bad information, but we've actually made things worse by telling people to call these numbers where, at least from the people I'm talking to, they're not getting calls," Mandelmann said.
Cohen suggested that the city's current state of trying to quell the outbreak is due in part to "failures on multiple levels" and an overly optimistic view by federal health officials that monkeypox could be contained by vaccinating only those most at risk of contracting it, contracting it and spreading it, a strategy known as ring vaccination.
With better preparation, he argued, the vaccines could and should have been distributed in large quantities about six weeks ago.
For now, local public health officials are wondering along with San Francisco residents when more doses will be delivered.
"I think we're trying to hope for the best and plan for the worst around the allocations," Cohen noted. "But we'll continue to keep everyone updated because we're on the edge of our seats for that as well."
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