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Health and Wellness Shifting strategies for Monkeypox vaccines in Charlotte and the state
Shifting strategies for Monkeypox vaccines in Charlotte and the state
Health and Wellness
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By Anne Blythe/North Carolina Health News| qnotes Contributor
Raynard Washington, the Mecklenburg County health director, takes umbrage when he hears people say the monkeypox vaccine clinic staged at the Charlotte Pride celebration last month fell short of expectations.
In mid-August, Mecklenburg Public Health worked with the state Department of Health and Human Services to administer the Jynneos vaccine at the Pride events through a pilot program offered by the White House and Centers for Disease Control and Prevention.
The pilot program had set aside 50,000 doses of the vaccine from the Strategic National Stockpile, vials that had been reserved to fight potential smallpox outbreaks. Monkeypox is related closely enough to smallpox that the vaccine can be used to prevent either disease, even though monkeypox is a much milder infection that rarely causes death.
Mecklenburg County received enough vaccines to inoculate 2,000 people from monkeypox that weekend. The county health department had more supply than takers at the two-day event.
Nonetheless, Washington chooses to put a different spin on the large-scale vaccine event than some in the national media. “I definitely would not call vaccinating 540 people not a success,” Washington said during a phone interview with NC Health News. “That pilot that we did with the CDC and the feds was literally organized the week of.”
A little more than a week before, the Food and Drug Administration amended the emergency use authorization for Jynneos, changing how the vaccine could be administered. Before then, the vaccine was administered subcutaneously, in the layer of tissue between the skin and the muscle below, in two doses four weeks apart.
The Mecklenburg County health department had not planned to do a largescale event because supply was limited before the FDA decision on Aug. 9. That allowed administration of the vaccine intradermally, just under the skin, similar to how tuberculosis tests are given. Changing the administration method stretches the supply because only one-fifth of a fivemilliliter vial is required per dose, meaning vaccine administrators could get five shots from a vial instead of one.
With a couple thousand vials en route, Mecklenburg, which had the highest number of cases at the time, did a lot of scrambling days before the Pride events.
“So in context, certainly we would consider it a success that we were able to mobilize so quickly, and to get so many people engaged,” Washington said. “We have been since the beginning of our response activities, sort of managing both a broader outreach campaign and a very targeted campaign, specifically at the Black and brown community to assure that access was available.
“We noticed very early on that there was a divergence in our case demographics and our vaccine demographics, where we were seeing more individuals of color with cases and fewer, a lower proportion, that were getting the vaccine.”
The health department worked with party promoters, nightclubs and an inclusive church to get the word out and provide monkeypox vaccination opportunities during the Pride celebrations.
“We started working with the party promoters several weeks before Pride, and participated in Black Pride so we started working closely with them,” Washington said. ”Even in one weekend, where at just a couple of parties, we were able to vaccinate 200 people … and so we had been working the ground prior to Pride, and Pride got a lot of national attention. “Our campaign efforts have been going on before and after that, vaccinating individuals,” he said.
Engaging the Community
Monkeypox cases in North Carolina and across the country have largely been confined to men who have sex with men, or MSM.
As of Sept. 15, 446 cases of monkeypox had been reported in North Carolina, according to DHHS. Ninety-eight percent of the cases were in men. Ten women have contracted the virus, according to the dashboard.
So far, North Carolina has vaccinated at least 16,042 people to protect them against monkeypox. The shots are available to anyone older than 18 who has had close contact with someone infected with the virus within two weeks.
The shots also are recommended for people who have had sexual contact within the past 90 days with gay, bisexual or other men who have sex with men or transgender individuals. People who were diagnosed with syphilis in the past 90 days or people with HIV or taking medications to prevent HIV also are encouraged to get a vaccine.
In North Carolina, where nearly 70 percent of the cases have been among the Black population, they represent only 27 percent of the people who have been vaccinated. A week and a half ago, Kody Kinsley, DHHS secretary, went to North Carolina, Central University, an HBCU in Durham, and got a vaccine to highlight the partnerships that DHHS wants to continue to build with HBCUs. At a White House briefing on Sept. 7, Demetre Daskalakis, deputy coordinator of the White House Monkeypox Response team, said building partnerships at the ground level with county health departments and community organizers would be key to virus containment efforts.
“It’s not about just the vaccine allocation,” Daskalakis told reporters, “It’s about that intense community engagement that happens on the ground because, ultimately, public health is a local event. And so, giving the tools that people need to be able to sort of reach health goals is what we’ve been doing. And the support of organizations that serve Black and brown people have been pivotal in really turning the tide in what I think you’re going to see, the new vaccine numbers emerging over the next few weeks.” Erika Samoff, who heads up HIV/STD surveillance for the state’s Division of Public Health, said the plan is to recruit and deploy more community health workers to help attack the spread of monkeypox.
“Which I think is a really smart way to spend public health funds, to employ people who are coming from the populations that are sometimes most affected by disease,” she said. “I think that’s something new that we haven’t had before.”
The Response Thus Far
David Wohl, an infectious disease specialist at UNC Health, spoke recently with NC Health News about the federal response to monkeypox compared to its response to COVID-19. Public health advocates complained in May, June and July that the demand for vaccine vials outpaced the supply.
“We’ve all become armchair epidemiologists and procurement specialists,” Wohl said. “I do think that there were problems with the monkeypox response, but they are at a different level of magnitude compared to what happened with COVID-19 during the previous administration. “These are two very different outbreaks. These are two very different fumbles, if you will. So while the current administration was slow off the block in things like procuring vaccines and getting therapeutics out there, to their credit, testing was never a problem as far as capacity.”
There was no scramble to get reagents and stand up testing sites. Health care workers were not waiting for personal protective equipment.
Nonetheless, some things frustrated Wohl.
“But it is a tenth or a hundredth of the incredible mismanagement that we saw during COVID-19, for months on end, that continues to reverberate,” Wohl said. “Those miscues and misinformation from our own government continue to reverberate in the fact that people don’t want to do things like wear masks, not all the time, but some of the time, or take a vaccine.”
Wohl treats people with monkeypox and has not gotten a vaccine himself.
“I don’t think I need to be vaccinated against monkeypox because of my occupation because I’m careful,” Wohl said. “I don’t think that I’m going to catch it. I think the PPE we have, the protective gear, does protect us. So I’m not really feeling that I’m at risk sufficiently to take a vaccine.” ”Just here in North Carolina, in the last few days, the criteria for getting vaccinated has basically expanded to if you’re a man who has sex with men, and I would hopefully put into that, also I would add, if you’re a transgender woman who has sex with men, we should consider vaccinating you. I think sex workers of any type should get vaccinated,” Wohl added. “I think if we can start expanding to the people who really are at greatest risk, then if we start seeing any indications that we should be expanding this more broadly, then we should do it.”
At this point, Washington and his Mecklenburg public health team and their community partners are focusing sharply on the parties, nightclubs and events, where they know they might find people at risk of getting monkeypox but less likely to seek out a vaccine on their own.
“Our general philosophy is we’ve got to meet people where they are here and do so in a way that honors and respects their identity and culture, so we’ve been working to do that and make sure we bring vaccines into the community and let the community help us drive our response,” Washington said. “I think so far we’re making good progress. I look forward to putting this outbreak behind us.”
