Lessons for Community-Based Scale-Up of Monkeypox Vaccination From Previous Disease Outbreaks Among Gay, Bisexual, and Other Men Who Have Sex With Men in the United States

• Published in: American journal of public health (1971) 2022-11, Vol.112 (11), p.1572-1575
• Main Author: Holloway, Ian W
• Format: Article
• Language: English
• Subjects: Bisexuality; Community; COVID-19; COVID-19 vaccines; Disease control; Disease Outbreaks - prevention & control; Disease prevention; Epidemics; Federal government; Gays & lesbians; Health disparities; Health planning; Health services; HIV; HIV Infections - epidemiology; Homosexuality; Homosexuality, Male; Human immunodeficiency virus; Humans; Immunization; Infectious diseases; Invasive meningococcal disease; Jurisdiction; Male; Men who have sex with men; Meningococcal disease; Mens health; Minority & ethnic groups; Morbidity; Mpox; Mpox (monkeypox); Outbreaks; Pandemics; Prevention; Prophylaxis; Public health; Sexual and Gender Minorities; Sexually transmitted diseases; Smallpox Vaccine; STD; United States - epidemiology; Vaccines; Viral diseases
• ISSN: 0090-0036; 1541-0048; 1541-0048
• DOI: 10.2105/AJPH.2022.307075

As of August 5, 2022, there have been more than 7500 confirmed or suspected monkeypox (MPX) cases in the United States-mostly among gay, bisexual, and other men who have sex with men (GBMSM).1 These numbers are certainly underestimates, given the lack of widespread testing. Although effective vaccines exist, they are in short supply, and to date, the federal government has prioritized MPX postexposure prophylaxis. The World Health Organization and the Centers for Disease Control and Prevention (CDC) have highlighted the significance of controlling the spread of MPX early on as the number of cases climbs rapidly2; however, this will take coordinated planning by public health officials, local health jurisdictions, and GBMSM communities as the federal government makes more vaccines available.In the coming months, the federal government will deploy an estimated 1.6 million doses of the two-dose JYNNEOS vaccine to prevent MPX.3 Although scale-up of MPX vaccination is a key pillar of the Biden-Harris administration's strategy to combat the MPX virus, the plan lacks guidance for local health jurisdictions about how to deploy vaccines to reach those most affected by MPX. The health inequities that GBMSM already face compared with their heterosexual counterparts demand focused attention on our communities without further stigmatizing GBMSM in the context of MPX. Fortunately, we can rely on scientific evidence from previous infectious disease outbreaks primarily affecting GBMSM, including HIV and invasive meningococcal disease, as well as lessons learned from the COVID-19 pandemic.Although invasive meningococcal disease is more virulent and fatal than monkeypox, vaccine coverage among GBMSM is low: the 2018 study by Holloway et al. estimated that less than 40% of GBMSM had been vaccinated during an ongoing outbreak in Southern California.4 By contrast, a February 2022 CDC Morbidity and Mortality Weekly Report noted that nearly 90% of GBMSM had received at least one dose of the COVID-19 vaccine,5 which may bode well for MPX vaccination campaigns. However, the long-complicated relationship between GBMSM and public health presents potential barriers: many GBMSM continue to face challenges trusting and accessing health care services. If efforts to control the spread of MPX in the United States are to be effective, public health must work collaboratively with GBMSM communities on vaccination implementation. Figure 1 outlines four key strategies for improving MPX vaccine