New York has emerged as a hot spot for a growing monkeypox outbreak, but as the city prepares to receive thousands of doses of vaccine, it is unclear how the city will distribute them equitably to the people most at risk for the disease: sexually active gay, bisexual and other men who have sex with men, among whom the global outbreak has been centered.
Last week, a single clinic in Chelsea offered 1,000 doses of the vaccine that the city’s Department of Health had released from its stock. Hundreds of men turned up as walk-ins, leading the line to close to new people after only about 90 minutes.
The city did not publicly announce the clinic’s opening, at noon on a Thursday, until 30 minutes before. And by Monday, the last shots had been distributed by appointment.
The process led to criticism that those most connected to the world of public health and with the time to take hours off during a workday got most of the first slots.
As of Thursday, 78 cases of monkeypox had been diagnosed in the city, more than double the number that had been reported a week ago, according to the Health Department. And statewide, there were 72 cases as of Wednesday, or 20 percent of the nation’s total of 351 cases.
But more doses are on the way. Gov. Kathy Hochul announced on Thursday that the federal government would soon send the state 8,195 additional doses of the monkeypox vaccine, with about 6,000 going to New York City.
“In New York State, we have seen a disproportionate number of monkeypox cases, especially within our L.G.B.T.Q.+ communities who have been hit especially hard,” Ms. Hochul said in a statement. “I recognize the fear and anxiety this outbreak has caused, especially for L.G.B.T.Q.+ New Yorkers, which is why my team and I will continue to work around the clock to secure as many vaccines as possible for our residents.”
The city has vowed to broaden access to doses once they receive more, but there were no details about the distribution plan as of Thursday afternoon.
“This effort was just the beginning and as supply increases, we hope to expand to other areas of the city,” Michael Lanza, a spokesman for the Health Department, said earlier this week.
He added that the Health Department had selected the Chelsea Sexual Health Clinic, in Manhattan, as the location for the first doses because it was among the best-known sexual health clinics in the city, with “a very long history in the community and providing culturally competent care to L.G.B.T.Q.+ New Yorkers.”
The Department of Health has recommended the monkeypox vaccine for men at high risk of exposure, which they have defined as men who have had multiple or anonymous male sexual partners over the last two weeks.
The vaccine allocation, part of a national distribution plan for hundreds of thousands of doses announced by the White House on Tuesday, comes as monkeypox continues to spread and as experts warn of the quickly closing window for containing the virus.
The U.S. Department of Health and Human Services will provide an immediate 56,000 doses of the monkeypox vaccine, called Jynneos, and an additional 240,000 doses in the coming weeks, the White House announced. Another 750,000 doses are expected to become available over the summer, and a total of 1.6 million doses are expected to be ready by the end of this year.
What to Know About the Monkeypox Virus
What is monkeypox? Monkeypox is a virus endemic in parts of Central and West Africa. It is similar to smallpox, but less severe. It was discovered in 1958, after outbreaks occurred in monkeys kept for research, according to the Centers for Disease Control and Prevention.
What are the symptoms? Monkeypox creates a rash that starts with flat red marks that become raised and filled with pus. Infected people may also have a fever and body aches. Symptoms typically appear in six to 13 days but can take as long as three weeks after exposure to show, and can last for two to four weeks. Health officials say smallpox vaccines and other treatments can be used to control an outbreak.
How infectious is it? The virus spreads mainly through body fluids, skin contact and respiratory droplets, though some experts suggest that it could occasionally be airborne. Typically it does not lead to major outbreaks, though it has spread in unusual ways this year, and among populations that have not been vulnerable in the past.
Should I be worried? The likelihood of the virus being spread during sexual contact is high, but the risk of transmission in other ways is low. Most people have mild symptoms and recover within weeks, but the virus can be fatal in a small percentage of cases. Experts say that monkeypox is unlikely to create a pandemic scenario similar to that of the coronavirus.
“This vaccine currently has some limitations on supply, and for this reason the administration’s current vaccine strategy prioritizes making it available to those who need it most urgently,” Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said at a news conference.
Federal officials also announced that state health authorities could request doses of an older smallpox vaccine, called ACAM2000, but it is associated with harsh side effects, including death, among immunocompromised people, pregnant women and older adults.
Demand for the vaccine in New York City is expected to outpace the initial supply, raising tricky questions of who should get access to it. Public officials have urged the federal government to provide as much vaccine as possible. The Jynneos vaccine requires two doses to be fully effective, given one month apart.
“When you have a large population that wants to protect itself, I think we need to do everything in our power to allow them to do so,” said State Senator Brad Hoylman, who has been pushing for more doses.
In addition to the vaccine, experts have urged increased education and testing campaigns to make sure that more people are aware of the symptoms of the virus so they can get checked for it.
For now, monkeypox testing remains centralized to a network of public laboratories, making it difficult for some health providers to order tests. The C.D.C. is allowing some commercial labs to conduct the test, however, which should make testing more accessible in July.
Gregg Gonsalves, an epidemiologist at the Yale School of Public Health and a longtime H.I.V./AIDS treatment advocate, warned that the cases that have been picked up by testing were likely “the tip of the iceberg.” He and other experts are concerned that the outbreak may expand into other populations, particularly congregant settings like prisons and homeless shelters, if health officials do not do more soon.
“We have a path between containment of this outbreak or its continued persistence, particularly in the gay community,” he said. “And I think we’re on this road to persistence in the gay community as a new feature of our lives for the time being.”