Even though 60% of the people who have gotten monkeypox in Michigan so far are Black, 70% of the doses of the vaccine that can prevent infection or limit symptoms after exposure have gone to white Michiganders.
Black residents have gotten just 17% of the doses administered so far in Michigan, new state health department data shows.
And when the first doses of Tecovirimat, the antiviral treatment more widely known as Tpoxx, arrived in Michigan, Oakland and Washtenaw counties got them — not Detroit, a majority Black city that has 38% of Michigan’s known monkeypox infections, said Dr. Shira Heisler , a Wayne Health physician and medical director of the Detroit Public Health Sexually Transmitted Diseases Clinic.
‘No way to physically get’ viral treatment to needy patient
These are among the inequities fueled by an underfunded public health system already battered by the COVID-19 pandemic, a rising number of sexually transmitted diseases and newly stressed by the world’s biggest monkeypox outbreak, Heisler said.
In those early weeks of the monkeypox outbreak, Heisler said she fielded calls from people concerned they might have the virus. Because her clinic was so short-staffed, she didn’t have anyone else to pick up the phone. She was also testing and treating patients with the virus and administering vaccines.
Doses of Tpoxx were “only physically available in two neighboring county health departments,” said Heisler, whose STD clinic is the largest in the state. “I had a patient who was immunosuppressed, HIV-positive, was in significant pain from monkeypox. … However, there was no way to physically get the Tpoxx to the patient.”
“I physically couldn’t get it for him.” The patient didn’t have access to transportation, and no courier service was available.
“So I was going to drive there. Me and the epidemiologist were on the phone (into the) wee hours of the evening to figure it out. … There’s no infrastructure, organizational infrastructure to be able to do this.”
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The state health department told the Free Press in an email Wednesday that doses of Tpoxx were initially ordered directly from the Strategic National Stockpile by providers.
“When the state facilitated product coming into (Michigan), that product was allocated to the (local health departments) that currently had cases. This included city of Detroit Health Departments and clinicians in the city who were treating positive patients,” said Chelsea Wuth , a spokesperson for the Michigan Department of Health and Human Services.
Doses of the Tpoxx treatment now are available, she said, “in every Michigan local health department and select providers who have encountered a large number of Tpoxx patients. We also maintain a stock of product in Lansing to replenish Tpoxx inventory for those that are running low.”
Funding for monkeypox response ‘is unsustainable’
Even though the monkeypox outbreak is beginning to wane — the rate of new cases is slowing in Michigan and nationally — Heisler was among a group of doctors from the National Coalition of STD Directors to call on Congress on Wednesday to allocate more federal funding to support the monkeypox response to ensure access to care is more equitable and to shore up a crumbling public health infrastructure.
“The Senate has rejected a request by the Biden administration for $4.5 billion to support MPV response, otherwise referred to as monkeypox,” said David Harvey, executive director of the National Coalition of STD Directors.
“Let me be clear, this is unacceptable and our community will continue to fight for the resources we need. … We will not rest until we succeed.”
Clinics like Heisler’s have not seen funding increases despite rising demands from monkeypox and a growing number of sexually transmitted infections such as syphilis, gonorrhea and herpes.
No money for overtime to reach vulnerable population
Without more money, clinics like hers can’t hire more staff, she said. And without more workers, they can’t do the kind of outreach needed to stop the spread of the virus in the most vulnerable communities.
“Something that we have seen in the past two months … is the disparities that are already happening in monkeypox,” Heisler said. “People of color have lower rates of vaccination and higher rates of cases. One of the ways to combat this was pop-up vaccine clinics — so meeting the most affected individuals where they’re at: gay bars, ballroom events, Pride events.
“All of these events occur at nighttime. Well, we don’t have any funding for staffing. I can’t pay overtime.”
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So Heisler and others collaborated with an LGBT clinic and sought volunteers recently to organize a pop-up clinic, vaccinating 37 people — 95% of whom were people of color.
While that was a success, “it is unsustainable,” Heisler said. “All of us worked on our own time with no compensation. … When STIs continue to go up, and now we have the monkeypox outbreak on the ground, we are stretched very thin.
“Myself and my staff are doing all this all because if we don’t then our community will not get properly cared for and the health disparities will continue to grow. And this is just not a tolerable outcome. So just because we are a community that looks out for each other, this doesn’t take away the responsibility of the federal government to take care of us.”
Who’s getting monkeypox infections in Michigan?
Since the US monkeypox outbreak began in May, 265 cases have been identified in Michigan, state data shows, and 97% of the cases have been identified in men. The city of Detroit has had the most cases, with 102 infections.
Of the men who’ve been infected with the virus, 94% reported having sex with men, and 55% are HIV-positive.
New demographic details about the state’s outbreak also shows that of the people who have been infected in the state:
- 60% are Black
- 34% are white
- 6% reported they are Hispanic or Latino (who can also identify with another race)
- 2% are Asian or Pacific Islander
- Less than 1% are American Indian or Alaskan Natives
- 3% identified as “other”
Who’s getting monkeypox vaccines in Michigan?
Though the majority of people with monkeypox in Michigan are Black men, doses of the Jynneos vaccine, which is approved for use against smallpox and monkeypox, have disproportionately gone to white Michiganders.
Of the 8,775 doses of the Jynneos vaccine that have been administered in Michigan for which racial and ethnic data is known:
- 70% — or 5,213 doses — were given to people who are white.
- 17% — or 1,240 doses — have gone to Black Michiganders.
- 9% — or 656 doses — were given to people who chose “other” for a racial/ethnic designation.
- 8% — or 624 doses — have been given to people who are Hispanic or Latino.
- 3% — or 246 doses — went to people who are Asian or Pacific Islander.
- 1% — or 67 doses — were administered to people who are Alaska Natives or American Indians.
Closing the gap on monkeypox health disparities
The state health department is working to address the disparities around monkeypox infections and access to vaccines and treatments, Wuth said.
“These disparities are not unique to Michigan and are being observed across the country in relation to cases and vaccine uptake,” Wuth said.
“Helping Michiganders make the best-informed decisions to protect their health and the health of their community from monkeypox (MPV) requires a combination of providing key prevention information to the public and working with partners and trusted messengers to ensure information reaches affected communities.”
The US Centers for Disease Control and Prevention launched the Monkeypox Vaccine Equity Pilot Program earlier this month to try to close the gap on monkeypox health disparities.
The agency is offering up to 50,000 doses of the Jynneos vaccine to agencies that can deliver them in nontraditional ways to people who are disproportionately affected by the virus and face barriers to getting health care.
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Eligible to apply are state and local health departments; cities already getting vaccines from the Strategic National Stockpile; tribal governments, and federally funded tribal health care facilities. They must be willing to report data about cases and vaccination to the CDC.
The Michigan Department of Health and Human Services applied to the CDC for additional doses of vaccine to host five events as part of the equity initiative. Four of the five were approved this week, Wuth said.
“None of the events have occurred yet. We are not aware of any events submitted by other Michigan organizations,” she said.
Vaccines will be available, Wuth said, at the following events:
- The PrEP Rally Ball in Detroit on Oct. 1.
- Gigis Nightclub in Detroit on Oct. 15.
- Liberty Leather Bar in Pontiac at two separate leather-themed events planned for Oct. 15 and Oct. 29.
- Michigan Leather Pride in Detroit on Oct. 21.
Harvey, the National Coalition’s executive director, said the CDC’s vaccine equity pilot program is making a difference.
“We are seeing numbers come down,” he said, in terms of new cases. But the successes have come largely because of the willingness of volunteers and workers at already poorly funded local STI and sexual health clinics to step up to partner in the effort.
“It’s a robust initiative, but there’s not enough money in it,” he said.
Contact Kristen Jordan Shamus: [email protected] Follow her on Twitter @kristenshamus.
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