The monkeypox epidemic in the United States appears to be slowing down.
New infections are beginning to decline in some major cities where the virus struck early and spread quickly. And while there is still uncertainty, the Centers for Disease Control and Prevention currently planning that the epidemic “will most likely continue to develop very slowly” over the next few weeks.
Health officials say this is the cause of cautious optimism – but not complacency.
Much of the improvement is attributed to changes in sexual behaviorand progress is uneven, with new cases increasing in parts of the United States and disproportionately affecting certain minority populationslike black and Latino men.
The United States relies on a strategy of vaccinating high-risk populations – largely gay men and gay men, especially men who have sex with men on social media where the virus is spreading. But there are still open questions: Scientists don’t yet have much real data on the ability of the JYNNEOS vaccine — approved by the Food and Drug Administration in 2019 — to stop infection and transmission. And the vaccination campaign must succeed in reaching those who could benefit most from vaccines.
NPR caught up Dr Demetre Daskalakisa month after taking up the post as Deputy Coordinator of the White House Monkeypox Response, to talk about leading the epidemic and what it’s like to go from being an HIV doctor and HIV activist to queer health to that of proud face of the government’s response to monkeypox.
This conversation has been edited for length and clarity.
Pien Huang: As you look over the next few weeks or months, where do you see the outbreak heading? Is it realistic to think that we could have virtually no cases in the United States?
Demeter Daskalakis: I think we’re going to get to a point where we’ll see occasional cases because of introductions [of the virus] other places. We will also potentially see small clusters. But in terms of this big curve that we’ve seen, I think it’s going to dissipate so it’s no longer an epidemic, but more episodic.
If you look at the epidemiology of cases that occur outside of gay, bisexual, and other men who have sex with men, there are a lot of end chains: you have someone [with monkeypox]then maybe their family contacts [get it] and then it ends.
I wouldn’t be surprised if we keep seeing little chains [of transmission]. Then the vaccine would be used more for contact-based vaccination as opposed to population-based and behavior-based vaccination campaign. [we have now].
You and other experts have credited behavioral changes with helping to slow the spread of monkeypox in the United States. What does this mean for controlling the epidemic in the future, given that the virus has spread “almost exclusively” through sexual contact?
It is not impossible that we can see the cases increase if the behaviors regress. We definitely see that the messages – from the CDC and the US government as well as the interpretations of others – have really moved the needle, in terms of some of the behaviors associated with exposure to monkeypox.
Unique partnerships [meaning one-time sexual encounters] that men who have sex with men report are down – 50% have stopped doing it or reduced it – less anonymous sex, all things we advise as temporary measures, until we We put vaccines in people’s arms and they can come back to life as usual.
We’re in that phase where getting supply and maintaining demand [for vaccines] is so important. It’s reasonable to think people will change their behavior for a while, but it’s not reasonable to think they’ll change it forever. And we’re not asking forever, we’re asking now.
Why not call it a sexually transmitted infection? After all, gay and queer communities are generally quite accustomed to talking about sexual health.
The jury is out on what it’s going to be called. I think what is important is that monkeypox is sexually associated no matter what.
What’s important to me is less the semantics and more that we give the right advice, and where people go [to seek information and care] have the resources to do the job.
A article you co-wrote which was published recently shows that numerous cases of monkeypox are found in people living with HIV and in those with a recent history of STIs. why is this the case?
It is the social network, and the behaviors associated with it, that may explain why HIV-positive men who have sex with men are overrepresented.
One of my favorite lines in the diary actually says – I love it so much, I’ll read it to you verbatim – “It’s important that HIV and STI prevention and care delivery systems are leveraged for monkeypox assessment, vaccination, and other prevention and treatment interventions.”
[On Wednesday]sort of timed with it [paper]the CDC released updated guidelines for some of its grantees, indicating that they could use both staff and funds earmarked for HIV and STDs to actually support monkeypox.
It’s a bit revolutionary. He puts it in this context of this thing called a syndemic, which is like the different epidemics interacting. So it integrates monkeypox where it belongs, which is with the work we do every day to prevent HIV and STIs.
Recent data from the CDC shows that vaccination rate may be in decline. It seems that we are close to a point where many people who want to get vaccinated have done so. How do you make sure people get both vaccines even if cases go down?
So first of all, supply, supply, supply – supply is important because some of the changes in demand are driven by the idea that “there is no vaccine, so why should do I look for it? »
We have solved this problem with the new intradermal vaccine strategy increase the supply in the field and with [getting] After [vials]whether from overseas business, or with filling and finishing on land of the vaccine.
We have [sent vaccine doses to] some big events that signal that “the doctor is open” and that vaccines are more accessible.
The other work we do is on equity. We [recently sent doses to] Atlanta Black Pride, where they did almost 4,000 shots, also with Southern Decadence in New Orleans, where they did about 3,500. Those are the big releases.
But we will also soon publish a path to small capital interventions which are for more innovative niche ideas that penetrate deeper into the community.
Is there a danger of people looking at the current numbers and saying “monkey pox is slowing down, so I don’t need a vaccine?”
Still, there’s a risk that people will say, “Oh look, the curve is down and we’re going to move on.” But we’ve been very good at messaging that two shots plus two weeks means you have optimal coverage. So the experience I’m hearing so far is that people are interested in getting both of their vaccines and they just want [health authorities] to open availability [so they can] Catch them.
How was it to be in such a visible role as the gay/queer person who is the face of the White House monkey pox response?
In my very first hour on the job, I met with the president and he said my job is to make sure we work really hard for the LGBTQ community, especially in the vein of equity. So literally I landed and was told to do exactly what I love to do. It was awesome.
I get to work with Bob Fenton, [the White House Monkeypox Response Coordinator], who looks like a rock star from the point of view of major event emergencies. I’m learning some really valuable things from him that definitely come out of my normal wheelhouse.
Is there a tension between the role you have as a government official and your longtime work as an HIV doctor and gay health advocate?
It’s about being the doctor for one person at a time, and then being the doctor for an entire community and our entire population. You have a very specific responsibility when making decisions for millions of people. I value [my time working with patients]. I feel like these experiences with humans and patients end up making sense of it all for me.