As monkeypox cases rise, so do concerns about disparate access to care

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• Lisa Desjardins:

  Now, a declared national emergency monkeypox continues to spread in the United States. So do concerns over disparities in access to testing and vaccines for vulnerable communities. Joining me now is Gregg Gonsalves, an epidemiologist from the Yale School of Public Health. Greg, thank you for coming back in just the week since we last spoke with you, the number of monkeypox cases has doubled. So what is this moment right now? Can we still contain this?

  Gregg Gonsalves, Yale School of Public Health: Well, you know, Lisa, I'm also alarmed by the rapid growth in monkeypox cases around the U.S. In May, we hadn't even really thought about monkeypox as a concern. It's an endemic disease in the United States. But as you said, we have over 7100 cases now in almost every American state, if we could have contained it, we would have moved quickly and expeditiously in early June to ramp up vaccine deployment, ramp up testing, ramp up access to treatments. But we've sort of dilly-dallied for eight weeks now. And now, as you said, we are exporting cases rise precipitously across the country.

• Lisa Desjardins:

  You know, these past few years have put such a spotlight again, on health disparities in this country in a big way in crisis, health crises that we're facing, you study this, I wonder, who do you think is most a danger from monkeypox, and then who is most at danger from not getting access to treatment for it?

• Gregg Gonsalves:

  Well, Fenit Nirappil from the Washington Post has done a lot of great reporting on those health disparities in monkeypox. And he was writing the other day that, you know, of the known cases, we know where we know race and ethnicity. We have about 38% white, 32% Latino and 26% black. But African Americans only account for about 17% of who've received TPOXX, the treatment for disease. So what we're seeing is that the health disparities we've seen in COVID, we've seen an HIV or recapitulating themselves with this new virus, monkeypox.

• Lisa Desjardins:

  We hear a lot, of course about men who have sex with men, is there a treatment disparity there as well?

• Gregg Gonsalves:

  Right now, you know, over 95%, close to 99% of these cases are in men and men who have sex with men. So while monkeypox is not a gay disease, the gay community is facing the brunt of this right now. The big problem is that we have a vast shortage of vaccines, we can't get our arms around this — the outbreak. As I said there are disparities and access to treatment. There — people have health insurance and access to medical care, we're quickly seen by their physicians can get treated for pain, can get access to TPOXX, others are waiting for weeks and weeks to try to get a test or once they get tested, have nowhere to go if they need to go to the hospital, for instance, to manage their pain because it's so excruciating. And so we're creating a caste system of who's going to get access to what's needed for monkeypox. And a few months when we do have vaccines, I expect there to be restaurant by people who have access to resources and it can sit online and hit refresh until they get an appointment, but it's going to seep into the rural south and other places in which the HIV virus has gone beforehand.

• Lisa Desjardins:

  You know, I wonder you mentioned of course resources, affluence is sort of one issue about access. But some of this is also demographic to ask a complex question, I hope it's not naive. Why do we still have these persistent malignant kind of biases in healthcare? These are often — these systems are run by health professionals, many of them are trained to try and think about marginalized communities. Why are we still here?

• Gregg Gonsalves:

  So a couple of things are — the health disparities are baked into the American healthcare system. The former Surgeon General David Satcher wrote a piece of while ago, I think in Health Affairs where he talked about the excess deaths among African Americans in this country in the 10s of 1000s, at least. And so we talk about health disparities not just with monkeypox, but with COVID, with HIV, with cervical cancer, with sexually transmitted diseases like syphilis and gonorrhea, it's baked into the system for quite a while, not only on income and your wealth, but on race as well.

• Lisa Desjardins:

  The White House says now, of course this problem with the enough vaccine and not enough vaccine that it's considering splitting some of these doses maybe injecting them a different way that could work. Do we know if that would work? And does that address the disparity issue at all, could it?

• Gregg Gonsalves:

  Well, health disparities are going to linger no matter what, as I said, they're baked into the system. Right now we need more vaccine. And the federal government should really be working as hard as they can to figure out how to get more of this product online before the fall. I'm splitting the doses is a risky strategy, we have very little data on the effectiveness of this vaccine in the context of this current outbreak because simply we haven't seen monkeypox erupt in the United States before at this level, nor have deployed the vaccine for that purpose. So, you know, the NIH is going to do a study of splitting doses. But that information is going to take weeks and weeks for us to get and to implement.

  But right now, we need to really be scaling up our availability of vaccines that we have now, figuring out if there's ways to ramp up production, making sure that people get access to TPOXX. The other thing we haven't talked about is that, you know, this disease requires 21 days of isolation, right? And I might be able to stay home if we get sick, but there are many people who have to go right into work. And so how are people going to find support to work through the pain and to figure out how to support themselves and their and their families while they're dealing with this disease.

• Lisa Desjardins:

  And one more question, do we know if this disease can be asymptomatic if there are carriers of this disease who may not show any signs that they have it?

• Gregg Gonsalves:

  So remember, this disease is transmitted by close physical contact, right? It's skin to skin. So you're exposed skin against the lesion of somebody who already has the disease, whether there's asymptomatic transmission, you know, through other means, through bodily fluids, for instance, is not certain yet, but the classical presentation is to have a lesion and to have skin to skin contact that way. So there's a lot we don't know. But remember, this virus has been around, at least in human cases for 50 years. So it's not an old virus. We're learning more about how it's presenting specifically in the context of this outbreak. But skin to skin close physical contact right now in the context of close sexual relations is what's driving the pandemic.

• Lisa Desjardins:

  Important information for the whole country to think about. Gregg Gonsalves of Yale's School of Public Health, thank you for joining us.