San Francisco isn’t ready for monkeypox, despite what we’ve learned from COVID

Days after Adam Fuller attended a big party over Pride weekend, he received a disturbing message in a group thread. It was a screenshot of party organizers alerting attendees that someone at the event had tested positive for monkeypox.

Fuller got to work. “There were so many people there that it’s almost impossible to know if I had contact with this person or not,” he said. He researched the disease, learning that it belongs to the smallpox family, is transmitted by skin-to-skin contact, and that there is an effective vaccine even after exposure. His doctor referred him to Strut, a Castro District health center run by the San Francisco AIDS Foundation. But when he reached out, Fuller was told he wasn’t eligible.

The reason: a limited supply of vaccines. Despite months of advance warning that monkeypox cases were rising and a 40% rise in cases citywide in just one week, Strut only has 60 doses of the Jynneos vaccine.

It’s an oddly familiar and infuriating scenario. Two and a half years into a global pandemic, why are we so ill-prepared for monkeypox?

Many saw it coming. Tyler TerMeer, CEO of the AIDS Foundation, said they feared they would only receive a few dozen doses of the vaccine before Pride. The disease has largely affected members of the gay community, which, through its many programs, the organization is well prepared to serve.

“We knew there were limited cases in the United States at that time, but it was increasing and the number of cases could probably increase here in the Bay Area after the events of Pride,” said Ms. TerMeer said.

This prediction turned out to be true. The alert Fuller received was sent to thousands of people. Outrage ensued, with many taking to Twitter to decry the vaccine shortage.

The city is completely unprepared for a small outbreak of monkeypox. Once again, we find ourselves responding to a public health crisis for which we have had ample time to prepare.

According to guidelines from the city’s public health department, anyone attending two parties where cases have been recorded is eligible for the shot. But the city’s vaccination clinic, which offers vaccines on a first-come, first-served basis, is so overwhelmed that it has suspended all COVID and low-cost vaccines due to monkeypox demand, and notes on her website that due to staff shortages she may I am not aware of voicemails.

The AIDS Foundation faces a similar increase. Within a day of setting up a monkeypox vaccine hotline, she received 500 calls. As of Wednesday afternoon, 300 people exposed to monkeypox were on the waiting list for a vaccine.

The Ministry of Public Health told me on Thursday that they had just received 2,000 doses and were working out where to deploy them. But that may not be enough yet and the supply is low. Last week, the US Department of Health and Human Services announced that it plans to distribute just 56,000 doses across the country. An order for 2.5 million doses from Danish manufacturer Jynneos is not expected to arrive for months.

In the meantime, the lack of preparation and attention from the federal government and drugmakers has reignited a deep trauma for queer people since the early years of the AIDS epidemic.

“I am a person who has lived with HIV for 18 years and I am very concerned that we are woefully unprepared in this country to respond to it,” TerMeer said. “It feels like that urgency isn’t there, which is hard to digest when you’re someone who identifies as queer and knows the history of what happened to our community.”

Next week, the AIDS Foundation plans to hold a town hall on monkeypox, and Supervisor Rafael Mandelman, who represents the Castro, has called for a hearing on the city’s response. But for the thousands of people who received exposure notifications after Pride, who are seeking timely testing and vaccines, a hearing is too little too late.

As for Fuller, he is in quarantine at home, but not for fear of transmitting monkeypox. At some point during the Pride festivities, he contracted COVID-19. The irony is not lost on him. “My challenge right now is figuring out if my symptoms are related to monkeypox, or is it just COVID?” he said.

Until San Francisco catches up, he can’t test to find out.

Nuala Bishari is an opinion columnist and columnist at the San Francisco Chronicle. Email:

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