Monkeypox Outbreak: Disparities in Vaccination and Infections Among Black and Hispanic Communities
Atlanta festival organizers had begun offering monkeypox vaccinations for the population before the event, as Melissa Scott, one of the organizers, noted. The festival also provided Covid-19 vaccines on-site.
The monkeypox vaccine offers protection but requires two doses to become fully effective. Scott saw the festival as a superb opportunity to reach a significant portion of the population that was deeply affected by the outbreak.
According to the Centers for Disease Control and Prevention (CDC), there were roughly 20,000 presumed or confirmed monkeypox cases in the United States by Friday. The virus primarily spreads through close contact and can infect anyone, but the outbreak's victims were disproportionately homosexual, bisexual, and other men who had sex with men. No group was hit harder than those identifying as Black or Hispanic/Latino.
Almost 38% of the monkeypox cases occurred in Black individuals, but they only represented 12% of the U.S. population according to CDC data as of August 27. Hispanics/Latinos, on the other hand, comprised 19% of the U.S. population, but accounted for 29% of the cases.
Trends in Hardest-Hit Cities
Not all cities in the United States report or publish population data. However, in cities with high monkeypox case counts, Black and Hispanic individuals are overrepresented among the afflicted and underrepresented among the vaccinated.
In Philadelphia, for instance, 55% of the monkeypox cases were identified as Black, while 16% were Hispanic and 24% were White. However, 56% of the vaccinations went to Whites, 24% to Blacks, and 12% to Hispanics.
As of mid-August, 71% of the monkeypox patients in Atlanta self-identified as Black, 12% as White, and 7% as Hispanic, while 44% of the administered vaccines went to Whites, 46% to Blacks, and 8% to Hispanics.
In Houston, Blacks are overrepresented among the patients, making up 32% of all cases, but they only account for 23% of the population. Only 15% of the vaccinated individuals, according to the Houston Health Department, are Black.
Despite Hispanics/Latinos representing 21% of Houston's cases, they make up 45% of the city's population and 32% of the vaccinated individuals. Whites, on the other hand, make up 24% of the population, 17% of the cases, and 39% of the vaccinated.
In Los Angeles County, 40% of the cases were Hispanics/Latinos, according to the county health department. However, only 32% of the first doses were administered to members of this community. Hispanics/Latinos comprise 49% of the Los Angeles County population.
Whites in Los Angeles receive the most vaccinations against monkeypox. They accounted for 41% of the first doses, and are responsible for 29% of the cases. Whites comprise 25% of the Los Angeles County population.
Blacks are somewhat overrepresented in Los Angeles County, with a 9% share of the population, but 11% of the cases. Only 9% of the people who received their first shot are Black.
Chyke Doubeni, Chief Health Equity Officer at Ohio State University, expressed uncertainty about the causes of these disparities but stated that monkeypox was not the first disease to demonstrate such disparities. He believed that, unless significant changes occurred, the same patterns would emerge during the next outbreak.
“I’d say we’re quite good at repeating the same mistakes," Doubeni explained. "It’s the same story, the same underlying causes. There are barriers to treatment and information. For example, a system where people must stand in line for hours to receive a vaccine simply doesn't work for people with hourly jobs.”
City Leaders Call for More Action
Mayors across the country have repeatedly urged the Biden administration to do more to protect these communities since months ago. On Tuesday, the administration announced a pilot program for Black and LGBTQ+ communities.
Robert Fenton, coordinator of the White House Monkeypox Response Team, highlighted the need to work closely with local partners to ensure impoverished communities receive vaccination resources.
“Justice is a cornerstone of our response, and we are aware of the need to invest additional resources in this area to ensure that we are reaching the communities that are most affected by this pandemic,” Fenton stated.
The administration will send thousands of monkeypox vaccine doses to organizations serving Black and Brown communities. Collaboration with state and local health departments will also help establish on-site vaccination clinics at large LGBTQ+ events, such as Black Pride in Atlanta, Pride in Oakland, California, and Southern Decadence Festival in New Orleans. Thousands of individuals will be able to receive vaccinations at each event, with enough vaccine supply to inoculate up to 5,000 people.
Public health officials said they would also collaborate with community leaders to find smaller gatherings, such as family and club events, to set up pop-up vaccination clinics, which have proven popular with younger people. For these outreach initiatives, authorities have reserved an additional 10,000 vaccine doses.
However, there will be no pop-up clinics during June's Pride Month events. A pilot vaccination program that began during the Charlotte Pride Festival and Parade on the weekend ended up with only about a quarter of the doses being administered. Officials still considered it a major success, however.
“It’s important to respect the strategies that Charlotte might employ if they’re going to lead in this area," Dr. Demit Daskalkis, deputy coordinator for monkeypox response in the White House, stated on Tuesday. "More than 500 vaccinations are a significant achievement — visiting a Pride event and getting vaccinated is a big deal — and every number I find surprising.”
Outreach Efforts Pay Off
In Fulton County, Georgia (which includes Atlanta and other major suburbs), 79% of the monkeypox cases were Black, but only 42.5% of the population was. Since the outbreak began, the county health department has started collaborating directly with organizations working with Black and Brown communities.
Authorities have set up clinics, displayed QR codes with appointment information, and extended clinic hours to accommodate working individuals trying to get vaccinated. As a result, 70% of the monkeypox vaccines administered in the county went to Black individuals. Nationally, only 10% of the vaccinations were administered to Blacks, 22% to Hispanics or Latinos, and 44% to Whites.
Dr. Lynn Paxton, regional health director for Fulton County, explained that Black communities are disproportionately affected by monkeypox. Therefore, efforts towards health equity are particularly important in health departments.
The Biden administration has acknowledged the importance of justice in its monkeypox strategy.
“Our vaccine strategy is to ensure that we meet the needs of individuals who seek services, support, or community, especially in Black communities,” Daskalkis stated.
Barriers to Access
Public health experts attribute these disparities to a combination of barriers related to access to treatment, vaccines, and culturally sensitive educational materials.
Sean Cahill, director of health policy research at the Fenway Institute in Boston (a health organization working with sexual minorities), expressed frustration over these unnecessary barriers.
For example, the monkeypox treatment drug Tpoxx is still considered experimental, requiring affected individuals and doctors to complete lengthy forms. For weeks, no translation of these forms was made available outside of English. The CDC finally provided the Spanish-language forms in mid-August.
“For patients who speak Spanish or Chinese or don’t speak much English, filling out these forms can be a real challenge,” Cahill said. The problem is even worse for individuals who do not have access to a computer or a printer.
Cahill also pointed out logistical challenges as a hurdle to patient care.
“It’s just a few logistical challenges that are hurdles in patient care — but they don’t have to be,” Cahill said.
Critics have accused the Biden administration of not responding effectively to the monkeypox crisis, particularly when it comes to communities of color.
“As soon as we begin vaccination, we need to engage in conversations with Black and Brown community organizations to lead on high-risk population vaccination,” said Daniel Driffin, an HIV patient advocate and HIV patient who lives in Atlanta. He serves as an advisor to NMAC, a national organization focused on health equity and racial justice to end the HIV epidemic.
To secure an appointment for a test or treatment, individuals, especially early on in the pandemic in the U.S. when vaccine supplies were scarce, had to constantly monitor Twitter to find out when the vaccine was becoming available. Appointments are usually booked within minutes.
“Your health shouldn't be determined by Twitter or Instagram,” Driffin said.
He added that it is particularly difficult for some individuals, particularly in Georgia, to arrange appointments for tests or treatment.
“Many Black and Brown individuals in Georgia, particularly men, may not have regular access to medical care,” Driffin stated.
Racial Disparities in Other Health Crises
Of course, this is not the first public health crisis to disproportionately affect Black and Brown communities.
According to CDC data, a higher proportion of new HIV diagnoses and cases is among Black individuals compared to other racial and ethnic groups. Hispanic and Latino individuals are also particularly vulnerable to HIV.
Racism, stigma, homophobia, poverty, and limited access to healthcare services exacerbate these disparities, while Black and Brown communities are disproportionately affected by the Covid-19 pandemic. Datasuggests that cases and fatalities among Black individuals are higher than among White individuals, when accounting for age.
Dr. DuBeni, a public health expert, has often noted that more needed to be done to help these communities, and that public health officials often do not start by asking communities what they need or what works for them. They instead develop materials in English and only transition to other languages when the material is available.
“I think that everything is done with good intentions, but it doesn't always start with a goal,” said DuBeni.
He has seen cases where state health departments spent months developing materials in English before even beginning to translate them into Spanish.
“I think it's all done with good intentions, but it often doesn't start with a goal,” DuBeni said.
He said that individuals in Black and Brown communities may have to hold out longer to receive necessary healthcare due to institutional racism, social, and economic factors.
“Don't accept ‘no’, ” DuBeni said. “People shouldn't be ashamed to seek medical care for monkeypox. It has nothing to do with them as individuals and we can control this outbreak before it gets out of hand. People have the right to receive the answers they need.”
Scott, an organizer for the Atlanta Black Pride, expressed satisfaction with the targeted public health outreach efforts by the local health department. One of the festival's goals was to improve the health of the community while also encouraging people to have fun.
“We're working hard to ensure we're reaching the people who need it most,” Scott said.
CNN's Deidre McPhillips contributed to this report.
Sources
- Patterson, H. (2022). With monkeypox spreading, experts increasingly concerned about disparities in vaccination. CNN.
- Sneed, S. (2022). Health disparities coupled with extra hurdles face LGBTQ+ people of color in monkeypox battle. CNN.
- CDC (2022). Human Monkeypox: MMWR.
Enrichment Data:
Monkeypox, a viral disease, has posed multiple challenges associated with health equity, resulting in disparities in vaccination and infection rates among Black and Hispanic communities in the United States.
- Health Equity Challenges:
- Social and economic factors can create challenges to health equity and vaccination access for marginalized communities. These factors may limit reliable and timely information about the vaccine, as well as safe and effective vaccines themselves.
- Vaccination Access:
- Lower vaccination rates are observed among those disproportionately affected by monkeypox, indicating barriers to vaccination, especially in communities of color.
- Trusted Healthcare Providers:
- Collaborating with trusted healthcare providers and community-based organizations is crucial to ensuring that vaccine eligibility is not a barrier and that barriers to getting vaccinated are removed. However, these efforts may not be completely effective in all communities, leading to disparities in vaccination rates.
- Cultural and Linguistic Barriers:
- Developing culturally and linguistically tailored communication materials can help partners share information about monkeypox, but these materials may not always be accessible to all communities, exacerbating the disparities.
- Historical Trust Issues:
- Mistrust of healthcare systems and institutions, particularly amongst Black and Hispanic communities, can deter individuals from seeking vaccination, stemming from historical experiences with medical experimentation and unequal treatment in the healthcare system.
Addressing these issues requires a holistic approach that includes community engagement, culturally sensitive communication, and ensuring equitable access to healthcare services.
