Black and Hispanic people are more likely to get monkeypox but less likely to be vaccinated

Trends in the hardest-hit cities

Not all US cities keep or publish demographic data. But among those with the most monkeypox cases, people of color are often overrepresented among the sick and underrepresented among the vaccinated.

In Atlanta, as of mid-August, 71% of monkeypox patients identified as Black, 12% as white and 7% as Hispanic, while 44% of the vaccines have gone to white people, 46% to Black people and 8% to Hispanics.

However, while Hispanic people account for 21% of the cases in Houston, they make up 45% of the city’s population and 32% of those who have been vaccinated. White people are 24% of the population, 17% of the cases and 39% of those who have been vaccinated against monkeypox.

White people are the most vaccinated against monkeypox in Los Angeles. They’ve gotten 41% of the first doses, and they account for 29% of the cases. White people make up a quarter of the population of the county.

Black people are overrepresented among the cases. They make up 9% of the population in the county but 11% of the cases. Only 9% of those who got their first vaccine dose identify as Black.

“I would say as a public health community, we’re very good at repeating the same mistakes multiple times,” he said. “It’s the same story, the same underlying causes. There are barriers to care and information. Systems that require people to stand in line for hours for a vaccine do not work for people with hourly jobs, for instance.”

Administration efforts

“Equity is a key pillar in our response, and we recognize the need to put extra resources into the field to make sure we are reaching communities most impacted by the outbreak.”

The administration will send thousands of vaccine doses to organizations that work with Black and brown communities. The initiative will also work with state and local governments to set up vaccination clinics at key LGBTQ events that attract hundreds of thousands of people, such as Atlanta Black Pride, Oakland Pride in California and Southern Decadence in New Orleans. They will send enough vials to vaccinate up to 5,000 people at each event.

Federal health officials say they also will work with local leaders to identify smaller gatherings for pop-up vaccine clinics, like house and ballroom events that are popular with younger people. They’ve set aside an additional 10,000 vials for those equity initiatives.

“It’s important to also respect sort of the strategy that Charlotte may have had in terms of how to get the word out,” Dr. Demetre Daskalakis, the White House’s assistant monkeypox response coordinator, said Tuesday. “And so, 500-plus vaccines is a great success — it’s not a clinic, and so really, going to Pride and getting vaccinated — any number, especially that, I think is remarkable.”

Outreach efforts paying off

The outreach seems to be working in Fulton County, Georgia, which includes Atlanta and several large suburbs.

Black people make up 79% of monkeypox cases there but are only 42.5% of the population, according to the last census. Since the start of the outbreak, the county Board of Health said, it has initiated its own efforts to engage directly with organizations that work with Black and brown communities. Officials have set up clinics, posted QR codes in bars that link to appointment information, and extended hours at clinics so people don’t have to take time off from work to get vaccinated.

As a result, nearly 70% of the monkeypox vaccines that the county has given have gone to people of color, the board said. In comparison, only 10% of doses nationwide have gone to people who are Black, 22% went to Hispanic or Latino people, and 44% went to people who identify as white, according to the Biden administration.

“Communities of color have been hit particularly hard by monkeypox,” said Dr. Lynn Paxton, Fulton County’s district health director. “So efforts targeting health equity have been especially crucial for the Board of Health.”

The Biden administration said equity is a key priority with its monkeypox strategy.

“Our vaccine strategy is to meet people where they seek services, care or community, especially in communities of color,” Daskalakis said.

Obstacles to access

The extra efforts have been prompted by several obstacles to access to treatments, vaccines and culturally sensitive education material, public health experts say.

Sean Cahill, director of health policy research at the Fenway Institute in Boston, a health organization that works with sexual and gender minorities, says he has been frustrated by these unnecessary barriers.

For example, the monkeypox treatment Tpoxx is still considered experimental, so patients and doctors have to fill out paperwork required by the CDC to get it. For months, not one of the forms was translated into a language other than English. The CDC made the Spanish-language form available on its website in the second week of August.

“For patients who speak Spanish or Chinese or don’t speak a lot of English, it can be a real challenge for them to complete these forms,” Cahill said. It’s even harder for people who don’t have access to a computer or printer.

“There’s just some logistical issues that have been a constant challenge to help patients, and there needn’t be,” he added.

To get a vaccine appointment, particularly in the beginning of the US outbreak when vaccines were in much shorter supply, people essentially had to follow their local health department on Twitter to find out when they were available, Driffin said. The appointments would often fill up in minutes.

“Your health status should not be dictated by Twitter or Instagram,” Driffin said.

He added that it’s especially difficult for some people to get appointments to get tests or treatments.

“Especially here in Georgia, where many individuals, especially men, Black and brown people, may not have access to regular medical care. So where are they supposed to go?”

Echoes of other outbreaks

This is not, of course, the first health outbreak to disproportionately affect Black and brown communities.

Black people account for a higher proportion of new HIV diagnoses and cases compared with other races and ethnicities. Hispanic and Latino people are also disproportionately affected by HIV.

These same communities are overrepresented in the Covid-19 pandemic. People of color have a disproportionate number of cases and deaths compared with White people when accounting for age differences, according to the CDC.

The CDC has regularly said that more needs to be done to help these communities, and public health officials’ inclination to want to help is good, Doubeni said.

“But typically, they don’t say ‘Oh, we have a problem. Let me see how I can work with the community to see what is beneficial for them,’ and they especially don’t do this from the beginning,” Doubeni said.

On more than one occasion, Doubeni said, he has watched government public health officials spend months to create education materials in English. Only after those materials come out will they start working on a Spanish version.

“I think it’s all well-intentioned, but unfortunately, it doesn’t always begin with an end in mind,” he said.

He tells people that because of institutional racism, and for social and economic reasons, those who are in communities of color may have to be persistent to get the treatment they need.

“Don’t take no for an answer,” Doubeni said. “People should not be ashamed to have to seek treatment for monkeypox. It has nothing to do with them as a person per se. We can control this outbreak and keep it from running out of control. And it’s your right to get the answers you need.”

Atlanta Black Pride organizer Scott said she’s been pleased with the local public health department’s targeted outreach. One of the event’s goals has always been to strengthen the community’s health while encouraging everyone to have fun.

“We’re trying to make sure we reach the people who need it most,” she said.