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For weeks, Austin tech worker Taylor Scot Harrell desperately tried to get the monkeypox vaccine ahead of his vacation so that he wouldn’t contract a painful and contagious skin rash on an upcoming trip to Europe.
Anyone can get the virus, which has no known long-term chronic effects and rarely leads to hospitalization. But it is painful and debilitating — and as a gay man, Harrell is part of what is currently a high-risk group for exposure.
And even though Harrell was trying to be proactive, he wasn’t eligible for the vaccine because he’d had no known exposure.
“I knew, just because of my high-exposure group and where I would be traveling, that I could potentially bring back this disease,” Harrell said. “But I couldn’t get one, even though the government literally says I’m at the highest risk.”
Demand for the monkeypox vaccine in Texas appears to be growing as cases of the virus are increasingly reported in the state’s metropolitan cities. Clinics that focus on LGBTQ health care say they are getting calls daily from their patients concerned about their risks and hoping to be inoculated.
There is only limited federal supply of the recently approved monkeypox vaccine being distributed as a growing number of states report confirmed cases. In Texas, health officials are allowing doses only for those with known exposure, although other states where counts are higher have gotten more doses than they can use for a broader range of high-risk recipients. Texas officials say they have so far been able to meet the demand for shots by people who have been exposed
While the virus is spreading almost exclusively among men who have sex with men, both in Texas and globally, it is not considered a sexually transmitted infection and that is not the only group of people who can contract it, said Chris Van Deusen, spokesperson for the Texas Department of State Health Services.
In fact, the one other time there was a U.S. outbreak of monkeypox, two decades ago, it almost exclusively struck people who had cared for infected pet prairie dogs.
“There’s nothing peculiar to that population [of men who have sex with men] that makes them more susceptible,” Van Deusen said. “That’s just the group that it happens to be circulating in right now. It will likely spread beyond that, at least to some extent.”
The difficulty in getting a vaccine in Texas frustrates Harrell. His neighbor was vaccinated by public health officials in New York last month — at the airport, the moment he got off the plane to head to the Pride Parade — even though he also had not been exposed.
His social media feeds are full of people in other states talking about proactive public programs to inoculate those who have sex and are at risk of exposure, he said.
“They say, ‘Come get your shot,’ ‘let us help you find a vaccine.’ I see it on my stories daily. I see nothing like that in Texas,” Harrell said. “There are obvious channels being put in place by East and West Coast cities to make sure that this vaccine is available. There is clearly a mobilization of this vaccine in those cities. And I am not seeing that here.”
A burgeoning global outbreak
Monkeypox is most easily spread through contact with the lesions that are caused by the virus. That kind of skin-to-skin contact does happen during sex, but it can also occur in other situations. Harrell, who knows four people who have tested positive, said he and his friends are being careful about prolonged skin contact in social situations even when sex isn’t involved.
It can also travel through respiratory droplets while kissing. And it can be contracted by touching contaminated surfaces, bedding and clothes. Because monkeypox is not considered a sexually transmitted infection, it is not prevented reliably with condoms or abstinence. It is not, however, an airborne disease and is difficult to pass to others through casual contact.
But it is spreading, with at least 110 confirmed cases in Texas and more than 2,100 nationally. That number has grown exponentially every week since it first hit the U.S. in mid-May. California, with more than 500 cases, has more than any other state. Worldwide, there have been nearly 14,000 cases, including five deaths, according to the World Health Organization.
With no in-office diagnostic testing available to clinics or doctors for at least a few more months, the process of confirming cases is cumbersome and slow, doctors say. Most in the health community presume that the cases in Texas, nearly triple what they were a week ago, will start to jump substantially as federal health officials ramp up their testing program nationwide.
DSHS has not started any statewide public awareness campaigns aimed at the general population about the risks of monkeypox and how to prevent it. Instead, it’s relying more on local health networks to get the word out quickly and efficiently to people at high risk of contracting it, Van Deusen said.
Because there is no statewide approach to public awareness, testing or vaccination of high-risk people, providers are working as hard as they can, they say, to get in front of the virus’ further spread.
“Public education and vaccine availability are my two biggest concerns,” said DeeJay Johannessen, CEO of the HELP Center for LGBT Health & Wellness in Fort Worth.
An Austin lab this week joined the federal government’s effort to ramp up national testing for monkeypox, the last of five commercial labs nationally that have been tapped by the U.S Centers for Disease Control and Prevention to help contain the virus, CDC chief Dr. Rochelle Walensky said.
With all five sites now active, along with the CDC’s national laboratory response network, the level of federally sponsored tests has jumped from 6,000 per week in June to more than 80,000 per week — a critical step in preventing community spread, learning who and where the disease is hitting hardest and identifying those who should be prioritized for vaccination and treatment while supplies of both are limited, Walensky said.
“The ability of commercial laboratories to test for monkeypox is an important pillar in our comprehensive strategy to combat this disease,” Walensky said in a statement. “This will not only increase testing capacity but also make it more convenient for providers and patients to access tests by using existing provider-to-laboratory networks.”
Texas providers want easier access to tests, which can take a few days because samples currently have to be tested off-site at a limited number of facilities, potentially delaying treatment for people who have been exposed.
But there’s also been high demand for a preventive vaccine, Johannessen said.
Johannessen’s clinic, which serves about 3,000 LGBTQ patients mostly in the North Texas area, has identified 10 confirmed cases among its patients — but gets calls every day from people wanting to take the vaccine to protect themselves if they should come in contact with someone who has the virus, he said.
“We send stuff out to our patients about it and what to be aware of, the risk factors, because there’s a lot of fear,” he said. “We’re getting multiple calls every day from people requesting the vaccine and having to explain to them about the limited availability of vaccines nationwide and more specifically in Texas.”
Over the July 4 weekend, Harrell spent time with a friend who later tested positive for the virus. Because of that, Harrell finally qualified for the vaccine — which he received last week. He leaves town on Friday for his trip to Europe. So far, he has not taken a test — but has also had no symptoms.
When Harrell finally got his vaccine, he arrived at the clinic at the same time his dose was delivered in a cooler.
“I guess that speaks to the supply, if they’re ordering mine specifically on the day we make the appointment and it’s getting delivered when I get there,” he said.
Texas health officials who treat large numbers of high-risk patients say the lack of vaccines that can be used as a widespread preventive measure is the single biggest barrier to eventually containing the virus.
“It’s a huge concern,” said Dr. Vandana Shrikanth, an infectious disease expert and a medical director at Legacy Community Health, which also fields daily requests for the vaccine. “There are so many people out there who are high risk, and they’re not being protected.”
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