Thousands of people across Massachusetts have been vaccinated against monkeypox, and the outbreak appears to be on the decline.
But state data show wide disparities in how vaccines are being distributed, and how the outbreak is affecting Black and Hispanic residents. The inequities are prompting health care providers to develop new strategies for reaching out to people at risk.
White people have received the majority of monkeypox vaccines. Black and Hispanic residents have received less than 20% — but they represent nearly half of all cases.
“Black and Latinx men who have sex with men are not being vaccinated according to their level of risk,” said Dr. Cassandra Pierre, associate hospital epidemiologist at Boston Medical Center. “They are overrepresented in terms of monkeypox infections, and underrepresented in terms of who's receiving vaccinations.”
It’s a repeat in some ways of the rollout of COVID vaccinations: The people most affected by the virus were sometimes last to receive vaccines because of barriers to access or mistrust in the health care system.
Pierre said it’s frustrating to see the same problems playing out again.
“We need to really consider and employ different strategies for outreaching to members of that at-risk community who may still be unaware of their at-risk status, or how to access vaccine, or lack the time or transportation to get the vaccine,” she said.
Monkeypox spreads through close personal contact and can cause a painful rash. Most cases in the current outbreak in the U.S. have been among men who have sex with men, though the virus can affect anyone.
Vaccines are available for people with known or possible exposures to the virus, including people who recently had multiple sexual partners.
The vaccine is given in two doses, typically 28 days apart.
More than 16,000 people in Massachusetts received at least one dose of vaccine by Sept. 21, according to data from the state Department of Public Health.
Hispanic people account for 12% of those vaccinated, but a far higher share — 31% — of monkeypox cases. This gap has only grown in recent weeks.
Black people account for 5% of those vaccinated — but 15% of people who’ve contracted the virus.
White people represent 63% of those vaccinated, but they make up a little less than half of identified cases.
“We just have to put our heads together to figure out: How do we maximize what we have right now and ensure that other populations are getting access to those services?"Ismael Rivera, JRI Health
Health care providers and advocates say the reasons for the disparities are deep-rooted and complex. Some people don’t trust the health care system based on previous experiences of bias and racism. Some want to get vaccinated but don’t have the time or resources to get to a clinic. Others lack information because of language barriers.
And when it comes to monkeypox, doctors said, some people could be concerned about identifying as men who have sex with men because of past stigma they have experienced.
Dr. Kevin Ard said many patients coming to the sexual health clinic at Massachusetts General Hospital this summer didn’t know about monkeypox or that a vaccine could help reduce risk.
“Awareness of the vaccine was not universal,” said Ard, an infectious disease doctor who leads the clinic.
When Massachusetts launched a vaccination effort in July, the vaccine, called JYNNEOS, was in short supply.
There weren’t nearly enough doses to protect everyone at risk. Only a small group of clinics were selected to give vaccines, and their appointments filled up fast. Some providers wait-listed or turned away hundreds of people every day because they didn’t have enough supply.
It was first-come, first-served vaccination.
“That favors people who can take time off from work to do it, who can spend a lot of time refreshing a website or on a phone line waiting for someone to answer,” Ard said. “It favors people who are connected to the information channels where they would hear about it quickly.”
Ard said he’s concerned, but not surprised, to see racial and ethnic disparities in vaccinations. He said health care providers wanted to reach out to more people earlier, but they were hamstrung by the short supply.
In August, federal officials approved a new strategy to stretch vaccine supply by administering smaller doses through a needle injected into layers of skin, instead of beneath the skin. This increased the vaccine supply five-fold.
Now, providers are turning more attention to reaching the people who have been left behind. They acknowledge there is no quick fix.
Boston Medical Center is offering vaccines to eligible patients who already receive treatment to protect against HIV.
A study from the Centers for Disease Control and Prevention found that nearly 40% of monkeypox cases were in people with HIV.
Fenway Health is texting and emailing patients of color who might be eligible for monkeypox vaccines, said Adrianna Boulin, director of community impact and engagement. It’s also working with groups that serve LGBTQ communities to educate people about vaccines.
JRI Health in Framingham has more than 800 people scheduled for vaccinations in the coming days. But Ismael Rivera, the director of program management and development, said many more people are eligible.
JRI Health is using a van to bring pop-up monkeypox vaccination clinics to more communities, a strategy it also used to distribute COVID vaccines. The staff share information in English, Spanish and Portuguese.
Rivera said they’re also planning to partner with churches, schools and nonprofit organizations.
“We just have to put our heads together to figure out: How do we maximize what we have right now and ensure that other populations are getting access to those services?
“If they can't come to us,” Rivera said, “how can we come to them?”