We Are Already Blowing Our Monkeypox Response
The story of one young man in Berlin shows that Germany is blowing it. We’re next. We should reschedule Pride celebrations — let this summer be lesbian-led — until we can vaccinate thousands of gay men.
Stuart is a young gay man in Berlin who got a monkeypox diagnosis this week. The pox on his rear end hurt too much to let him sit down, the two on his lips are “annoying and ugly,” and the ones in his genital tract feel like gonorrhea.
At present, the German government has neither medicine nor vaccine for him, nor for the two other men in his social circle who are infected. Contact-tracers called him, but the “sex-positive” events he enjoyed at a famous Berlin club and other venues in mid-May were anonymous, so he had little to offer them.
His first symptoms — headache, fever and chills — felt like flu. The first lonely pimple on his neck resembled acne. Only when a half-dozen appeared on his buttocks a day later did he suspect monkeypox and visit a doctor — meaning he might have been unwittingly spreading the virus for two weeks or more.
All Germany’s vaunted medical establishment can do for Stuart is say “Please stay home.” Stuart’s flatmate hopes he’s safe — partially because Stuart is careful about disinfecting their shared bathroom, but mostly because he’s old enough to have had a smallpox shot as a child.
This is ridiculous. This is not how you beat an epidemic. This is failure.
Germany’s outbreak is racing through its gay male population. Berlin alone has more than 100 cases.
Ours is next. There are now about 1,800 confirmed and suspected cases of monkeypox in the world, mostly in Europe. But there are also nearly 50 confirmed cases in this country, spread from Massachusetts to Texas to Hawaii.
And if Germany can’t get it right, we certainly can’t. Germany’s Covid response was far better than ours. It was hit hard by the virus three weeks earlier than we were. A German lab developed the first test outside of China, the one the W.H.O. adopted. A German company, BioNtech, made the core component of Pfizer’s vaccine. Germans accepted distancing, masks and vaccines far more maturely than we did. As a result, Germany’s per-capita death rate was roughly half of ours. That war, we lost.
Stuart would prefer to be in a quarantine center like those Wuhan set up early on for everyone infected with Covid. If he could spend his time with other men with monkeypox, he said, “I would feel physically and psychologically safer, and more calm.”
That way, if he needed a doctor or a hospital admission, he’d get it. If drugs became available, he’d get them. And the stigma — which he described as “worse than H.I.V. right now” — would be less.
Instead, he’s alone with his pain and his fears.
So what are we in the United States doing as a new epidemic comes roaring towards us?
We’re celebrating Pride Month. One potential superspreader event after another. I fear that the result is going to be hundreds of American men infected in the next few weeks and the permanent entrenchment of the virus in gay male America. If that happens, it will mean hundreds hospitalized in the next year or so, some permanently disfigured and probably a few dead — guys who don’t yet know that they are also HIV-positive.
It’s hard to be sure, since it’s too early to see patterns emerge. But right now, we are watching and waiting — but not diagnosing people until, as in Stuart’s case, multiple pox appear. That’s too late to prevent transmission. Late diagnosis, fruitless contact-tracing and ring vaccination — against a background in which no one under 50 is vaccinated — seems unlikely to work.
The responsible thing to do would be to immediately declare this the Summer of Lesbian Pride, and to put a hold on all sex-positive events for men. Don’t cancel them — just re-schedule them for the fall. Then, with the grace period that buys, make an all-out effort to vaccinate hundreds of thousands of men at risk and develop a rapid test that anyone can take at the door to the bar. Then let the parties resume.
This isn’t 1981. This time we have a vaccine. We could soon have a test. We should use them — as fast as possible.
We have 100 million doses of the ACAM2000 vaccine that’s safe if you don’t have untreated H.I.V., immune suppression or widespread eczema. (It’s safer than the one that I, like almost every other American over age 50, had as a baby.)
Unfortunately, we have only about 72,000 doses of the even safer Jynneos vaccine. The Danish company that makes it has 1 million more doses in stock that are legally owned by the U.S. government. But most of them aren’t ready to inject yet, and it can’t make any more until next year. (We used to have 28 million doses, but they were allowed to expire without being replaced, which bears looking into.)
What are the chances of Pride being delayed now? Probably zero. It’s not just that the demand for fun, penned up for two years by the Covid pandemic, is so strong. Nor that monkeypox has already faded from the headlines.
It’s that too much corporate money is involved. Money that will likely twist any calls for a pause into back-and-forth accusations of puritanism, sex-hostility and homophobia.
Anyone who remembers the 1980’s, or has read Ronald Bayer’s excellent 1989 book “Private Acts, Social Consequences,” will remember how hard San Francisco’s bathhouse owners fought against closure by the city health department. The owners were getting rich by encouraging men to get drunk and have sex on their premises. They used every tactic they could to stay open: lawsuits, ads in gay papers saying the virus wasn’t real, appeals to gay rights, accusations that city officials were homophobes.
It worked. They accepted some restrictions but they stayed open. In New York and Los Angeles, local politicians were too cowed to even make a serious effort to close the baths and bars. Lots of men believed the false rumors touted by the owners that the disease was not caused by a virus or spread by sex. And throngs of men died.
How about we try to not repeat that?
Instead, we are making half-hearted efforts in the face of a gathering storm.
Unfortunately, the first travel advice issued by the C.D.C. provoked confusion and laughter. It advised Americans venturing overseas to: Avoid contact with anyone with open sores. (Never bad advice but hardly specific enough.) Avoid rodents and monkeys, especially as food. (We had to be told?) Avoid contaminated bedding. (Not a major threat.)
And it initially advised wearing a mask — something that would probably make sense only if you could strap on a super-sized N95 as a chastity belt. It was reminiscent of the old joke about five addicts sharing a needle and scoffing at a critic: “Hey, we’re all wearing condoms!”
That paragraph was quietly removed.
By contrast, the new C.D.C. advice on “Social Gatherings, Safer Sex and Monkeypox” is far better. It reads as if it was written by a different agency. It deals frankly with risky sex, including mentions of fetish gear, back rooms and sex toys. Laughing in the face of the Congressional conservatives the agency normally cowers from, it uses words like “cum” and “poop.”
The C.D.C. is not yet ready to publicly post pictures of genital or anal sores to look for, but they are out there, in a fact sheet arguing that knowing the symptoms is “essential to keep our community of gay sluts safe.”
One suspects that Dr. Demetre Daskalakis, the agency’s chief of HIV/AIDS prevention, had a hand in the new C.D.C. view. He has a long history from his days in New York City of fighting hard but with humor against both stigma and infection, first with PrEP against HIV, then with vaccine against the dangerous meningitis strain that began spreading through gay clubs in 2010.
Dr. Daskalakis is working with Pride event sponsors to turn sex-positive venues into educational ones.
But that won’t be enough. Without an enforced pause, the virus will spread faster than good advice can. Even if a combination of Jynneos and ACAM2000 doses were rolled out fast, immunity still requires six weeks to kick in: two shots a month apart, plus two weeks for antibodies to build.)
As things stand now, many men will suffer. They won’t be the virus’s final frontier; the C.D.C. says it is spread by prolonged skin-on-skin contact, it may be spread by kissing. That’s not “gay sex,” that’s all sex, and even just messing around. The potential to make the leap into all sexually active Americans is high, especially as the virus adapts.
We must move faster and more firmly, both to isolate and help men like Stuart who are already infected, and to protect the many thousands more who are now at risk. And to build a dam of immunity against a viral flood.
An earlier version of this article incorrectly described which portion of the population is not vaccinated against smallpox. Routine childhood administration of that vaccine ended in 1972, so almost no one under 50 — not over 50 — has had it. Having had smallpox vaccine in childhood is believed to confer some protection against monkeypox.