Rafael Mandelman, San Francisco District 8 Supervisor, in a 2018 photo. District 8 includes the Castro, Glen Park, Noe Valley, Diamond Heights, and Mission Dolores. (Photo courtesy of The Office of Supervisor Mandelman)

SAN FRANCISCO (KRON) – People who set up appointments to receive a second dose of the monkeypox vaccine may not have their appointments honored in San Francisco as health officials seek to provide as much protection to as many people as possible.

“We do intend everyone will receive a second dose. The guidance from the state is to prioritize first doses. As soon as we have the supply to administer those second doses we will administer those doses,” Dr. Stephanie Cohen, the medical director of San Francisco City Clinic, told a San Francisco Board of Supervisors committee during a public hearing on the city’s response to the outbreak July 21. “This will only be a delay for a second dose.”

When District 8 Supervisor Rafael Mandelman, who called the hearing and represents the Castro neighborhood on the board, pressed Cohen about whether people who’ve already made appointments will have those appointments honored, she reitorated “we are asking our vaccinators to prioritize first doses.”

When asked by Mandelman about whether Magnet at Strut in the Castro will be able to honor second appointments, San Francisco AIDS Foundation CEO Tyler TerMeer said “we will be unable to respond unless we receive more vaccine.”

Mandelman told anecdotes of people he knows who, in spite of involvement in city government and politics, had to go to extraordinary lengths to receive monkeypox vaccine doses. One waited 12 hours total in lines over a period of three days; the first two days he was told to go home because vaccine doses had run out, Mandelman said.

Another was exposed to the virus at a party and called phone numbers that the health department put on its website, only to not hear back and only find out where and how to get vaccinated through “gay Twitter,” Mandelman continued.

Mandelman blasted the long, early morning lines outside the few places where San Franciscans can get vaccinated.

“Although I’ve been grateful for much of what the department of public health has been doing, I think that communications have been poor, and we’re actually getting bad information,” Mandelman said. “I’m not sure how we’re going to communicate with people whose appointments are not being honored. That would be quite a bad look.”

Mandelman said that “although the response of the federal government looks so bad [that] everyone looks better in comparison … I do think the inability to return those phone calls, people waiting in line for hours and hours, are pretty unforgivable.”

During her presentation, Cohen shared demographic numbers showing that in San Francisco 100% of the cases are among either cisgender or transgender men, and 88% identify as gay, but reiterated that anyone can get monkeypox and said “as it continues to grow it certainly could spread to other communities as well, but that has not happened yet in this new global outbreak.”

FILE – This 2003 electron microscope image made available by the Centers for Disease Control and Prevention shows a monkeypox virion, obtained from a sample associated with the 2003 prairie dog outbreak. The U.S. government is building up its supply of monkeypox vaccine to contend with escalating cases identified in a surprising international outbreak, health officials said Friday, June 10, 2022. (Cynthia S. Goldsmith, Russell Regner/CDC via AP, File)

‘Kind of a travesty’

Mandelman was harsh in his criticism of the federal response to the monkeypox outbreak. He speculated that it is not more effective either due to incompetence or because officials at the national level decided it is a “less urgent” problem.

“This is not the 1980s, Joe Biden is not Ronald Reagan, and monkeypox is not HIV,” Mandelman said. “But this is an eerily familiar experience for the queer community, especially for long-term survivors of the early, ugly days of the AIDS crisis and the federal response.”

Mandelman contrasted the federal government’s ability to vaccinate 40 million people for COVID-19 within three months of 2021 with its goal of vaccinating 3.5 million for monkeypox by the middle of next year.

“The urgency is now and although that’s an improvement of the plan two weeks-to-a-month ago [two million by end-of-2023], it’s still totally inadequate to a crisis now,” Mandelman said. “It’s an abysmal goal.”

Mandelman said that public health officials had been warning of the potential spread of monkeypox out of West Africa for over a decade, which was the reason for the creation of the Jynneos vaccine a few years ago. Yet “despite significant investment, the Trump and Biden administrations only ordered enough to vaccinate 28,000 people — not the millions they should have ordered,” Mandelman said.

“If that’s the best we can do, it raises troubling questions about our pandemic playbook,” Mandelman said. “If it is a less urgent response than it could’ve been, it would be great to know why and who made the decision. … It does seem to me it would have been preferable if the federal government used it’s immense resources to overdo the response to monkeypox ,and nip it in the bud.”

Instead, Mandelman said, the government did the “bare minimum.”

“It is plain our federal government is not on a war footing on monkeypox and that is not acceptable,” Mandelman said.

Cohen agreed with Mandelman.

“I share your same questions and concerns about this,” she said. “I think some is about concerning issues of national pandemic preparedness.”

Cohen said the decision to try a “ring vaccination strategy” proved particularly damaging (ring vaccination obviously being impossible when people don’t know those they’ve exposed).

MADRID, SPAIN – JUNE 06: A medical laboratory technician picks up from a fridge a reactive to test suspected monkeypox samples at the microbiology laboratory of La Paz Hospital on June 06, 2022 in Madrid, Spain. Europe is at the centre of the monkeypox virus outbreak, the World Health Organisation reported 780 confirmed cases with Britain, Spain and Portugal reporting the largest numbers of patients. (Photo by Pablo Blazquez Dominguez/Getty Images)

Even harder to get than vaccines are tests, which are only available in select facilities and can only be performed on rashes or sores; and treatments, which are extremely limited because they are not approved for monkeypox yet by the US Food and Drug Administration, though they are recommended by the US Centers for Disease Control and Prevention in the most serious cases.

San Francisco requested 35,000 vaccines for the initial phase response, Mandelman said. As of July 15, only 7,743 doses have been received, vaccinating about 3,400 people as of 3 p.m. Thursday.

Mandelman said he has asked unvaccinated people to “dial down” risky sexual activities.

“What are we communicating to people about what they ought to be thinking about this summer if they haven’t been vaccinated?” he asked TerMeer, mentioning the upcoming Up Your Alley and Folsom Street fairs.

“In general, we are an organization that recognizes we can’t tell people just to abstain or to ‘dial back’ because it will continue in some group of folks regardless of what we say,” TerMeer said. “We do want to make sure folks are be prepared to dial up their conversations with their partners.”

TerMeer said people should consider wearing long-sleeve outfits to crowded dance parties.

“These parties are still going to happen,” TerMeer said. “We are actually working on a campaign before the next set of festivals.”

What are the symptoms of monkeypox?

Symptoms of monkeypox include onset of flu-like symptoms and distinctive rashes or sores that could look like pimples or blisters.

While these red, flat spots which become bumps can be anywhere on the body, they are most likely in the genital or rectal areas, or at the fingers, mouth or eyes. The spots become bumps, which break and crust over into a scab. They may be itchy, but not necessarily.

Further, some people only get one or some of these symptoms; it is possible to have a fever but never a rash, or have these symptoms sequentially and not concurrently.

What is the monkeypox vaccine?

Getting a vaccine within 14 days of exposure can prevent or mitigate disease risk, as the incubation period can be weeks. Healthcare providers should test for other infections with similar symptoms, such as syphilis. Tests for monkeypox are confirmed at specialized labs. The monkeypox virus is in the orthopoxvirus family alongside smallpox, for which routine vaccination in the United States ended in 1972 after the disease was declared eradicated here. The smallpox vaccine is at least 85% effective against monkeypox, though its effectiveness reduces over time.

Side-effects of the Jynneos vaccine could include redness, pain or swelling at the injection site, muscle pain, headache, fatigue and nausea.

Who can get a monkeypox infection?

While “many of the cases are occurring within networks of gay, bisexual, trans people, and men who have sex with men,” San Francisco Department of Public Health spokesperson Noel Sanchez stated, anyone can become infected with the monkeypox virus.

“SFDPH takes monkeypox seriously,” Sanchez stated. “While most cases resolve on their own without pills or treatment, monkeypox can be serious. We are trying to contain outbreaks and reduce transmission to avoid the virus spreading to more people and potentially becoming endemic. To that end, we are doing education and outreach to communities most at risk; tracking monkeypox cases; distributing and administering vaccines as a preventative measure to people at high risk because of an exposure; and supporting testing and clinical guidance to providers, among other efforts.”

Sanchez advises people to:

  • cover exposed skin in crowds
  • avoid sharing bedding and clothing
  • talk with close physical and sexual contacts about health, rashes and sores
  • be aware of symptoms