SAN FRANCISCO (KRON) – The first summer since the end of most COVID-19 restrictions hit the gay community particularly hard, with the emergence of yet another viral outbreak and a response from the federal government that some compared to its disastrous response to AIDS four decades ago.

But in the ensuing months, monkeypox has often fallen off the front page as case rates have steadily declined. But how did that happen?

‘Community really came together’

Frank Strona is the MPX response lead with the San Francisco Department of Public Health (the agency, and the state’s health department, refer to the virus that causes the disease by its initials). Strona told KRON4 News in late September that he wouldn’t say cases had flatlined, but that a proactive response both from local public health authorities and ordinary people at elevated risk helped prevent the worst thus far.

“Everyday people are putting the word out that those at greatest risk need the vaccine first, it’s two doses, here’s how and where you can get it,” Strona said. “It’s not an unsolved mystery. It’s very clear from a public health response perspective. People at greatest risk — gay and bisexual men and trans people — immediately took action, looked to public health sources, [and] historically knew from the way San Francisco responded to HIV, STDs and COVID what to do.”

The city went from a 7-day rolling average of new cases of 20 per day (on July 30) to 2 per day (by the end of September) to 0.3 per day (by Oct. 16, the last day for which a rolling average was calculated).

On July 30, the city had only vaccinated 7,023 residents for monkeypox. Today, that total is 27,380.

Oct. 31 will be the last day of the city’s monkeypox emergency, the city announced last week.

The outbreak has also slowed around the country since the Biden administration declared a state of emergency Aug. 4. A subsequent consequential decision from federal health authorities was, amid a shortage of the Jynneos smallpox vaccine being used to inoculate against monkeypox, to split each vaccine dosage into five and change the method of administration, in order to vaccinate more people.

In this photo provided by the San Francisco AIDS Foundation, a person receives the Monkeypox vaccine at the San Francisco AIDS Foundation Monkeypox vaccine clinic in San Francisco. (San Francisco AIDS Foundation via AP)

The city moved to this alternative method of vaccine administration in mid-August, and also administered vaccines at events that drew a large number of gay men from the entire region and world, such as the Folsom Street Fair on Sept. 25, and the Castro Street Fair on Oct. 2.

Nationwide, monkeypox has been following a similar trend. On July 30, 311 new cases were reported in the entire U.S. On Oct. 16 that was just seven cases. The 7-day rolling average of new cases was 398 on July 30, and 64 on Oct. 16.

“Very similar to the epidemic of HIV, the community really came together in the monkeypox response in San Francisco to educate one another and bring awareness to the issue,” Tyler TerMeer, CEO of the San Francisco AIDS Foundation, told KRON4 News in late September. “They mobilized to advocate for services they needed and deserved when the public health response wasn’t there.”

A pivotal moment came when LGBTQ groups protested outside of the U.S. Department of Health and Human Services office in San Francisco, before the public health emergency had been declared. This after the Alice B. Tolkas LGBTQ Democratic Club, which put on the demonstration, called out Mayor London Breed for staying mum on the issue for weeks.

Health advocates troubled by racial, ethnic disparities

But Strona and TerMeer both warned that monkeypox is not by any means over.

TerMeer said that the federal government has failed at distributing vaccines equitably. Indeed, data released last month from the U.S. Centers for Disease Control and Prevention shows that vaccine distribution and monkeypox reality were radically opposed on the basis of race and ethnicity.

Both Santa Clara and San Francisco counties have reported that monkeypox is disproportionately affecting Latino men who have sex with men. (Chart courtesy of the Santa Clara County Dept. of Public Health)

Of those whose racial or ethnic background is available, 204,006 doses of vaccine nationwide as of Sept. 13 (37.7% of the total) went to white, non-Hispanic people, 91,280 doses (16.8%) went to Hispanic people, 50,475 doses (9.3%) went to Black, non-Hispanic people, and 31,644 (5.8%) went to Asian, non-Hispanic people. However, Black Americans accounted for 41% of total monkeypox cases reported to the CDC as of Sept. 4. Twenty-seven percent were among Hispanic and/or Latino Americans, 26% were among white Americans and 3% were among Asian Americans.

FA man holds a sign urging increased access to the monkeypox vaccine during a protest in San Francisco, July 18, 2022. (AP Photo/Haven Daley, File)

“This is a tale as old as time,” TerMeer said. “You can take any past public health crisis and know certain groups of people are going to have higher barriers and will be more disproportionately impacted. Some of that is due to a long history of stigma, or valid reasons for medical distrust.

“Some reasons are more structural — public health systems are doing their best to create access to services for people in need but not through an equitable lens,” TerMeer said. “We learned in the response to COVID-19 that we need to meet the community where they’re at.”

To this effect, testing and vaccine sites have been set up where people at risk have been more likely to get together and “designed in a way folks could be there to recieve a variety of services — COVID-19, monkeypox, flu.”

Sen. Alex Padilla (D-Calif.) joined other lawmakers and the secretary of the U.S. Department of Health and Human Services sharing their concerns over these disparities.

KRON ON is streaming live

“This discrepancy in public health has been a serious cause for concern for health care workers as white men have been receiving a disproportionate amount of vaccinations while making up a smaller percentage of being at risk for monkeypox,” the letter stated.

Strona hopes people don’t let up and that the city avoids backsliding in its fight against the virus.

“If you haven’t gotten vaccinated or got the first dose 28 days ago, get your dose,” Strona said. “We need people to get their second dose. We need folks in the community to talk about this, talk to people at risk or people who don’t realize they are at risk so they can get vaccinated.”