Dan DeChellis began looking for a monkeypox vaccine around the Fourth of July but couldn’t find one near where he lives in Orlando, Florida.
After about a week of searching online, he and three friends made an appointment in Wilton Manors, a town about 3½ hours south by car. Dichelis, who is gay, said he didn’t understand why the vaccine wasn’t available closer to home or why it was so hard to get answers from his local health department about who was eligible.
“My biggest takeaway from our experience is the variation from county to county in the state of Florida,” said Dichelis, 30, a supply chain manager who lost a half-day of work while traveling to receive his first vaccine dose.
The perception of a lack of coordination in the response to the monkeypox virus in the South has revived familiar concerns about recent state policies that leave members of the region’s LGBTQ+ community feeling marginalized and discriminated against. More urgently, it raises questions about whether state and local health departments are doing enough to protect people who are infected with the virus: men who have sex with men.
States such as New York and California have followed recommendations from the Centers for Disease Control and Prevention to prioritize promotion, vaccination, and treatment of gay and bisexual men for monkeypox. Such states have declared a public health emergency and launched aggressive, targeted vaccination campaigns. While the states of New York and California have the highest number of cases, Florida, Georgia, and Texas are home to strong gay communities and together account for more than a quarter of the nation’s confirmed cases of monkeypox.
But in Florida and other areas of the South, gay men fear that the monkeypox response is not being consistently prioritized because of the virus’ impact on the health of gay men, particularly those who are black or Hispanic. And they worry that local governments are not responding urgently to diseases that primarily affect marginalized populations.
“They wouldn’t go out of their way to help us,” said Hank Rosenthal, 74, a gay man and retired emergency medicine doctor who lives in Fort Lauderdale, Florida.
Jeremy Redfern, a Florida Department of Health spokesman and spokeswoman for local health departments, said the agency is “fully integrated” to respond to public health needs across the state’s 67 counties. “There are no jurisdictional boundaries to our reach in Florida,” he said. “There is no politics about monkeypox.”
But recent laws like Florida’s that ban the instruction of gender identity and sexual orientation in some elementary school grades — what opponents refer to as the “Don’t Say Gay” bill — and create state restrictions on transgender care for people with Medicaid LGBTQ+ advocacy groups say sexual orientation and a hyper-politicized environment surrounding issues of gender identity. And some groups have felt the need to take matters into their own hands, especially in states that have played down the Covid-19 pandemic and banned face mask and vaccine mandates to limit the spread of the virus.
“We mobilize, and we try to make things happen because our job is to take care of our community,” said Ricardo Martinez, CEO of Equality Texas, an advocacy group for LGBTQ+ rights. “We cannot rely on the state to provide the relief and protection we need, so we must organize ourselves.”
Florida’s first suspected case of monkeypox was reported in Broward County in late May. Since then, the health department has reported that more than 2,200 of the state’s cases — about 2 in 3 — have occurred in Miami-Dade and Broward counties in South Florida, where DeChelis and his friends traveled to get a monkeypox vaccine.
The vaccine, called Genios, is shipped directly from the strategic national stockpile to five county health departments. From there, the state sends the vaccine to doctors, hospitals and other county health departments “as needed,” Redfern said.
The national stockpile ships the vaccine to five sites per state and at first uses a delivery system that was unfamiliar to state officials; This would require them to manually track doses and place orders via email rather than an automated system, creating a bottleneck. On September 6, the US Department of Health and Human Services announced that it had awarded a $20 million contract to a private wholesale company to “significantly” expand vaccine distribution to more sites in the coming weeks.
As the government response improves, LGBTQ+ advocates and those who have tried to get vaccinated in Florida say vaccine access and information were inconsistent in the first months of the virus’ spread. They said local health departments used different eligibility criteria, recruitment scheduling systems and public outreach.
Brandon Lopez of Orlando said that when he first tried to get vaccinated through his local health department in June, he was told that only health care workers in laboratories and those who drew blood were eligible. Lopez, 30, said she thought about driving to Miami to see friends there getting shots but was told the appointments were for local residents only.
Some counties announced online schedules for appointments in mid-July, but many people who tried to sign up said there were no slots available or they received an error message asking them to create a new email account.
“I see my friends who live in Chicago, who live in San Francisco, who live in Washington, D.C., and they’re just able to walk to one place,” said Josh Roth, 33, of Orlando, who waited nearly three weeks to get his first vaccine dose. “They may have hours to wait, but they are able to get the shots.”
Advocates also worry that people with more education, money and time may be better able to access the shots.
Preliminary data suggest that black and Hispanic men are disproportionately affected by monkeypox, yet according to the CDC, non-Hispanic white patients received the first dose of the vaccine more than any other group.
More appointments began in Florida in mid-August after the FDA approved a new method of administering the vaccine that required training and specialized equipment but stretched the nation’s limited supply.
DeChelis did not have to drive to Wilton Manors for his second shot on August 23, and Roth received his second dose as scheduled. After weeks of trying to get an online appointment, Lopez received the vaccine in early August at the Orange County Health Department in Orlando.
But the experience made him feel that monkeypox was not an urgent matter for local health officials. “My expectation is that if it doesn’t affect a mass group of people, it won’t be a priority,” Lopez said.
After monkeypox outbreaks began, some health departments in the South began partnering with so-called trusted messengers from the LGBTQ+ community to raise awareness and host vaccine clinics.
In South Florida, for example, Broward County’s health department is reaching out to high-risk groups in the community for help getting people vaccinated, said Robert Bu, CEO of the Pride Center at Equality Park, a nonprofit that provides health and social services for LGBTQ+ people. People and that host a vaccine drive. In Texas, Equality Texas held a webinar with doctors and other experts who answered questions from the public.
But in other areas, gay and bisexual men said they couldn’t get answers, not even from their local health department.
Florida, Georgia and Texas together account for 26% of the nearly 22,000 confirmed cases reported as of Sept. 9, but their response has not been the same as that of California and New York, where emergency declarations from governors have allowed more health care workers to administer the vaccine and local health departments to vaccinate. , to access more money from the state for education and outreach.
“An emergency declaration does nothing for the response,” said Redfern, a spokeswoman for the Florida Department of Health, which is also responding to a current outbreak of meningococcal disease that primarily affects gay and bisexual men.
“The new state of emergency order for Georgians is nothing that isn’t already being done,” said Andrew Eisenhower, a spokesman for Republican Gov. Brian Kemp. He also said the Georgia Department of Public Health is raising awareness about monkeypox and recently launched a statewide portal to schedule vaccinations.
In Texas, officials in Austin and Dallas declared local states of emergency in early August. The Texas Department of State Health Services declined to comment on whether a statewide declaration is valid.
Some providers, such as Dr. Ivan Melendez of the Hidalgo County Health Authority in South Texas, agree that because monkeypox is primarily spread among men who have sex with men, a statewide declaration is not necessary. Lab testing, vaccines and guidelines are available for clinicians and the public.
But others say an emergency declaration would signal that a threat exists, free up funding, require additional reporting and cut bureaucratic red tape.
“It gives us a coordinated response,” said Jill Roberts, an epidemiologist and associate professor at the University of South Florida. “It allows for more information: Where are the vaccines going? Where are the cases happening? Where can we hit hot spots?
Dr. Melanie Thompson, an Atlanta physician who provides care to people living with HIV, said she wants the state and governor to play a stronger role in coordinating a uniform response in Georgia’s 159 counties. Not all local health departments are adequately staffed or funded, Thompson said.
“They’re all there doing their own thing,” he said. “Some counties do a really good job with it. Other counties don’t.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.
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