The Biden administration declared monkeypox a public health emergency on Thursday, but during the 40-minute media call for that announcement, federal officials never mentioned the virus’s disproportionate impact on Black Americans.
It’s an absence that harks back to the first weeks of the coronavirus when, in the spring of 2020, Black people were dying at exceptional rates with little acknowledgement from government leaders.
As monkeypox cases topped 7,100 nationwide this week, data from the U.S. Centers for Disease Control and Prevention showed that Black Americans — along with Hispanic Americans — are bearing the brunt of the outbreak. More than a quarter of monkeypox cases in the U.S. have infected Black people — double the rate expected given their population.
In late May, as the outbreak took hold in the U.S., Black Americans made up 12% of all new cases. By mid-July, that proportion had jumped to 31%, according to CDC data. For white Americans, the proportion dropped from half of all monkeypox cases to less than 40% during the same time periods.
The continuation of racial health disparities is a result of “our inability to have any humility around what is wrong in our society and actually try to address it by first naming it,” said Dr. Kim Rhoads, an associate professor at the University of California San Francisco. “We’re not good at that.”
The severity of racial disparities for monkeypox varies by location. In New York City, the number of cases among Black residents is comparable to their population size, about 30%. In California’s Santa Clara county, about 40% of cases are among Hispanic or Latino men who have sex with men, despite Latinos only making up 26% of the region’s population.
In Georgia, however, the disparities facing Black residents are particularly stark. Black men make up more than 80% of cases, according to the state’s department of public health. About 30% of Georgia’s population is Black.
One Atlanta resident who has been sharing his experience in isolation with monkeypox on social media, said he wants more information from health officials on how to end the spread of monkeypox.
“I consider myself desperate,” said Angelo Perry, who was diagnosed two weeks ago. “I consider myself desperate for not only getting better, but I consider myself desperate for more information.”
In Thursday’s call, federal officials discussed that LGBTQ communities and men who have sex with men are particularly vulnerable to the monkeypox virus. Those communities will be primary targets of government education, vaccination, and treatment outreach, they said.
Yet, racial disparities were not mentioned. While officials broadly talked about “impacted communities,” there was no discussion of Black or Latino communities needing additional resources.
These groups, data shows, are among those disproportionately affected within the LGBTQ community itself, said Dr. Oni Blackstock, a primary care and HIV physician in New York.
“It seems like that is not always appreciated or lifted up,” she said.
The World Health Organization recommended men who have sex with men reduce their number of sexual partners and reconsider having sex with new partners while the outbreak continues.
“This public health emergency will allow us to explore additional strategies to get vaccines and treatments more quickly out in the affected communities. And it will allow us to get more data from jurisdictions so we can effectively track and attack this outbreak,” said Robert J. Fenton Jr., who was recently announced as the White House national monkeypox response coordinator.
In response to a request for comment from Capital B after the Thursday press briefing, the CDC said in a statement that, “while anyone can get monkeypox, available data indicate that monkeypox has disproportionately affected sexually active gay and bisexual men and racial and ethnic minority groups. These communities must be empowered with information to make informed decisions about their health — not stigmatized.”
When asked why these disparities were not discussed or mentioned in Thursday’s call, Kristen Nordlund, a CDC representative, said the agency “has released data like this previously, as late as last week in a call with clinicians that is advertised to the public and that media can attend.”
Read more: Everything You Need to Know About Monkeypox
The wide variation in racial and ethnic disparities of monkeypox from place to place is likely a result of structural racism and institutional barriers, said Dr. Sabrina Assoumou, an infectious disease physician at Boston Medical Center. That includes local policy decisions such as Medicaid expansion.
“Infectious diseases tend to exploit existing structural issues and impact communities that have been historically excluded,” she said. “To address these issues, we need structural and policy solutions.”
Some experts fear the racial disparities in monkeypox cases could be even greater than the data shows, given race and ethnicity haven’t been recorded for a significant number of cases. It’s likely that some monkeypox infections are going undiagnosed, said Blackstock, especially within communities with high rates of poverty, lack of health insurance, and other structural barriers to care. Those barriers can prompt lower rates of testing and treatment due to fear of racism or homophobia from clinicians.
“If we lead with equity, it actually helps everyone. Everyone wins in the end,” she said. “It’s unfortunate that there hasn’t been an explicit discussion of how the response is taking equity, and in particular racial equity, into account.”
The monkeypox disparities appear to be similar to those from the early months of the COVID-19 pandemic, when it became clear Black folks were catching the virus and dying at alarming rates. It was a trend that shocked some Americans who, following the murder of George Floyd and racial justice protests in 2020, were paying attention to how racism affects health outcomes.
Now, in the third year of the coronavirus pandemic, the conversation surrounding racial equity in public health response has dwindled.
“Monkeypox was really our opportunity to show what we learned from COVID,” said Dr. Stella Safo, a New York City-based primary care physician. “We’re failing in our public health and our federal and local responses.”
On his first day in office, President Joe Biden signed an executive order committing to advance racial equity in the U.S., including within the health care system. Less than a month later, with clear data showing the coronavirus was devastating Black communities, his administration announced a COVID-19 Health Equity Task Force. The individuals selected came from a range of racial and ethnic backgrounds.
The monkeypox outbreak has prompted a far less robust response to racial health inequities. In the announcement of leadership for the national monkeypox response team, which was released in early August, there was no mention of the racial disparities in cases.
“I was disturbed and frustrated that there wasn’t a Black or Latino queer man or person on the leadership,” said Blackstock. “That struck me immediately.”
While the virus is spreading most rapidly within the Black, Latino, and LGBTQ communities, anyone can get it and everyone should be alert, experts said.
The country is facing a “critical inflection point” that requires a more aggressive response, said FDA Commissioner Robert Califf in Thursday’s briefing. Officials from the CDC, Department of Health and Human Services, and White House were also on the call.
Monkeypox, unlike COVID-19, does not spread easily and remains relatively rare. And while it is not exclusively a sexually transmitted infection, it is passed through prolonged skin-to-skin contact. People who are not sexually active can contract the virus. It can be transmitted through sharing bedding and clothing that a person sick with monkeypox has used.
Both viruses may cause initial symptoms that include fever, chills, and body aches, then they deviate. Coronavirus infection can present as shortness of breath, while monkeypox appears as a rash. And when COVID-19 emerged in the U.S. in 2020, it was a new pathogen, one with little understanding and no vaccine. Meanwhile, monkeypox was first identified decades ago, and vaccines have already been developed and distributed, though they’re limited in quantity.
It’s endemic in certain African countries, meaning its spread is confined to specific regions, yet those countries have struggled with limited access to vaccines.
In the U.S., local health departments are managing vaccinations. And due to limited supply, some places have restrictions on who’s eligible to receive them.
Experts recommend being mindful of skin-to-skin contact without stigmatizing any groups. If you have a fever and a rash, get tested and isolate, said Safo, who has been testing patients at a referral center in New York.
Thinking about challenges Black and Latino men who have sex with men might face in accessing care is important, said Blackstock. Sigma, racism, and homophobia can hinder them from receiving quality treatment and getting the vaccinations they need to limit the spread of the virus.
Health experts noted that demographic data that includes race and ethnicity is critical to knowing where to disseminate information, education and resources in order to combat transmission of monkeypox. With Black folks disproportionately impacted, data could help target access to vaccines.
“Now that we have the information,” Assoumou said, “it’s really critical to act on it.”
Capital B Atlanta Health Reporter Kenya Hunter contributed to this report.