“It was like trying to win the lottery. It was so difficult.”
On a hot Saturday afternoon last weekend, at New York City’s Bronx high school of science, Alexx Dunn, 42, waited in line for a monkeypox vaccine at a public health immunization site.
For his elusive appointment that are usually only be booked online, Dunn needed two cellphones (the second borrowed from his co-worker), four different chances to sign up for the shot after failing to get an appointment with each new batch of time slots released, and precious time away from his job as a retail manager in the fashionable Manhattan shopping district of SoHo, work that he quickly returned to as soon as his Saturday appointment was over. In the US, the rapid increase of monkeypox cases has now officially been declared a national public health emergency. Before Thursday’s announcement by the Biden administration, the New York City mayor, Eric Adams, and the New York state governor, Kathy Hochul, issued separate emergency declarations. New York City has the bulk of US cases so far, with San Francisco also badly affected.
New York health officials offer vaccinations via an online sign-up portal under strict eligibility, including for those who may have been exposed to monkeypox. Currently, men and members of the LGBTQ+ community are the groups most affected, though anybody can contract the virus.
But amid belated increases in appointment availability for those eligible, since the latest outbreak of this relatively rare virus reached Europe and the US in the second half of May, experts and patients are observing that the vaccination process privileges a select few.
Those who have the most resources – time, fast internet access and electronic devices, knowledge on monkeypox and vaccinations, sometimes acquired via well-connected friends – have been best placed to snap up limited appointments, while leaving out marginalized communities.
Demographic data on who’s getting vaccinated has been largely unavailable. But current figures from the Centers for Disease Control and Prevention (CDC) shows that racial minorities make up the majority of US monkeypox cases, ABC News reported.
Data from 28 July showed that of the 4,600 reported US cases of monkeypox, Hispanic people accounted for 31% and Black people 27%, despite only making up 19% and 13% of the general population respectively.
Data out of New York City follows a similar trend. Out of 1,630 monkeypox cases in New York reported as of 4 August, Black and Hispanic people together made up more than half.
But many worry that the vaccine process isn’t best serving the communities and neighborhoods worst affected by this, and fears abound amid preventable spread.Last Saturday, some faced more challenges than others.
“Super easy to sign up for online. No problem at all. Took me maybe three minutes to do the whole thing,” said Steven Harris, 39, who is white and was able to get the appointment while working from home in Manhattan and then travel to the Bronx, the city borough with the lowest percentage of white residents and the highest rate of poverty.
But others, such as Charles Robinson, 28, described a dissimilar experience, with Robinson, a biology PhD student, using two laptops to finally secure an appointment on the glitchy health website.
“It’s complete bullshit. I don’t understand why we gotta do all this stuff to do one thing,” said Robinson, a Black man, after receiving his first of two recommended vaccine doses on Saturday after traveling from Harlem.
Daslyn Colson, who also got a vaccine on Saturday, added that from what she had heard and seen – mainly the line being populated by white people despite the vast majority of Bronx residents being non-white people – the overall process seemed to push out actual Bronx residents who may be disproportionately affected by monkeypox.
“I know there were some issues the previous times when they had the first wave of vaccines available and people were coming into the Bronx and taking them from Black and brown folks. Seeing that a lot today.”
Colson, a Black woman in her late 20s, travelled from East New York to get the vaccine, finding no available appointments online closer to her home.
Colson’s observations echoed complaints and fears on social media and by others in line, that mostly privileged white people would be able to take advantage of the few available monkeypox vaccine resources.
Jason Cianciotto, vice-president of communications and public policy at GMHC, the city non-profit born out of the HIV/Aids crisis in the early 1980s whose website says “Monkeypox: be aware but don’t panic”, spoke of the vaccine shortage.
“It [impacts] the low-income communities of color, immigrants, transgender and gender non-conforming people who, for many reasons, have historically lacked access to healthcare, technology, [and may have] jobs that might prevent them from being able to hop online to try to get an appointment,” Cianciotto said.
Cianciotto and Anthony Fortenberry, chief nursing officer at the city’s Callen-Lorde community health center, both spoke to the Guardian of a startlingly low level of available vaccine doses that is exacerbating existing health inequalities.
New York City only has 79,000 monkeypox vaccines available, with the US distributing less than one-third of the estimated 3.5m it will need, the New York Times reported.
“[With] the vaccine, when you ration healthcare, only the most privileged are able to access it,” said Fortenberry.
For those who do not see a regular physician, getting information on monkeypox is difficult. LGBTQ+ adults, particularly transgender people, are more likely than the general population not regularly to see a doctor or have health insurance, according to a June 2022 report from New York state’s department of health.
Even for those with healthcare coverage, information is patchy.
“I had to do the research. I don’t see the information readily available. It was just by word of mouth,” said Colson, adding that the overall process has been “messy”.
Similarly to Dunn, 23-year-old Zachary Skurka, who called the vaccination rollout a “hot mess”, had to call out of work to make his monkeypox vaccine appointment, adding that many of his friends have been unable to make or keep available appointments due to work conflicts.
“It’s very hard,” said Skurka. “I’ve had a lot of friends who haven’t been able to book appointments because they’ve either been at work or didn’t make it to the appointment window on time to book one because they were too busy or the site wasn’t working. Many [different] reasons, so they’re still waiting,” he added as he waited outside the Bronx school.
“Everybody doesn’t have the ability to wait by the phone and be able to play with the phone to be able to get the appointment,” added Jonathan Adams, 38, who commuted across the city to get the vaccine after snagging an appointment on his fourth try.
Cianciotto said that many GHMC clients, particularly those with poor internet access or disabilities, have struggled in the current process.
While appointments can now be made via telephone for those struggling online, Cianciotto said that those additional options are poorly advertised.
Inequality in vaccine supply is at risk of becoming a global problem.
New York City is slowly opening up more vaccine locations.
But Sandile Mhlaba, 24, had to commute over an hour to the Bronx by public transportation from the Bedford-Stuyvesant neighborhood in Brooklyn to get the shot.
“I’m an immunocompromised person so if I have to be on the subway [train] for a long period of time, around a bunch of people who aren’t wearing masks, that’s obviously really challenging, but I wanted to prioritize my health so I said it’s worth it for this,” Mhlaba said.
Meanwhile, for Bronx residents like Julio Arniella, 56, the flood of people commuting for the vaccine, including from wealthier neighborhoods such as Manhattan’s Chelsea, has pushed him and other residents out of securing their shot.
Arniella was only able to secure his vaccination when he used a different zip code, having been unsuccessful using his Bronx postal code, he said.
“For a person like myself, living in the Bronx, I can’t even put my own zip code in to get an appointment,” said Arniella. “I was not able to get one in my own borough.”
Representatives from the New York City department of health said data breaking down vaccinations by demographics was being worked on.
The department sent along 23 July coverage about outreach efforts in a gay bar in the Queens borough, more than two months after the first US cases in this outbreak, amid US public health services being severely depleted by the catastrophic coronavirus pandemic.
Back in the Bronx, Dunn talked about the pressure to get the monkeypox vaccine amid the crush of unmet demand.
“Imagine thousands of people trying to get the vaccine at one time … I feel like I was trying to save my life, it was crazy,” said Dunn before rushing back to work.
