With supplies running low, many gay and bisexual men are struggling to get appointments at sexual health centres – and for some, the handling of the outbreak has alarming echoes of the HIV/Aids epidemic
Photograph: Anna Gordon/The GuardianPhotograph: Anna Gordon/The GuardianIn a waiting room at the Mortimer Market Centre, a sexual health clinic in central London, a slow but steady stream of men who have sex with men are arriving to receive their first monkeypox vaccination. It is a sweltering afternoon, and all available slots have been filled, as they have ever since vaccines started to be delivered here in early July.
By 4pm, the waiting room has cleared. With appointments over for another day, Kim Lombardi, the clinical lead for the vaccination team at Central and North West London NHS foundation trust, sets out just how high the demand has been. “At the moment,” she says, “we’re seeing up to 200 people a day. But we could see far more if we had supply to deliver.”Photograph: Anna Gordon/The Guardian
First identified in humans in the Democratic Republic of Congo 50 years ago, monkeypox is a relatively well-known virus. “It’s more generally observed in west and central Africa,” says John McSorley, a sexual health and HIV clinician, and a past president of the British Association for Sexual Health and HIV. “Its circulation in Europe and other continents beyond Africa – and this expanding outbreak – is unusual behaviour.
“This outbreak beyond Africa tends to be spreading primarily in men who have sex with men aged 16-65, otherwise in relatively good health or with access to good healthcare,” McSorley continues. “The mortality level has been lower than our initial worries, but it’s still there: for example, two men in their 30s in Spain with no underlying health conditions died recently.”
According to the UK Health Security Agency , as of 17 August, close to 30,000 MSM had received their first monkeypox vaccination. If all goes according to plan, they should get a second shotalthough it’s unclear when this will prove possible. They are getting modified vaccinia Ankara vaccine , also used to protect against smallpox. But there is still a long way to go. The UK government initially ordered 50,000 doses , and a further 100,000 are expected to arrive in late September.
Dr Andrew Lee, the UKHSA’s monkeypox incident director, rejects suggestions that the agency was slow to get to grips with the outbreak. “We acted immediately to tackle the spread of the monkeypox virus,” Lee says, “and have worked continuously with a range of stakeholders to investigate the outbreak, alert people to the symptoms and support those affected.”
Greg Owen, a sexual health and HIV activist who now works with the Terrence Higgins Trust was a key figure in the fight for PrEP to be made available on the NHS, a drug that – if taken correctly – almost eradicates the risk of contracting HIV sexually. In July 2012, the United States Food and Drug Administration announced it was approving PrEP as a drug for this purpose.
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