Big Cities Health Coalition (BCHC) held a virtual monkeypox virus briefing Aug. 10 fthat ocused on local public health activities in Chicago.
Speakers included BCHC Executive Director Chrissie Juliano and BCHC member and Chicago Department of Public Health (CDPH) Commissioner Dr. Allison Arwady. BCHC Communications Director Elizabeth Green moderated the discussion.
"[BCHC] is a forum for America's largest metropolitan health departments to exchange strategies and jointly address issues so they can best promote and protect the health and safety of the more than 61 million they serve," said Juliano at the start of her slide-show presentation.
Juliano said that big cities experiences health challenges in a more acute way than other parts of the country due to their density and greater health disparities and structural inequities. She added that, as of Aug. 10, there are 9,492 cases of monkeypox nationally and of that amount 5,947 of those cases are located in 31 of BCHC's 35 total member cities with 570 of those cases in Chicago. Juliano said this dashboard will be updated once a week.
In terms of the challenges BCHC member cities are facing, Juliano pointed to the scarcity of the vaccine, questions around allocation that makes it harder for cities to get more vaccine doses to keep up with their needs, lack of flexible funding so money can be moved around as needed including Congress passing the Prevent Pandemics Act "to strengthen the public health system at all levels of government and also sufficiently fund it in a long-term manner" and changes needed at the federal level so there is a more coordinated response to these outbreaks going forward as well as transparency with the Strategic National Stockpile. Juliano said overall there needs to be better systems in place to respond to these national health emergencies in a quick and efficient manner.
Juliano also spoke about the local responses each member city is doing in terms of the monkeypox outbreakmost importantly, around prevention methods. She said that working with community-based organizations is the key to this success, and that it is vital to fix the public health data systems at all levels of government so accurate and timely information can be shared with the public.
Arwady said most people think about cases and contacts to solve the problem when asked about virus outbreak responses but those two issues are not the biggest challenges to begin her slide-show presentation. Arwady said communication and coordination are where things go wrong when they are not addressed properly. She said that BCHC is focused on sharing communication and coordination lessons with each other. Arwady said CDPH's mantra is "No Temporary Scaffolding: Efficiency and Equity" and that includes response structures, data transparency and metrics, message mapping, public messaging for many audiences and having easily accessible avenues for people to ask questions including an all-hours phone line.
"I know that our average time right now for contract tracing [for the monkeypox virus] is zero days," said Arwady.
Arwady pointed to the different kinds of messaging CDPH is directing toward each affected community to make sure they have all the information necessary including where to access the vaccine. She added that having funds available to hire a graphic designer has helped their messaging immensely.
In terms of where the 570 cases are in Chicago, Arwady said that they cover most of the neighborhoods in the city. She added that the public-facing website updates these figures daily and that includes all demographic categories. Arwady said that most of the Chicago cases have been men with a high percentage of those being gay men.
Arwady said early on they were getting criticism for highlighting the men who have sex with men (MSM) community being the most at-risk for getting monkeypox and CDPH pointed out that the data showed that most but not all of the cases came from that community so that is where the focus was. She added that MSM complained that CDPH's messaging was stigmatizing toward them.
As for CDPH's current monkeypox vaccine plan, Arwady said it includes monitoring current cases, case investigation and contract tracing; providing resources and education to clinicians, community groups, business and the general public and vaccinating those at high risk. Arwady said Monkeypox testing is available at any doctor's office or clinic in Chicago and that 50 clinical sites have diagnosed at least one case of Monkeypox.
Arwady said that Chicago began receiving monkeypox vaccine doses from the federal government on June 3, totaling 33,000 doses. According to the slides, Chicago will receive 20,000 more doses in the coming weeks, the federal government has ordered millions more doses from international entities but those will not be available for a few months at the earliest and the Illinois state government has re-directed some of the federal vaccine doses in other parts of the state to Chicago since this is where the epicenter of the disease is located in the state. Arwady added that they are distributing these doses as quickly as they get them.
LGBTQ+-focused vaccination events and locations in Chicago have included an alfresco event with the Puerto Rican Cultural Center, CALOR, both Center on Halsted locations, Jackson Park, Life is Work, Pride South, Silver Room Block Party, Sex Workers Outreach Project- Chicago, Taskforce, The Promontory, TPAN, Vogue University, Bassline Event, Cell Block, Chicago Coalition of Kink Clubs, Fantasy Event, Hydrate, Jeffrey Pub, Onyx (Club Escape), Steamworks and Touche.
Arwady also spoke about the outreach CDPH did at the recent Northalsted Market Days event that included palm cards and posters in both English and Spanish, CDPH Health Corps members at each entrance to provide educational materials and answer questions, banners at the gates and a PSA by comedian Matteo Lane that was played at bars and restaurants.
One demographical area of concern is Latinx Chicagoans, according to Arwady; regarding that group, only 29 percent of the cases are in that community and 14 percent of those people have gotten vaccinated. CDPH is stepping up their outreach efforts to that community so more of them get tested and vaccinated.
Arwady also spoke about the FDA's emergency use authorization for the Jynneos vaccine to be administered in smaller doses via the intradermal injection method which is just under the skin as opposed to a more deep tissue method. This will allow for five doses to be administered from one vial of the vaccine but it will also require smaller needles and syringes, different training and different reporting and information structure so the process will not be able to start right away. She said that so far Chicago has only been able to give one dose of the two dose vaccine regiment.
During the Q&A session Windy City Times asked Arwady, "How is the CDPH making sure that the LGBTQ and especially MSM community is not stigmatized like they were during the first years of the HIV/AIDS crisis since monkeypox is affecting that community more than others? [Also,] what is BCHC doing in this regard?"
Arwady said, "This has been top of mind since day one" and the goal is to be "transparent and matter-of-fact about the data. I have a lot of LGBTQ folks who are on my team … and they have been involved in craft some of that messaging but, more importantly, we have gone out to our partners and really encouraged them to give us feedback on the basics and also use that message mapping. … The LGBTQ journalist group has been useful. … [Also,] just being honest [helps]."
Juliano said "having conversations like this media briefing helps, making sure our members are exchanging this information and facilitating that but the main thing we do as a team is [ensure] we are working with national partners whether it is the federal government or advocacy organizations in public health … who are really engaged in this work so we sit in on coalition calls … where everybody learns something new on [those weekly calls].
One reporter asked about the concerns about one dose versus two doses and now the one dose being stretched to five doses per vial among gay men in Chicago who say they are getting less protection when that is not the case.
Arwady said that stretching the dose amounts will allow people to get two doses faster; otherwise, it would have been months between both doses. She added that the focus now is two doses for anyone who is a known contact from a case, immunocompromised and clinician judgment.
Another reporter focused on close contact from the blister that might form from the intradermal injection and Arwady said that as far as she can surmise this is not something to be worried about because the JYNNEOS vaccine was developed to be a safer version than the older ACAM2000 smallpox vaccine.
One question focused on the 28-day range between both doses and Arwady said that if people get the second vaccination beyond that 28 days the effectiveness is the same.
There were also questions regarding contract tracingspecifically, if it has gone well or not gone well and whether it has gone better or worse than other outbreaks.
Arwady said that there has not been a lot of success with contact tracing and this was not a surprise to her and her CDPH team. She added that they have been promoting the tellyourpartner.org/ website where there is less identifying information required.
One reporter wanted to know when Chicago is expected to start administering the vaccine intradermally, with Arwady responding" in about two weeks," with some settings ready to go before others.
Funding restrictions issues were also brought up. Arwady said CDPH is primarily federally funded and that money is attached to specific diseases. She added that because of this restriction it often takes months to get new funding allocated for something like Monkeypox vaccine doses and distribution efforts. Arwady said that, in her opinion, funding should be based on population size, not specific virus outbreaks.
Juliano said that, in terms of funding issues, they are not the same everywhere. She echoed Arwady that there should be a base level of funding everywhere in this country to tackle these health issues. Juliano said the partisan politics around COVID are affecting Congress allocating money for any public health preparedness measures, which is "not okay."
See bigcitieshealth.org/monkeypox-data/ and chicago.gov/city/en/sites/monkeypox/home.html .
For more information on vaccination events in Chicago, visit chicago.gov/city/en/sites/monkeypox/home/vaccine.html .