The number of monkeypox infections in Washington state has more than tripled in the past couple of weeks, prompting a growing number of residents frustrated with the slow pace of vaccine distribution to start looking out of state for shots.
As of Wednesday afternoon, at least 56 monkeypox infections had been confirmed in Washington state, including 51 in King County, with a couple others in Pierce and Snohomish counties. In early July, the count was at 15. Several of those infected were hospitalized for a short period of time, but no deaths have been reported, according to the state Department of Health.
Still, concern about available treatment and vaccines has been growing within the region's LGBTQ+ community — particularly among men who have sex with men, a group that's been hit especially hard in the current outbreak. (That has not been the case in previous outbreaks in other parts of the world, where it affected broader swaths of the population.)
Many worried about exposure or infection are beginning to look elsewhere for shots, including at clinics in San Francisco and Canada.
In the United States, the Food and Drug Administration has approved two vaccines that help prevent monkeypox infection or reduce the severity of illness. But because Washington's case count is much lower than other states' (New York has counted 500-plus infections, while California has confirmed at least 350), our allotted number of vaccines from the federal government is more limited, DOH has said.
When Grover Cleveland, 58, heard about monkeypox vaccine clinics in Canada, he was skeptical.
"They obviously don't have an unlimited supply either," said Cleveland, who lives on Seattle's Capitol Hill. He's an American citizen, and had doubts about whether or not he'd be eligible for a shot in Vancouver, British Columbia. But he felt he had exhausted his Seattle resources and wanted to get vaccinated before an upcoming overseas trip — so last weekend, he made the three-hour drive.
"When I got there, I said I was from Seattle and that I didn't know if this would work," he said. "They just said, 'Well, we'll make it work.' "
Seattleite Adam Feinstein, who also drove up to Vancouver recently for the vaccine, said the process was fairly quick and seamless.
As a member of a high-risk group, Feinstein, 31, said he had been anxious for weeks about case counts and wondered if monkeypox would escalate the way COVID-19 has.
"A lot of people, including myself, have been waiting around with bated breath," he said. "When I heard word that there was an opportunity to go to Canada, for me it was a no-brainer. Why wouldn't I take this opportunity?"
Still, some hiccups remain. The monkeypox vaccine — known as JYNNEOS in the U.S. and Imvamune in Canada — is meant to be given in two doses, and when Feinstein asked the clinic nurse what the plan is for a second dose, she didn't have an answer.
"In order to vaccinate more people, at least for right now, they were not scheduling second appointments," Cleveland said.
Feinstein has been checking every day for updated guidelines in the U.S. and in Vancouver.
"We're having to take public health care into our own hands," he said. "It's my biggest frustration of health care here."
In B.C., the first monkeypox cases were identified in early June and had increased to 40 confirmed infections as of Tuesday, according to Vancouver Coastal Health and B.C. Centre for Disease Control.
At the time, Vancouver public health teams focused their vaccination efforts on close contacts of those who were infected, but once evidence of local transmission emerged, they expanded vaccine eligibility, according to Vancouver Coastal Health.
Now, the agency lists appointments for adults "who are transgender people or who self-identify as belonging to the gay, bisexual and other men who have sex with men community."
To be eligible, a person also has to meet one of the following criteria: received a diagnosis of a bacterial sexually transmitted infection like chlamydia, gonorrhea or syphilis in the past 2 months; had two or more sexual partners within the last 21 days, attended venues or other sites for sexual contact within the past 21 days or may be planning to; had casual sex in the last 21 days or may be planning to; or engaged in sex work or may be planning to. Confirmed exposure or infection is not a requirement.
The regional health authority says no ID or Medical Services Plan is required, in part to encourage vaccination. This week, an online booking site for a vaccine clinic hosted at a Vancouver secondary school had 737 open appointments on Wednesday, Thursday and Friday.
To date, about 3,800 people have received the monkeypox vaccine in Vancouver. Vancouver Coastal Health declined to share how many doses B.C. has received.
While the agency is not actively encouraging people from outside B.C. to seek vaccination at its clinics, anyone who makes an appointment, shows up in Vancouver and meets the eligibility criteria can receive a shot, Vancouver Coastal Health said.
In Washington state, eligibility is stricter while supply remains tight.
Those who haven't been infected but might be at risk of exposure, for example, aren't currently eligible to receive a vaccine, according to DOH.
Kiefer Harrington heard about options to get vaccinated in Vancouver through a text group chat.
"It was the first possible chance to get vaccinated without getting sick first," Harrington, 30, said. But he couldn't clear his schedule for that day to go to Canada, so his friends went without him.
"When I saw the rise of monkeypox a couple months ago, it was already a concern of what would happen," he said. "I was disappointed, but not shocked, at what the response to the new virus has been."
He knows people who are already sick with the virus, and more who are scared of contracting it. The ones he knows who have been vaccinated are mostly in San Francisco; one or two got their first shots in Atlanta, while a friend in Washington, D.C., is on the waiting list.
Harrington wondered whether it would be morally right for him to get a shot that isn't being provided by the U.S. government and not paid for by his taxes. But he noted the number of available slots that had gone unfilled.
"If our government stepped up, and did what they were supposed to do, we wouldn't be in this mess," he said. "This is ultimately where I put the blame back on our government. You had the same time Canada did, and they got theirs in order."
In Washington, Public Health — Seattle & King County was allocated 1,420 doses (710 courses) with the bulk of the shipment arriving from the federal government last week. The first priority is to connect with providers to reach higher risk contacts of known cases, said spokesperson Sharon Bogan.
Once the county receives more doses, eligibility will relax slightly and public health teams will focus on vaccinating those at highest risk for exposure, she said.
Planning will likely continue into the fall as more doses arrive, said Bogan, adding that public health teams are also now better equipped to address potential barriers to getting vaccinated, including insurance status, geography, structural racism and socioeconomic status.
"For example, first-come, first-serve strategies may not always reach those at higher risk, nor do they consistently reach those with more limited access to information, so we need to balance multiple approaches," she said.
Vaccination isn't the only strategy communities should be using, though, said Dr. Matthew Golden, director of the county's HIV/STD Program and sexual health clinic. Public health teams need to provide ongoing information about local spread, while health care organizations are tasked with increasing testing capacity and connecting people to treatment, he said.
"And people in the communities most affected by monkeypox — which right now is very concentrated in men who have sex with men — should consider steps they can take to reduce risk in the mid- to short term while we wait for a larger supply of vaccine," Golden said.
More information about the next allocation of vaccines should be available "soon," with possible delivery of additional doses next week, Bogan said.
Meanwhile, at least one Washington state official has expressed frustration at the federal level about the pace of the country's response to monkeypox. This week, U.S. Sen. Patty Murray sent a letter to Health and Human Services Secretary Xavier Becerra asking for clearer information about how the department is addressing challenges around securing tests, treatments and vaccines.
Seattle resident Erik Kaiser, 38, was too young to be aware of the early days of the AIDS crisis, but the country's monkeypox response hearkens back to stories he's heard of inaction toward HIV/AIDS.
"It seems like our city is a second-rate city because of it," he said. "I don't understand the inaction. It frustrates me incredibly."
He's heard from friends who contracted and had harsh experiences with the virus. One told him they could only sleep for a few minutes a night because of how painful the lesions are.
"It feels like because it's not immediately killing somebody that it's not important to treat like a public health emergency," he said. "But for my community, it is a public health emergency."
