One morning in early August, Lamar Carter gave up on trying to get the monkeypox vaccine.
Though the 49-year-old personal chef felt an urgent need to protect himself against the disease that was rapidly spreading among men in Atlanta’s Black LGBTQ community, he couldn’t secure an appointment at any of the sites offering the injections. He clicked various links, at all hours, over a two-day period.
“But everything was blocked or booked up,” he said. “I’m thinking this is insane. … It was like a secret society.”
Help came Carter’s way three weeks later over a vodka with cranberry juice at a bar. He met Greg Smith, the executive director of Here’s to Life, a local organization that offers support programs for the LGBTQ community. Smith wrote down Carter’s name and phone number, then assured him that he could help schedule the vaccination.
Their meeting was not by chance. Night after night, Smith was going from bar to bar, hoping to educate those at highest risk for contracting monkeypox about the vaccine. The outreach at a bar with a predominantly Black gay clientele was part of a coordinated, grassroots effort and reflected a shift in strategy that would change the vaccination rollout in Georgia.
Public health experts are optimistic the new approach will ultimately change the trajectory of the virus.
Credit: arvin.temkar@ajc.com
Credit: arvin.temkar@ajc.com
The White House is hopeful, too. Fulton County was singled out for praise by administration officials as an example of a major U.S. metropolitan area that’s confronting vaccine inequity. Black men who have sex with other men are not receiving monkeypox vaccines at a rate matching the number of cases affecting their population. Anyone can contract monkeypox, but men who have sex with men have been mainly affected in this latest outbreak.
After an initial cluster of cases in the United Kingdom in May, the first diagnoses started cropping up in Georgia in June and quickly ballooned. Just two short months ago, the situation looked grim. With cases exploding nationwide, the federal government on August 4 declared monkeypox a public health emergency.
Dr. Melanie Thompson, a doctor who cares for people living with HIV and researcher based in Atlanta, described it as “heartbreaking” to see people struggling to get tested and vaccinated. She said some were turned away from emergency rooms.
“One of my patients said, ‘It’s like the early days of AIDS. Nobody knows what’s going on. Nobody wants to take care of you. Nobody knows where to get help.’ It just broke my heart,” Thompson said.
Right then, she and others in metro Atlanta decided they would not let the past repeat itself.
An epidemic arrives
Kendoll Brinkley Brown, 39, was on three waiting lists for the monkeypox vaccine when he got sick.
During the last week of July, Brinkley Brown developed a bad headache and body aches. At first, he didn’t think much of it. He had recently been in a car accident and had just undergone a root canal. A day after the dental procedure, he noticed a lesion filled with pus on the front of his hand. It started itching and other lesions quickly followed on his arms and buttocks.
“At that particular point, I was already paranoid about the whole monkeypox outbreak. I stay pretty tucked away in a bubble. So I was hoping that it was not that, but something in my gut was telling me that it was,” he said.
Credit: Jenni Girtman
Credit: Jenni Girtman
Monkeypox causes a distinctive rash that goes through several stages from blisters to scabs before healing. The rash can be located in sensitive areas, cause extreme pain and, in some cases, lead to hospitalization. An infection can last from two to four weeks, and those infected are usually unable to work and must avoid contact with others.
After struggling to reach anyone with the Fulton County Health Department by phone, he eventually decided to go to the health department in person on Aug. 1. He said it took several hours for him to be seen and tested. As he suspected, he had monkeypox.
Before long, he was reeling in pain. To ease the agony, he soaked in warm baths with colloidal oatmeal. He took Ibuprofen.
During his visit to the health department, Brinkley Brown said he had asked for treatment, but was told there was none. And, although the health department promised to contact his doctor, he also said that he heard nothing during or after his bout with monkeypox, which left him frustrated.
He wasn’t alone.
History repeating
The immediate response to the outbreak at the federal, state and local levels was hampered by missteps and delays.
The first pop-up vaccination event in Fulton County took place on July 9, but only a paltry 200 doses of the vaccine were available and required an appointment. At the time, Georgia was ranked No. 5 for the most monkeypox cases in the U.S., but was receiving far fewer vaccines than other parts of the country with far fewer cases. State health officials weren’t even requesting all of the doses allocated to the state.
A DPH spokeswoman said the state wasn’t ordering its allocated vaccines all at once because officials planned to stagger the shipments. They needed time to prepare to store and administer the vaccines.
When vaccines became available, Fulton County sent press releases and posted information about vaccination opportunities on social media. When appointment slots were posted online, they were snapped up within minutes.
Credit: Miguel Martinez
Credit: Miguel Martinez
It didn’t take long for Joshua O’Neal, sexual health program director for Fulton County Board of Health, to notice a trend. “As a gay white man, I will say that the people who are connected to me on Instagram and my social networks, I talk about this, so they were most activated at the time,” said O’Neal, “and there were other communities who just weren’t aware and that’s when we started seeing the racial disparities.”
Though they didn’t yet have the data, O’Neal, HIV doctors and leaders of community-based organizations said early indications were showing the virus was heavily affecting Black men, especially those who are HIV positive. And they weren’t getting vaccinated at the same rate as white men, much to the chagrin of the state’s public health officials.
“Initially, people thought they could just put notifications online, and people would sign up for them and everything would be fine,” said HIV doctor Thompson. “You know, first come, first served. And what we saw were the same disparities being repeated again, the same HIV disparities, the COVID disparities. It was the most impacted populations who were being left out.”
“But what happened this time is they pivoted,” she said of public health officials.
O’Neal, at the Fulton County Health Department, and others insisted that they change course and work harder to get vaccines in the arms of the people most at risk.
“It was: Why is this not happening?” O’Neal recalled. “But also, if we have such a limited amount of these vaccines, we need to be doing the right thing to get it to all the people who are heavily impacted.” he said.
Collaborative approach
By mid-July, with O’Neal taking the lead, Fulton County Health Department started collaborating with several community-based organizations that advocate for the LGBTQ community. Among them, Thrive SS Inc., A Vision 4 Hope and Here’s to Life. They were prioritized for vaccine access and given a sign-up link to help their clients get appointments.
Credit: Miguel Martinez
Credit: Miguel Martinez
With monkeypox cases in the state surpassing 400 by the beginning of August, the new collaborative approach started taking shape in Atlanta and Fulton County: Federal, state, and local public health officials were working closely with activists, community groups and local HIV doctors and clinics. They gave presentations, held town halls, started outreach in bars.
In the backs of their minds, they kept thinking about the AIDS epidemic decades before, and how it should have been handled better. “People were like, ‘Never again. Let’s do what we have to do,’” said David Folkes, community health outreach manager at Thrive SS Inc., which focuses on the health of Black gay men, especially those living with HIV.
They decided to use Atlanta Black Pride week events in early September as an opportunity to reach a large number of people. Smith, of Here’s to Life, developed a QR code with details on how to get a vaccine and put it on postcards with information about Pride events. Taking the cards with him, he started making the rounds to local bars, including the one where Carter was sipping his cocktail and had given up on getting an appointment for vaccination.
Credit: arvin.temkar@ajc.com
Credit: arvin.temkar@ajc.com
“It was one of those things where we were in an emergency. It was a state of emergency,” Smith said. “We don’t want that stigma on the community. We don’t need an outbreak with gay men. It was an easy conversation: ‘Have you had your vaccination? Let me get you on a list.’”
When Smith brought up the monkeypox vaccine, Carter gladly accepted his help. His name was added to a list of 112 that Smith passed along to the Fulton County Health Department. Two days later, Carter received a text confirming his appointment for the first of the two-dose vaccine.
The payoff
In Georgia, case numbers were nearly doubling every week in mid-July and continued to jump in August. But, according to the most recent tally released Oct. 12 the total number of cases only rose 1.5% from the previous week.
Public health experts say the decline was likely brought about by a combination of factors, including vaccinations, immunity gained from infection in the population at risk, and a change in sexual behavior in the highest risk group. In a survey conducted by the CDC in August, roughly half of men who have sex with men said they had reduced the number of their partners and one-time sexual encounters.
“I really think this is a very interesting case study,” said Thompson. “Number one, what a difference it makes when there is good communication between the community and county, state and federal governments — because what we saw was a concentrated effort.”
There are still racial disparity issues to address. As the city prepared to host Atlanta Black Pride on Labor Day weekend, Black people accounted for 78% of monkeypox cases in Georgia but had received only 45% of the vaccines. That inequity in vaccines hasn’t changed, according to DPH figures.
And public health officials need to pay attention to the lingering psychological toll, said Brinkley Brown. He started an online journal on Facebook documenting what his days of managing the illness were like. That’s grown into an online support group.
“I’m glad to have made it through it,” he said.” I’m glad that my experience can be a testimony, and it has helped others come through their experiences.”
