WITH RISING RATES of monkeypox cases declared in Ireland over the past week, we are now expecting changes to the long-awaited announcement of an initially underwhelming vaccination plan.

Minister for Health Stephen Donnelly has announced that following recommendations from NIAC, vaccinations will now be administered intradermally (just under the skin) which will maximise the number of doses available.

But once again, there is now confusion as to who will now be prioritised from HSE’s estimated 6,000+ most at risk.

With estimates of more than between 34,000 and 76,000 (the number is uncertain due to poor data) sexually active gay and bisexual men in Ireland, it will be imperative that clear messaging is made available about exactly who is going to be vaccinated and when.

There’s also a need to provide a strong focus on supporting those who will not be eligible for a vaccine for some time, and those who will inevitably acquire monkeypox while the programme is being rolled out.

Community action

While anyone can get monkeypox, the current outbreak is most prevalent in communities of gay and bisexual men. This is simply because gay and bisexual men are more likely to have close and intimate contact with other gay and bisexual men.

Monkeypox is not formally recognised as a sexually transmitted infection, however, within this outbreak it is believed that much of the transmission is taking place during intimate and sexual encounters.

Even before the current outbreak of monkeypox virus was determined a public health emergency of international concern by the World Health Organisation, the response by communities of gay and bisexual men across the world was swift.

Within online and offline networks, people were sharing information, supporting each other and considering how communities’ were going to respond to this threat to important aspects of life, sexuality and sociability.

There is a long tradition of community-based healthcare activism and provision amongst LGBT communities, especially in area of sexual health, and it is well accepted that gay and bisexual men in general are far more conscious and aware of issues of sexual health than the general population.

In Ireland, quite quickly, various community organisations and activist groups such as MPOWER at HIV Ireland, ACT UP Dublin and the Man2Man programme began sharing information on the signs and symptoms of monkeypox, and guidance on what to do if you think you might have it. 

Managing the response 

Undoubtedly the current public health emergency posed by monkeypox is demonstrating the need for rapid adaptability, as well as clear communication as discussed above.

Last week, Minister Donnelly announced the formation of an advisory group on monkeypox under the stewardship of the Interim Chief Medical Officer. However, it appears that this group demands a more diverse set of expertise than it currently includes.

There is no single representative body for gay and bisexual men in Ireland, and one single representative of this group is unlikely to bring forward the diversity and depth of issues faced by all elements, of what are diverse communities. One single representative hardly counts as the “meaningful, helpful engagement” that Minister Donnelly has promised. 

Along with significant deficits in community participation, key expertise in the fields of healthcare provision is also absent in this oversight and management body.

Despite being the largest healthcare workforce in Ireland, and likely to be the key deliverers of vaccines, there isn’t a single representative from the nursing profession; there are also absences in the fields of laboratory and medical scientists. 

If we are going to deliver a quick, effective, and equitable vaccination programme to those most at risk, the Minister and Chief Medical Officer need to examine how this expertise is considered. 

Creative solutions to vaccine scarcity

The ability to vaccinate more of the people most at risk should be welcomed, but the lack of clarity around specifics is likely to just add to confusion.

Given the contrast between the supposed availability of vaccines, and size of the community most affected, the severity of monkeypox symptoms and the disruption to the lives of those who get monkeypox due to the long periods of self-isolation required, it is no surprise that gay and bisexual men, and others at risk of monkeypox, are angry and anxious.

But why are so few vaccines available and how can this scarcity be addressed? Central to the lack of vaccines is that a single company, Bavarian Nordic, holds the patent for the (publicly funded!) vaccine we need, their manufacturing plant is closed and the majority of their stock is promised to the US.

Their exclusive right to produce the vaccine would be removed through a TRIPS waiver that would allow compulsory licensing of the vaccine to other manufacturers. 

Supporting people dealing with Monkeypox

While continuing to seek routes to procurement of adequate vaccine supplies, the state should now concern itself with ensuring that the communities most affected receive appropriate and adequate support in the midst of this public health emergency.

This support should of course involve enhanced funding for sexual health services and LGBT+ community organisations, to continue their work providing information, psychological and emotional support within the communities – but direct financial support for those directly impacted by monkeypox should also be considered since those impacted are requested to self-isolate for periods upwards of 21 days. These people are isolating to protect the general population and therefore facilitating an easier isolation period is a public health measure. 

The growth in the monkeypox outbreak and the lacklustre response to it reveals a lack of acknowledgement of the significant anxiety that there is now among gay and bi men that is consistent with a long history of the health concerns of our community not being taken seriously enough.

The bottom line is that anyone can get monkeypox, and the likelihood is that this outbreak will spread beyond communities of gay and bisexual men.

When this happens however, it is important for us all to note that these communities did everything within their control to stop this occurring. It is past time that our government did the same.

Dr John Gilmore is Assistant Professor in Nursing at UCD and a Fulbright HRB Ireland Health Impact Scholar. His work focuses on areas of inclusion health and gender and sexual minority healthcare. 

Dr Chris Noone is a Lecturer in the School of Psychology at the University of Galway and a Director of the National LGBT Federation. The primary focus of his work is the intersection of health and identity among gay and bisexual men.