Sexual Health Clinics Struggle to Fight Monkeypox
After
decades of underfunding and two-and-a-half years into a pandemic that severely disrupted care, clinic staffers
and public health officials say the clinics are ill-equipped for yet another
epidemic.
“America
does not have what it needs to adequately and totally fight monkeypox,” said
David Harvey, executive director of the National Coalition of STD Directors.
“We are already stretched to capacity.”
Monkeypox
— a cousin of smallpox — is not technically considered a sexually transmitted
infection. But it spreads through close contact and is now being transmitted
largely through networks of men who have sex with men.
Because
the current monkeypox outbreak causes blisters or pimples on the genitals, many
patients are seeking care for what appears to be herpes, syphilis, or another
sexually transmitted infection. Patients often prefer to seek care anonymously
at public clinics, rather than visit their primary care doctors, because of the
stigma of sexually transmitted infections.
Although
most people with monkeypox recover on their own in two to four weeks, about 10 percent need
hospital care, said Peter Hotez, dean of the National School of Tropical
Medicine at the Baylor College of Medicine.
The degree of complications from monkeypox “has been much higher than any of us expected,” said Mary Foote, an infectious diseases expert at the New York City Department of Health and Mental Hygiene, who spoke July 14 during a webinar presented by the Infectious Diseases Society of America. In addition to severe pain, some people with monkeypox are at risk of permanent scarring. Foote said the pain can be excruciating, making it difficult for patients to swallow, urinate, or have bowel movements.
Sexual
health clinics have been stretched so thin that many lack the staff to perform
such basic duties as contacting and treating the partners
of infected patients.
These
clinics are some of the most neglected safety nets of the nation’s tattered
public health system, which has less authority and flexibility to fight outbreaks today
than before the Covid-19 pandemic.
With
1,971 monkeypox cases reported since May in the United States — and about 13,340 around the world —
doctors warn the epidemic may have grown too large and diffuse for them to
contain.
Shira
Heisler, medical director of the Detroit Public Health STD Clinic, said she’s
proud of the quality of care she provides but simply doesn’t have time to see
every patient who needs care. “We just don’t have the bodies,” she said. “It’s
a total infrastructure collapse.”
Funding
from the Centers for Disease Control and Prevention to prevent sexually
transmitted infections has fallen by almost 10 percent since 2003, to $152.5
million this year, even though syphilis cases alone have more than quadrupled
in that time. Taking inflation into account, that funding has fallen 41 percent since
2003, according to an analysis by the National Coalition of STD Directors.
Meanwhile,
hundreds of local and state health professionals who trace the origins, track
the trajectory, and stop the spread of cases reported by sexual health clinics
have quit or been replaced since the
pandemic began. Some left due to burnout, and others were driven from their
jobs by critics protesting unpopular policies on masks and lockdowns. Some
federal grants to strengthen the public health workforce are just
now being rolled out.
Data
reporting systems have not been updated during the pandemic, in spite of glaring inadequacies it helped reveal.
Public health workers still use fax machines to deal with monkeypox cases in
Florida and Missouri, public health officials told KHN.
“Even
with the advantages of having a test and a vaccine, we still haven’t invested
enough in the public health system in order for us to respond quickly enough,”
said Tao Kwan-Gett, Washington state’s chief science officer. Many people “will
tell you we have the best health care system in the world. But I think the
Covid-19 pandemic, as well as [the monkeypox] outbreak, shows that the system
is broken and needs fixing.”
The White House is distributing hundreds
of thousands of monkeypox vaccines now, releasing additional doses as they
become available, for a total of nearly 7 million doses within the next year.
But
Hotez said those vaccine shipments “may not be sufficient.”
Some
cities are running out of doses shortly after opening their doors. In New York
City, where monkeypox cases have tripled in the past week, the vaccine rollout
has been plagued by technical glitches; the vaccine website has crashed at
least twice. San Francisco officials said their
city is also running low on vaccine supply.
Monkeypox
vaccines can effectively prevent infection in people before they’re exposed to
the virus.
Experts
believe vaccines may help prevent infection after exposure, as well. But
they’re most effective if administered within four days after close contact with a
monkeypox patient, said Trini Mathew, medical director of antimicrobial
stewardship and infection prevention and control at Beaumont Hospital in
Taylor, Michigan. Vaccines given between four and 14 days of exposure may
reduce symptoms but not prevent the disease.
Yet
the battered public health system isn’t built for speed.
Although
monkeypox tests have become easier to access in recent days, some
public health systems don’t have enough staff to quickly locate and test
patients’ partners. And because most health professionals have never managed a
case of monkeypox, patients often must make multiple visits before being
accurately diagnosed.
Contacting
exposed people becomes more complicated if they live across the county or state
line, which can require coordinating an outbreak response with additional
health departments, said Shawn Kiernan, chief of the communicable disease
section for Virginia’s Fairfax County Health Department.
Decades
of budget cuts have led many sexual health clinics to limit their hours of operation, making
it harder for patients to receive care.
Public
health departments have lost key members of their teams in recent years,
including highly trained nurses and outreach specialists.
A
2020 KHN-AP analysis found that at least 38,000 state and local public health jobs have
disappeared since the 2008 recession, leaving a tattered workforce to confront
America’s public health needs — and that was before Covid hit. That
investigation found only 28 percent of local public health
departments have statisticians or epidemiologists, the disease detectives who
investigate the source and trajectory of infectious outbreaks.
More
than 2.4 million sexually transmitted infections
were reported in 2020, according to the CDC.
“I
don’t think any health department in America could handle all the STIs that get
reported to them,” Kiernan said.
The
federal government has spent billions of dollars fighting the Covid pandemic,
and some Covid-related grants will be used to expand the overall public health
workforce.
But
the CDC and Congress often designate funds for specific purposes, said Lori Tremmel Freeman, head of the National
Association of County and City Health Officials. “If you have somebody working
on Covid, you can’t just reassign them to monkeypox using the same bucket of
money,” Freeman said.
And
in some states, that money hasn’t yet reached public health departments or
sexual health clinics.
The
CDC gave Michigan millions of dollars to strengthen its
public health workforce, but the Michigan Legislature appropriated only a
portion of the money. Heisler wrote to multiple state legislators begging them
to free up the remaining funds. None replied to her.
Public
health workers say they hope monkeypox will be a wake-up call.
“I
hope this drives home the need for more investing in public health
infrastructure,” said Kwan-Gett of the Washington state health department,
“because without that investment, this is just going to happen again and
again.”
KHN (Kaiser
Health News) is a national newsroom that produces in-depth journalism about
health issues. Together with Policy Analysis and Polling, KHN is one of the
three major operating programs at KFF (Kaiser Family Foundation). KFF is
an endowed nonprofit organization providing information on health issues to the
nation.
