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Europe is experiencing a case of collective public health amnesia.
The COVID-19 pandemic has witnessed vaccine nationalism, conflicting official guidelines, and marginalized groups forced to defend themselves; while the early days of the HIV crisis were marked by virulent homophobia, stigma and unequal access to treatment.
Today, with 16,500 cases of monkeypox reported in Europe – mostly among men who have sex with men – history is repeating itself. Some communities are taking matters into their own hands, designing their own health information campaigns and even crossing borders in search of vaccines.
POLITICO spoke to people desperate to protect themselves against a virus which, although described as “mild”, can cause weeks of debilitating pain and lifelong scarring.
“As a single gay man, I’ve spent my life worrying about getting STIs and HIV, and for the past two years also worrying about COVID,” said Paulo, a director. 34-year-old Portuguese theater scene. “I can’t believe I now have to worry about another infectious disease.”
Unable to be vaccinated in Portugal, Paulo traveled to Lille, in the north of France. The city, close to the Belgian border, has become an unexpected place of pilgrimage for people from neighboring countries due to its willingness to kick foreign visitors. This is despite the fact that the government officially reserves monkeypox vaccines for French residents.
“I’m really worried about monkey pox…I don’t want to catch something that could leave me with permanent scars, cause a lot of physical pain and quarantine me for a few weeks in the middle of the short vacation I’m having this summer” , did he declare. “Only the most privileged people can travel for this specific reason and that doesn’t really seem fair.”
Although Paulo may receive his vaccine, the fact that many other people at risk will not be anytime soon, combined with unclear public health messaging, has left people in “anger and genuine anxiety”, said Robbie Lawlor, co-founder of Access to Medicines Ireland. , a campaign group.
The infection can be spread through the kind of close contact that occurs during sex, at crowded parties, or even when kissing on a date. The outbreak has led to disagreement over how to deliver accurate but non-stigmatizing messages, while limited vaccine supplies and strict eligibility criteria have left many desperate to get their hands on the vaccine without access.
Rates of sexually transmitted infections (STIs) were already rising across the board, as sexual health clinics and community health groups struggled to meet the demand for their services. “Now add something like monkey pox, something that’s so terrifying to so many people,” Lawlor said. “It looks like this geist that hangs over our community.”
Already seen again
The journey to Lille — which is only about an hour from Brussels by train — is not only made by men concerned about the health effects of monkeypox. Wouter, a 28-year-old architect based in the Belgian capital, said he had traveled to the French town over the weekend to get his shot to ease his anxiety over the “month-long quarantine periods and the social stigma” that come with catching it. .
“I’m not worried about death, but I’m worried about having scars, of course, and getting them and having to tell people I work with that I’ve caught what society considers to be a ‘slutty gay disease'”, he said. “As long as it stays in the gay community, politicians and the mainstream media don’t seem to care.”
For veteran activists, there is a strong whiff of stigma that surrounded HIV when it first spread among gay men four decades ago.
“One of the most striking parallels is with stigma and stigmatizing language,” said Susan Cole, community engagement and marketing manager at NAM aidsmap, a UK charity. “Reminds me a bit of the 80s.”
But there is disagreement on how to deal with this risk of stigma.
“It’s complicated because the community as a whole sees it very differently,” explained Alex Sparrowhawk, partnerships coordinator at Terrence Higgins Trust. While those who have lived through the worst days of the HIV epidemic may be hesitant to explicitly call out the group most at risk, others argue that the fact that men who have sex with men are primarily affected must be at least center of the message. .
Explaining the difficulty, Peter Piot, former director of the London School of Hygiene and Tropical Medicine and independent adviser to the European Commission, said “it’s a fine line”.
“The reality is that the overwhelming majority of those affected are men who have sex with men, but that’s…a subpopulation in the community,” Piot told POLITICO.
Then there’s the debate over whether large gatherings where sex or close contact may take place — whether summer music festivals or Pride events — should be completely cancelled.
Many activists say this approach simply won’t work.
“Behaviour change has never worked for HIV and won’t work for it either,” said Apostolos Kalogiannis, communications coordinator at the European AIDS Treatment Group.
“The community was really simple,” Kalogiannis said. Canceling events “would be the worst decision because then everything would be covered in private places and it would be much more difficult to reach this community [with] prevention and health promotion [messaging] about monkeypox.
Scramble doses
The fact that there are not enough vaccines to protect those who want them complicates the debate on risk communication.
Across Europe, vaccine eligibility policies vary. France, for example, had stockpiled the vaccine made by the Danish company Bavarian Nordic to guard against an outbreak of smallpox. With this vaccine now approved for monkeypox, the government has released 42,000 doses. Men who have sex with men, transgender people with multiple partners and sex workers are eligible.
This contrasts with other countries that are short on doses and have to limit access to subgroups of these collectives – for example, the Netherlands so far only offers vaccinations to those who receive PrEP , a prophylactic treatment against HIV. In Belgium, men who have sex with men are only eligible if they have had at least two STIs in the past year and can provide supporting documents.
The availability of the Nordic Bavarian vaccine varies greatly from country to country and within countries, and it is difficult to determine the size of existing stocks, as many governments keep this information secret for national security reasons. The Commission has jointly ordered more than 163,000 doses for the bloc, but this has nothing to do with the 250,000 doses bought directly by France and the 130,000 bought by the UK.
In the United States, by contrast, the Biden administration released more than a million doses of the Nordic Bavarian vaccine it had already stockpiled and declared monkeypox a national health emergency.
According to the French Ministry of Health, the vaccination centers set up by the regional health authorities should provide injections “free of charge to people eligible for vaccination who reside on the territory”. Yet Karima Chouia, head of a public health center in Lille that distributes vaccines, said he was not limiting doses to only French residents.
“We carry out a preventive vaccination so it is open to everyone, and yes we also see part of the Belgian population turning to us to get vaccinated,” Chouia told POLITICO. “We’re not creating limitations based on where you live – it’s a global goal for this vaccination to be widely available.
Lille is not the only French city to take up the challenge of vaccinating all those who want to be vaccinated. Clinics in Paris and several cities on the Franco-Italian border follow similar protocols.
‘It’s incredible’
In Milan, city councilor Michele Albiani cited France’s response in a bid to pressure her country’s government to deal with the crisis.
“It’s incredible that I, in Milan, can make an appointment to get vaccinated in France but I can’t do the same in my own country,” he told his followers on the social networks. “It’s a shame.”
A few days later, the Italian government announced that it would begin administering a limited supply of 4,200 injections to healthcare workers and members of the LGBTQ community considered particularly at risk. 16,000 additional vaccines should be available by the end of the month.
While community groups are tasked with educating those most at risk about monkeypox, resource-poor sexual health clinics, like the one in Lille that Chouia runs, find themselves on the front lines of the vaccination effort.
Much of the public health work “falls on the shoulders of organizations that are either event organizers or advocacy groups” that lack the infrastructure and funding to do that work, Cianán said. Russell, senior policy officer at the European branch of the International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA-Europe).
Although campaigners agree that sexual health clinics and community organizations are best placed to work with those most at risk of monkeypox, they need sustained support to do so.
Ann-Isabelle von Lingen, who also works at the European AIDS Treatment Group, said there was “no long-term investment in the community”, with organizations having to be ready to advise and provide support in crisis, often without the funds they need. “The Commission and local authorities must invest in a community emergency response,” said von Lingen.
With reporting by Helen Collis.
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