Alexander J. Millman, Ph.D1,2,*; Damian J. Denson, Ph.D3,*; Michelle L. Allen, MPH1; John A. Malone, EdD1; Demeter S. Daskalakis, Ph.D3; Diane Durance, MSN, MPH1; R. Chris Rustin, DrPH1; Kathleen E. Toomey, Ph.D1; Atlanta Black Gay Pride Festival Monkeypox Response Team (See author links)
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Gay, bisexual, and other men who have sex with men (MSM) were disproportionately affected during the 2022 US monkeypox outbreak, with black or African-American (Black) MSM the most affected demographic (1). As of September 28, 2022, Georgia has reported 1,784 cases of monkeypox; 98% of which occur in men and 77% in blacks (2). As of September 13, 2022, 60% of reported cases were among people with HIV infection, and 50% of people with monkeypox had a sexually transmitted infection in the past year (3). Due to racial disparities in the incidence of monkeypox and a high proportion of cases among MSM in Georgia, early vaccination, beginning in July, focused on improving equitable access by establishing new and leveraging existing partnerships with community-based organizations. that serve affected populations, including people with HIV infection. Despite these efforts, discrepancies persist due to the high demand and limited supply of vaccines. The Georgia Department of Public Health (DPH) requested CDC support for a vaccine pilot and received an additional allocation of 5,500 doses of JYNNEOS vaccine for administration at events leading up to and during the Atlanta Black Gay Pride Festival, a multi-day event held on the Day of Labor Weekend (September 2–5, 2022). The event celebrates LGBTQIA+ communities of color and welcomes more than 125,000 attendees each year. Prior to the festival (as of August 24), 17,546 people had been vaccinated in Georgia, of whom 96% were male, 34% aged 25–36, 44% black, and 8% Hispanic or Latino (Hispanic) (4).
During the period August 27 – September 5, DPH in Georgia, in conjunction with local public health departments in five counties of the city of Atlanta† and local community organizations administered the additional JYNNEOS vaccine distribution. Vaccination events held prior to the festival (August 27 – September 1) were located at local health department clinics and in places acceptable and convenient for black MSM, such as well-known large event spaces, bars and clubs. During the festival (September 2–5), daytime and after-hours vaccine events were held in health department clinics and in bars and clubs via mobile vans to increase outreach and access. Georgia DPH staff members used social media, community-based organizations, and field contacts to promote vaccination events. Vaccines were administered by the Georgia DPH, partner organizations and local health departments. Patient demographics were collected at the time of vaccination and entered into the Georgia Immunization Registry. Aggregated data was shared with the CDC. This activity was reviewed by CDC and was conducted in accordance with applicable federal law and CDC policy.§
In the period 27 August – 5 September, a total of 4282 doses of JYNNEOS vaccine were administered (78% of the additional distribution). Two-thirds (2,874) of the doses were administered before the festival and one-third (1,408) during the event. Overall, 2,886 (67%) doses were administered at 22 routine vaccination events at health department clinics, 702 (16%) doses at 20 mobile community pop-up events, and 694 (16%) doses at one fixed location (in Georgia event for mass vaccination sponsored by DPH). Among vaccine recipients, 93% were male, 55% were 30–49 years of age, 48% were black, and 8% were Hispanic (Table). The proportion of blacks receiving the vaccine was higher during the festival (53%) than before the event (46%), but the proportion of Hispanic recipients was similar (7% vs. 8%). Almost a third (31%) of records were missing country of residence data.
Vaccinating communities disproportionately affected by the monkeypox outbreak is important to stop the spread of Monkeypox virus and ending the epidemic (5). A community-based approach by a coalition of festival organizers, government organizations and LGBTQIA+ community advocates was successful in improving equitable monkeypox vaccination. This work highlights the value of health department and community-based organization in-person and virtual outreach to increase health equity. Challenges to an equitable approach to monkeypox vaccination include declining trends in vaccine demand up to the time of the event (possibly due to historical vaccine hesitancy or stigma), provision of second doses for out-of-state travelers, and recent concerns about obtaining second doses. because of skin discoloration associated with intradermal vaccine administration.¶ Georgia DPH is implementing additional events to ensure that people in Georgia receive their second dose of JYNNEOS vaccine. As vaccine supplies increase, dissemination strategies must continue to focus on eliminating disparities and removing barriers, particularly for individuals who may be hesitant to be vaccinated or feel uncomfortable being vaccinated at a large event.
Georgia Department of Public Health; Members of local public health staff in Clayton County, Cobb County, DeKalb County, Fulton County and Gwinnett County; festival organizers, promoters and employees; community partner organizations; CDC Community Engagement Task Force.
Atlanta Black Gay Pride Festival Monkeypox Response Team
Tracy Dabbs, Georgia Department of Public Health; Frederick Dobard-Gary, III, Georgia Department of Public Health; Paige E. Harton, Georgia Department of Public Health; Leah Hofacker, Georgia Department of Public Health; Huriyyah Lewis, Georgia Department of Public Health; Sheila Lovett, Georgia Department of Public Health; Dewayne Crowder; Vision, Hope; Brittany Johnson, Cobb & Douglas Public Health; Katherine Monroe, Cobb & Douglas Public Health; Linda O’Sullivan, DeKalb County Board of Health; Sandra Valenciano, Dekalb County Board of Health; David P. Holland, Fulton County Board of Health; Joshua O’Neill, Fulton County Board of Health; Audrey Arona, Gwinnett, Newton and Rockdale Health Departments; Dorian Freeman, Gwinnett, Newton and Rockdale County Health Departments; Alanna Sulka, Gwinnett, Newton and Rockdale County Health Departments.
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