It was a bit of a throwback,” says Oli Kasin, sitting in his Peckham flat with mild flu-like symptoms, 24 hours after receiving his first vaccine at the walk-in centre at Guy’s Hospital on Sunday.
Just eight months ago the 32-year-old was having his third Covid jab. But this time, it’s a different virus Kasin and his friends find themselves queuing for hours to protect themselves against: monkeypox, a smallpox-like virus which the World Health Organisation this week declared a global health emergency — its highest alert — after more than 16,000 cases were identified in 75 countries, including five deaths. Symptoms vary, but can include a flu-like illness, and skin rashes, with one in 10 cases requiring hospital care and extreme cases leading to painful, bursting skin lesions that leave the victim “[screaming] out loud in pain”.
While Covid is spread through the air, experts say monkeypox is mostly spread through forms of skin-to-skin contact such as sex, kissing, and direct contact with the infectious rash, scabs or bodily fluids. Since the outbreak was first reported in May, the majority of infections outside Africa — where the virus has been a concern for years — have occurred among men who have sex with men (MSM), sparking concerns among the LGBTQ+ community in particular. Gay, bisexual and queer men currently make up 98 per cent of cases in the UK.
“The idea that we’re having to go through another possible pandemic is a little bit daunting... but it probably feels more similar to the fear of HIV and what that did to the gay community,” says Kasin, who was among hundreds of mostly gay men who queued for more than two hours to get their vaccine in London this weekend.
He says the atmosphere was mixed; in many ways it was “fun” and “showed the best of the gay community: that we are on top of our health, care about ourselves and others” (”part of me was wondering if I’d find my future husband there”). But others say it brought back chilling images of waiting rooms during the 1980s AIDs epidemic, and many of their comments speak to wider fears echoing across the globe at the moment.
After two years of the world being ground to a halt by a contagious virus, could we really be on the cusp of another one? Could this one reignite the stigma around gay communities like the HIV/AIDs epidemic 40 years ago? And does that stigma pose serious risks to the efforts to contain it?
For virologists across the world, there are two key facts about monkeypox that are immediately reassuring: first, monkeypox is not a new disease like Covid was so we know more about it from the start; second, it is preventable by a smallpox vaccine, so a method of protection already exists and most people in the UK over the age of 50 should therefore already have protection.
But it is not without its concerns and unknowns. Recent weeks have seen an unprecedented spike in cases of the disease, with more than 18,000 confirmed worldwide infections and at least 2,000 confirmed cases in the UK alone. Earlier this year, a British child among UK’s then-20 recorded cases was reported to be in a critical condition and experts are advising the public to be aware of new rashes or skin bumps, but also be aware of the other possible causes such as shingles, STIs, chickenpox, bedbugs or insect bites.
Among those who have been diagnosed with monkeypox, London has quickly been earmarked as Britain’s epicentre. The “majority” of the 2,050 known UK cases have been found in London and a number of those patients are receiving medical care at specialist infectious disease units at the Royal Free Hospital and Guy’s and St Thomas’, two of the hospitals now part of the NHS’s vaccination programme, which was stepped-up last week. Last weekend, more than 1,000 vaccinations were delivered at clinics across the capital.
Most experts say they are not concerned about a global monkeypox pandemic on the scale of Covid but naturally, rising figures and a new state of emergency have increased concerns. Could it be the next pandemic? How is it affecting LGBT+ communities, who might already feel more marginalised in society than most? And if it’s not only transmitted via sex, but also touch, why aren’t others outside of that community more worried?
Among the scientific and medical communities, the overwhelming consensus is that while this monkeypox outbreak might be concerning, there is little to no risk it becoming the next Covid. “Don’t fall for fearmongering... this is not Covid,” was the message from Faheem Younus, chief of infectious diseases at the University of Maryland this week, insisting the risk of lockdowns due to rising monkeypox cases was “0 per cent”. Tweeting to his 512,000 followers, he listed the reasons why: monkeypox is not novel, is typically non-deadly, is less contagious than Covid, has been around for five decades, and is preventable by a smallpox vaccine. Dr Gareth Nye, an endocrinology specialist at Chester Medical School, agrees. “In essence, it doesn’t spread as fast [as coronavirus] and so is easier to control,” he says, pointing out that its obvious and painful symptoms mean people are at least more likely to know they have it.
Ironically, it’s actually Covid that could be (partly) responsible for rising monkeypox figures, he continues. “Our immune systems have had a break and are not used to fighting off diseases which is why so many of us have come down with bad colds.”
Dr Mark Lawton, a consultant from the British Association for Sexual Health and HIV, suggests there are reasons we haven’t really heard of this widely before. First, public awareness of viruses was heightened after the Covid pandemic; and second, scaremongering headlines about monkeypox and widely-shared photos of its symptoms mean more people are probably aware of the particular symptoms to look for. Most years the UK often sees a smattering of cases, he points out, but these don’t normally hit the headlines, and some may go undiagnosed.
So what is the concern then, if the symptoms are normally relatively mild and it’s unlikely to escalate into a pandemic? Lawton says his main concerns are twofold: first, increased pressure on already-stretched NHS services, particularly sexual health clinics. If monkeypox symptoms are identified in a patient, staff will need to take particular care with PPE since it’s a disease that’s passed on via skin-to-skin contact. “Quite simply, it slows the process down,” he says. “We need immediate action from the Government to fund additional resources”.
But Lawton’s wider concern is stigmatising already-stigmatised areas of healthcare and already-stigmatised people. Whilst monkeypox isn’t technically an STI, it can be passed on through sexual contact, and there is always a particular anxiety around any disease that is passed on in this way. “The last thing we want to do is create more stigma or fear around sexually transmitted diseases. The key thing to stop the spread is people coming forward — if we drive stigma, it might mean people don’t come forward.”
Members of London’s LGBTQ+ community agree. While Kasin is happy to be open about his sexuality and vaccination views on social media, many friends are not. “A lot of people I know say if they tested positive [for monkeypox] they wouldn’t feel comfortable to tell their employers. There’s definitely a fear of being treated differently because it’s through sex,” he says.
Josh Hopkins, 27, a trainee solicitor from west London, agrees. He had to call his local clinic 15 times on Monday before getting a vaccine appointment, and says there’s a fear and frustration that monkeypox isn’t being taken as seriously as other viruses because of the community affected. Just look at how information about the Covid jab was disseminated, he says, pointing to the nationwide drive to get the population jabbed, from celebrity videos to personal text messages. This time, his GP hasn’t been in touch to offer him the jab and half his friends didn’t know about London’s new walk-in centres and monkeypox clinics until he tweeted the number of the appointment line. “It feels like we’ve had to proactively seek [the vaccine] out ourselves.”
Like Kasin, Hopkins has dozens of friends who queued for as long as four hours for a jab on Sunday, and they’re the lucky ones who live in London. The monkeypox jab is not available in other areas of the country yet, so a friend from Birmingham had to travel to the capital to have the jab last weekend.
Experts are already warning that it might take more than a year to control this particular outbreak of monkeypox, because they and their colleagues “really missed the boat on being able to put a lid on the outbreak earlier”. “You’d think we’d have learnt lessons from Covid and tried to stop something new at the start,” says Hopkins, asking why GPs don’t seem to be actively promoting the vaccine yet, despite official guidance saying that “your local NHS services will contact you and offer you a vaccine”.
But having this virus taken less seriously is only half Kasin and Hopkins’s concern. The other is who will take the blame if it escalates. As a gay man, Hopkins says he sees the dark side of today’s “horrible culture war against queer people” every day and has already seen “stupid tweets” about monkeypox being a “gay virus”. Anti-vaxxers have been sharing conspiracy theories about Bill Gates and the monkeypox vaccine being the Covid vaccine in disguise. “I know I’m early but I’m also anti-monkeypox jab,” outspoken actor Laurence Fox tweeted when the outbreak first emerged in May. And even the name monkeypox plays into conspiracy theorists’ hands.
“That’s how it starts,” says Hopkins. “Information gets twisted and suddenly it becomes an anti-gay thing; that it’s our fault for being too promiscuous. This time next year, maybe it won’t have spread, but if it does, who are people who already hate the queer community going to blame? I don’t think it’s being fully weaponised just yet, but [these people] certainly tend to not need much of an excuse to do so.”
Information gets twisted and suddenly it becomes an anti-gay thing
Hopkins says the good thing about the queer community is they like to try to see the lighter side. Most of them have had lifetimes of jokes about promiscuity, so they’ve been reclaiming the jokes for themselves before others can, joking about how the vaccine queues are like another gay festival on social media. The upside is it’s highlighted how proactive gay men tend to be about their health. “I’ve spoke to my flatmates and family and clearly people aren’t that clued up [about monkeypox] outside the gay community.”
So how likely are non-LGBTQ+ communities to find themselves exposed, should we all be getting the jab, and how likely are anti-vaxx theories around the Covid vaccine to affect potential uptake? Lawton says healthcare staff are some of those who need to be most careful when it comes to transmission. In 2018, the third victim of a monkeypox outbreak in the UK — a healthcare worker, 40, from Lancashire — blamed the NHS-provided gloves she was wearing while changing another monkeypox patient’s bedsheets at Blackpool Victoria Hospital. She also told reporters she may have passed the virus onto her husband, 50, after he woke up with spots covering his entire face.
Experts say parents “should not be worried” about the rise in UK cases. Despite a school in Surbiton sending its reception class home over monkeypox fears earlier this month, cases in past outbreaks have predominantly been in adults. “Without any contact history with somebody that’s known or strongly felt to have monkeypox, and if you’ve got a rash at this time of year when we’ve seen lots of rashes from chickenpox and other things in children, hand, foot and mouth disease, then that’s what it’s likely to be,” Dr David Porter, paediatric infectious diseases consultant at Alder Hey Children’s NHS Foundation Trust, said.
When it comes to vaccination, Nye points out that most people over 50 in the UK will already have had the smallpox jab and therefore have protection. For the remaining under-50s, then, the main issues are to do with supply and personal choice, says Lawton. “Ultimately, it is a mild, self-limiting illness in most, so getting vaccinated should be a personal choice,” says Dr Nirusa Kumaran, a GP and founder of Elemental Health Clinic in south London.
It is a mild, self-limiting illness in most, so getting vaccinated should be a personal choice
The UK has ordered 130,000 doses of the vaccine, with the roll-out being run through sexual health services, and gay, bisexual and queer men are being prioritised for the jab — which is encouraged for men who have multiple sexual partners, participate in group sex or attend venues such as gay saunas.
Vaccine uptake over the next few weeks will be crucial in determining how the outbreak plays out, and in the meantime, experts will continue to put pressure on the Government to boost resourcing for sexual health services. Meanwhile, most members of London’s MSM community are optimistic that their speed of mobilising will pay off. “We’re often demonised for ‘spreading’ something,” one member wrote this week in a tweet that’s been liked more than 700 times. But “we will actually be studied in the future as examples of how communities can use informal networks and information sharing to secure public health solutions.”
Hopefully, he’ll turn out to be right.
