Day 6·Q&A

Monkeypox vaccine messaging must focus on at-risk groups to better control spread, says physician

Men who have sex with men are among the most at-risk groups of contracting monkeypox, and infectious disease physician Dr. Kevin Woodward says monkeypox vaccine messaging should be targeted to those groups.

'I think it's really important that ... we're clear with our communication,' says Dr. Kevin Woodward

Closeup of a a hand sticking a need tip into an upside down vial of monkeypox vaccine.
A health-care worker prepares a syringe filled with the monkeypox vaccine in Montreal. (Christinne Muschi/Reuters)

Dr. Kevin Woodward says a key part of preventing the spread of monkeypox is focusing mitigation and vaccine messaging on groups of people most at-risk of contracting the disease, rather than a general vaccine campaign.

He warned, though, that the messaging could risk stigmatizing some communities.

"[It] is true, anyone can get monkeypox," Woodward, an infectious disease physician and associate professor of medicine at McMaster University in Hamilton, Ont., told Day 6 guest host Saroja Coelho.

"But we also need to be really clear on these are the populations that are most at-risk now who should be going and getting vaccinations, who should be on the lookout for any symptoms that could be concerning."

In recent months, the rise in cases is predominantly affecting men who have sex with men. Monkeypox is not a sexually transmitted disease.

Woodward said it's important public health officials are "very clear" on the current situation, while avoid the same stigma that happened against the LGBTQ community during the HIV/AIDS crisis of the 1980s and '90s.

The monkeypox outbreak has expanded to more than 70 countries, prompting the chief of the World Health Organization to declare it a global emergency. 

According to the U.S. Centers for Disease Control and Prevention, more than 21,000 global cases of monkeypox have been reported since May. These numbers include more than 800 cases in Canada alone.

Woodward spoke to Coelho about communicating clearly to communities most at risk of monkeypox without stigmatizing them, as well as what mitigation strategies need improvement. Here's part of their conversation.

Infectious disease physician Dr. Kevin Woodward says public health officials need to focus monkeypox vaccine messaging on groups most at-risk of contracting the disease in order to control the spread within those communities. (Michael Cole/CBC)

How do you communicate clearly that people in this community are particularly at risk without giving the impression that they're at risk because they're part of this community?

With any infectious disease, it always starts somewhere. I think what we need to be clear on is to say that this infection that we're seeing right now is within the community. That's where it happened to start, and we really just want to stop it in its tracks so it doesn't spread to a lot of people, both within the community of LGBTQ folks and also within the larger Canadian population.

I think it's really important that, again, we're clear with our communication. This is not because you're part of the community that you're getting it. It's just this is, you know, almost the bad luck of where ... it happened to show up at first.

Letting the community know that, you know, these are the people that we're seeing the disease in and that you should go out and get vaccinated and get tested if you have symptoms is actually really important.

We need to vaccinate everyone who's at risk within the community, because if we don't do that, then we're not going to be able to completely control that spread within the community.-Dr. Kevin Woodword

That communication piece has become particularly interesting because Canada's chief public health officer, Theresa Tam, advised, [among] other things, that people have fewer sexual partners. What do you think about that particular statement?

There's always a difference between public health advice and what people do and what practical advice is. 

I'm old enough to remember in the '90s and 2000s when public health individuals would say, you should use condoms for oral sex, and a lot of the individuals that I see in clinics, we would kind of laugh about that and say all that really proves is that no one in public health has actually had oral sex.

Providing advice like you should reduce your number of sexual partners, especially after two and a half years of COVID, where a lot of people have been very socially isolated, really have been looking forward to the opening up this summer as a time to actually go out and start to enjoy life again — I don't know how practical that advice is. 

I think with this, the real advice I would give would be go out and get vaccinated. We know that vaccination is highly, highly effective in preventing M-pox, and so really increasing vaccination within the community, I think, is the best thing we can do.

You've been speaking about some of the strategies that are in place right now for dealing with this outbreak, including communication strategies, ... distancing, [and] vaccine availability.

If you look at the whole scope of mitigation strategies currently in place, what do you think is working and what do you think still needs to be addressed?

I think when you look at the news coming out of the U.S. and the difficulty people have had accessing vaccination there, I think we've actually done quite a good job in Ontario and Canada about getting that vaccine out quickly, getting it to the public health units where most people are infected, and also getting it into the arms of people who are at risk for M-pox. 

I think one of the areas, that we really need to continue to work on in this started within COVID, is this idea of support for people who need to isolate.

There were a lot of discussions that happened during COVID when people need to isolate for 10 days or five days, that we really needed to have sick days available for individuals. We needed to have supports for people to be able to stay at home. 

When we're looking at isolation for M-pox, it's much longer. So average 21 days, but it can be, you know, two weeks, four weeks, six weeks. 

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Asking someone to stay home for 21 days when we have no support for sick days, we have no real support for someone to be able to get groceries, we don't have great social supports for people who are isolating still — that's a big ask. 

I think that the government needs to step up to the plate a little bit and make sure that we have some supports in place for those individuals who need to isolate in order to really provide them with the ability to do so effectively.

Canada has a vaccine for monkeypox. Should we just launch a mass vaccination campaign the way that we did with COVID?

I don't think so. This is an evolving infection that we see happening, and right now, those cases have still been isolated to specifically to the 2SLGBTQ community. So vaccinating every single person in Canada or every single person in Toronto, I don't think is a really good use of resources. 

At the very beginning, when we were doing vaccines, we saw, you know, incredibly long line-ups outside of places that were given the getting the M-pox vaccine, and we want to avoid that. We want to make it simple for people to be able to pop in [and] get their vaccine when they need it. 

But I don't think we're at the time where we need to vaccinate the entire population ... [and] I don't think we have or will have the vaccine supply for that anytime soon.

And really ... if you're not a member of the community that's at risk right now, the likelihood of getting Mpox is incredibly low.

Written by Mouhamad Rachini. Produced by McKenna Hadley-Burke. Q&A has been edited for length and clarity.

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