People at risk of monkeypox need help, not stigma: Dr. Anthony Fauci
World Health Organization recently declared monkeypox a global health emergency
Dr. Anthony Fauci says the world "could have done better" in curbing monkeypox globally, but the window remains open to get it under control.
"The challenge now with monkeypox is to try and implement [strategies and interventions] effectively, and in an equitable way — without inducing the spectre of stigma," said Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) in the U.S.
"We have these interventions and we've got to get them to the people who need it — things like vaccines," he told The Current's Matt Galloway.
The World Health Organization declared monkeypox a global emergency on Saturday. There are 20,638 confirmed cases across 77 countries, according to the U.S. Centers for Disease Control and Prevention. As of Thursday, the Public Health Agency of Canada (PHAC) has recorded 745 cases of monkeypox in Canada, with the majority in Ontario and Quebec.
Monkeypox symptoms include headaches, fever, muscle ache, and fatigue, and can lead to rashes or very painful lesions across the body, which can take weeks to heal. The disease is spread through respiratory droplets during prolonged close contact, direct contact with skin lesions or bodily fluids, or through contaminated clothes or bedding.
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Though monkeypox is not a sexually transmitted disease, the rise in cases in recent months is predominantly affecting men who have sex with men. Contact tracing has tied outbreaks to sexual contact at raves in Europe.
Fauci said it's important to acknowledge "the reality" that the disease is having a disproportionate impact on that community, and directly address them, "[making] sure physicians who are caring for that community are aware of it, so that they don't miss it."
"And you've got to do that without stigmatizing the community," he said.
But avoiding that stigma shouldn't mean "watering down the message," said Dr. Kevin Woodward, an infectious disease physician and associate professor of medicine at McMaster University in Hamilton, Ont.
"This is affecting communities of [cisgender] guys who are into guys, trans and non-binary people who have sex with men … these are the people who should go out and get vaccinated," he told CBC Radio's Day 6.
"I don't think that by giving that information, you're stigmatizing," he said.
While Canada has implemented a monkeypox vaccine rollout targeting vulnerable populations, access has been uneven across the country. (One man in Newfoundland resorted to flying to Montreal to secure a shot.) There are also concerns that vaccine supply may become an issue, as other countries scramble to secure doses of the Imvamune vaccine, from Danish vaccine developer Bavarian Nordic.
But while anyone can contract monkeypox, Woodward said it's important that attention is paid to populations where the disease is already circulating.
"If we just say, 'Anybody can get monkeypox,' number one, we're going to have a ton of people — who are not really high-risk right now — worried about it, and trying to access vaccine," he said.
He said it also risks diverting the message from vulnerable groups, including the LGBT community, who "should be thinking about monkeypox, should definitely be accessing a vaccine if they're at risk based on their sexual contacts, and then be on the lookout for any signs or symptoms of disease."
Echoes of AIDS early days
Woodward said that in the 1980s and '90s, the public health messaging around HIV/AIDS was "much more accusatory."
"It was around, you know, 'You've got this disease because of your behaviour,' … that kind of message we don't want to send," he said.
"The balance is really around giving the right information, and at the same time not blaming people for getting a disease."
Fauci has become globally recognized for his work throughout the COVID-19 pandemic, but in a career spanning 40 years, he has also been at the forefront of HIV/AIDS research. This week he is a key speaker at this week's International AIDS Conference in Montreal.
In the early days of AIDS, Fauci said no one knew what caused the disease.
"We had no etiology, we had no therapy, and we had no vaccine," in the early days of AIDS, he said, and the challenge was to "rapidly try to develop interventions." (The etiology of a disease is the understanding of its cause or origin).
"Right now with monkeypox, we have something very, very different. We have an etiology. We have tests. We have vaccines, and we have therapies," he said.
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Fauci said mistakes were made at the onset of HIV/AIDS as well — but that it taught him the importance of working with affected communities.
"We were trying to do research and clinical trials in the classic, somewhat antiquated way, not involving the community," he said.
When groups like ACT UP pushed back on what they saw as government inaction, Fauci said he tried to put himself in the shoes of "the gay activists were who were suffering terribly from this mysterious disease."
"I came to the conclusion that I would do exactly what they were doing. I would be confronting the establishment and saying, 'You've got to get us involved,'" he said.
Fauci said he worked to include the activists' perspectives in his work. While it wasn't smooth at first, he sees it as an example of how seemingly opposed groups can work together to achieve a common goal.
"It really is a very important story of [how] you've got to listen to the involved communities, no matter what the disease is, no matter what is going on. You have to involve the community," he said.
Written by Padraig Moran. Produced by Susan McKenzie.