White House monkeypox response coordinator speaks exclusively with Blade

White House Deputy National Monkeypox Response Coordinator Demetre Daskalakis joined the Los Angeles Blade for an exclusive Zoom interview on Wednesday to discuss the latest challenges facing public health officials battling the monkeypox virus. (MPV) – from countering misinformation and educating the public to transitioning to intradermal vaccination dosing regimens.

Daskalakis previously served as the medical director of Mount Sinai Health System, headquartered in New York, and later was appointed Deputy Commissioner of the Division of Disease Control in the Department of Health and Mental Hygiene. of New York City. In late 2020, as the United States saw thousands of new covid deaths every day, Daskalakis joined the Centers for Disease Control and Prevention’s Division of HIV/AIDS Prevention.

A gay man who is a leading expert on LGBTQ health, during his tenure as city health official in New York City, Daskalakis’ work spearheading HIV and STD health programs has been credited for helping to reduce the rate of new HIV infections among gay and bisexual men by 35%.

So, while he notes that the United States has never experienced a monkeypox outbreak like this, before assuming this role in the White House, Daskalakis’ career had already included significant experience as a as a clinical provider and responsible for public health, including labor control. against anti-LGBTQ prejudice and stigma – which is crucial, given the over-representation of cases of VPD among men who have sex with men.

When it comes to messaging, Dr Daskalakis said he and his team have taken the more difficult but effective route, which is to focus on the ways in which one is exposed to MPV “and then work very hard. to get [messaging] through the right channels” to the right groups based on their relative risk.

This involves working with a variety of different partners, from associations of medical providers to groups like the Ryan White HIV/AIDS program and community organizations that serve LGBTQ patients, Daskalakis said. The aim is to “make the distinction between making sure you’re sending candid messages to people while not creating stigma,” he added.

As new data comes in, the communication strategy has changed accordingly, he said. Such flexibility became a cornerstone of coordinating a federal response effort because “we were able to be much clearer in terms of specific risk factors that potentially increase or decrease an individual’s risk.”

This means that the recommendations that gay and bisexual men “reduce your partner network and also consider avoiding anonymous sexual partners if you can” are based on solid scientific data on the transmissibility of MPV, Daskalakis said.

Another persistent challenge, of course, is the spread of misinformation and misinformation on social media. Last month, far-right U.S. Rep. Marjorie Taylor Greene (R-Ga.) asked on Twitter why children had contracted MPV if the virus was sexually transmitted.

Groups like the Anti-Defamation League cited the ruling as an example of how “spurious questions about the origin and spread of the disease” to establish “an explicit link between monkeypox and” children assaulted by gay people “” – giving “oxygen and scope” to these dangerous lies about LGBTQ people.

“Stigma is stigma and homophobia is homophobia,” Daskalakis said, and while these issues are older, more intractable, and broader than the public health messaging around MPV, it’s important not to “linking an infection to an identity”.

“Stigmatizing a disease and creating stigma really creates rabbit holes that lead people away from [figuring out] how to respond to an infectious disease – and how you respond to infectious disease, the focus on community, the focus on knowledge and the focus on data, which should serve as a guide” to convey messages to people, whether online social platforms or other channels, he said.

Daskalakis compared the approach to communication around HIV. “Focus on exposure,” he said, explaining that “anal sex is the most common way HIV is transmitted,” then making sure that message “gets to the people who need it.” to hear it”. This way men who have sex with men can understand the best risk reduction strategies and “gay sex” or gay and bisexual men are not unnecessarily linked to the virus in ways that could worsen or intensify Stigma.

On Monday, The New York Times reported on concerns expressed by state and local health officials over the delivery of MPV vaccines, many of whom pointed the finger at their federal counterparts for issues such as the arrival of shipments of doses that had been spoiled by high temperatures or misuse. handling.

Daskalakis acknowledged the challenges while reaffirming the CDC and White House’s commitment to working collaboratively with state and local partners on these efforts.

“The CDC has provided technical assistance, even down to a video that I think countries are currently using to teach [the proper administration of] intradermal injections, which is really exciting,” he said. “But this is all really designed to support jurisdictions and I think we’re spending our time throughout this really jurisdiction-related response.”

Daskalakis also praised the work being done by local and state health officials: “It’s really important to recognize that the challenges are real, and [also] the creativity with which they kind of take on these challenges at their jurisdictional level, to really reach the space that everybody wants to be in, which is more of the gunshots… That’s sort of the public health theme in general, especially in emergency response.” He added that it was encouraging to see “how people are using the advice of the federal government [including] the support we provide, to get things done.

Moving forward, despite the many challenges ahead, Daskalakis is optimistic about the future, in part because public health officials will have more data at their disposal. “I think we’re really working to accelerate – with studies that are going to happen – the efficacy, monitoring and safety of the vaccines that are happening to make sure we have a sense of how well they work.”

When asked if federal coordination efforts remain focused on exploring possible ways to cut red tape and paperwork, Daskalakis was again positive.

“In terms of bureaucracy, I think that’s one of the important roles in our coordination effort,” he said, working with partners at all levels to see how the vaccination and treatment process of as many people as possible can be made less cumbersome, with less paperwork and more efficiently.

A promising sign of this kind of breakthrough in the response to MPV came last week when the FDA cleared the intradermal injection method of the JYNNEOS vaccine for emergency use authorization.

This route of administration is not only safer, with a superior side effect profile compared to subcutaneous injection, but it also allows for more doses to be administered, Daskalakis said.

In terms of rolling out intradermal injections of the MPV vaccine, Los Angeles “kills it,” Daskalakis said. “It’s like lightning speed. It’s inspiring. It hasn’t been easy for such a large city to adapt so quickly to a new vaccination method, he said, but area health officials have gotten creative and “got it right.” play”.

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Raymond I. Langston