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Europe has a collective public health amnesia.
In the face of the COVID-19 pandemic, vaccine nationalism, conflicting official guidelines, and marginalized groups are forced to fend for themselves; and the early days of the HIV crisis were accompanied by viral homophobia, stigmatization, and unequal access to treatment.
History is repeating itself now, with 16,500 cases of monkeypox in Europe, mostly among men who have sex with men. Some communities are taking matters into their own hands, developing health information campaigns and even traveling across borders in search of vaccines.
POLITICO spoke to people who have spent weeks desperately trying to fend off the virus, which has been described as “mild” and can cause debilitating pain and lifelong scarring.
“As a single, gay man, I’ve spent my life worrying about contracting STDs and HIV, and in the last two years, I’ve also worried about COVID,” said Paulo, a 34-year-old Portuguese theater director. “I can’t believe I have to worry about another plague.”
Unable to receive vaccinations in Portugal, Paulo travels to Lille in northern France. The city, which is close to the Belgian border, is ready to attract foreign visitors and has become an unexpected pilgrimage destination for those from nearby countries. This is despite the fact that the government has officially reserved anti-rabies vaccines for French residents.
“I’m really worried about monkeypox … I don’t want to leave permanent scars, cause physical pain and quarantine me for weeks in between short vacations. it’s summer,” he said. “Only the more privileged can travel for this particular reason, and that’s not really fair.”
While Paulo may be able to get his vaccine, many others at risk may not soon, along with unclear public health messages, leaving people “angry and really worried”, said Robbie Lawlor, co-founder of Access to Medicines Ireland. , an agitation group.
The infection can be transmitted during sex, at crowded parties, or even during a kiss on a date. Inaccurate messages that stigmatize the disease have led to disagreements about how to convey them, while limited vaccines and strict eligibility criteria have disenfranchised many who have had to get their hands on the vaccine.
With rates of sexually transmitted infections (STIs) rising everywhere, sexual health clinics and public health groups are struggling to keep up with increasing demand for their services. “Now throw in something like monkeypox, and that’s very scary for a lot of people,” Lawlor said. “This geist seems to hang over our community.”
Deja vu again
The trip to Lille, just an hour’s train ride from Brussels, isn’t just made by men concerned about the health effects of monkeypox. Wouter, a 28-year-old architect based in central Belgium, said he visited the French city over the weekend to ease his worries about “month-long quarantine periods and social stigma”. .
“I’m not worried about dying, but I’m definitely worried about being scarred and holding on to it and having to tell the people I work with that I’ve got what society considers ‘gay whore disease,'” he said. “If he stays in the gay community, politicians and the mainstream media don’t seem to care.”
For veteran activists, HIV has a strong whiff of the stigma that first spread among gay men 40 years ago.
“One of the starkest parallels is around stigma and stigmatizing language,” said Susan Cole, community engagement and marketing manager at UK charity NAM aidsmap. “It reminds me of the ’80s.”
However, there are differences of opinion on how to address the risk of stigmatization.
Alex Sparrowhawk, partnerships co-ordinator at the Terrence Higgins Trust, said: “It’s tricky because the general public have a different perspective on it.” While those living through the worst days of the HIV epidemic are wary of speaking out about the at-risk group, others argue that men who have sex with men should primarily be front and center in the message.
“It’s a fine line,” said Peter Piot, former head of the London School of Hygiene and Tropical Medicine and independent adviser to the European Commission, explaining the challenge.
“The reality is that the vast majority of people who are affected are men who have sex with men, but it’s … a subpopulation in the community,” Piot told POLITICO.
Then there’s the debate over whether large gatherings where sex or intimacy might occur — summer music festivals or Pride events — should be banned altogether.
Many activists say this approach doesn’t work.
“Behavior change has never worked for HIV and it will never work for this,” said Apostolos Kalogiannis, communications coordinator for the European AIDS Treatment Group.
“The community was really straightforward,” Kalogiannis said. Canceling the events “would be the worst decision because it would contain everything in private places and it would be much harder to reach that community. [with] prevention and health promotion [messaging] related to monkey disease”.
Search for doses
Complicating the debate over risk linkage is the lack of vaccines to protect those who want them.
Vaccine requirements vary across Europe. For example, France has stockpiled a vaccine produced by the Danish company Bavarian Nordic to protect against smallpox. The monkeypox vaccine is now approved, and the government has released 42,000 doses. Men who have sex with men, transgender people with multiple partners and sex workers are eligible.
This is in contrast to other countries, which have insufficient doses and have to limit access to subgroups of these communities – for example the Netherlands has until now only offered vaccinations to those receiving PrEP, the preventive treatment against HIV. In Belgium, men who have sex with men are only eligible if they have had at least two STDs in the last year and provide documentation.
Availability of the Bavarian Nordic vaccine varies between countries and within states, and it is difficult to determine the extent of current stocks, as many governments keep this information confidential for national security reasons. The Commission has collectively ordered more than 163,000 doses for the bloc, but this pales in comparison to the 250,000 purchased directly by France and the 130,000 purchased by the UK.
In the US, by contrast, the Biden administration released more than 1 million doses of the Bavarian Nordic vaccine and declared monkeypox a national health emergency.
According to the French Ministry of Health, vaccination centers set up by regional health authorities must provide the vaccine “free of charge to eligible persons living in the region”. However, Karima Chouia, head of the public health center in Lille, which distributes the vaccines, said the dose would not be limited to French residents.
“We’re doing preventive vaccinations, so it’s open to everyone, and yes, we’re seeing some populations come to us to get vaccinated,” Chouia told POLITICO. “We’re not going to impose restrictions based on where you live — this is a global epidemic. . . The goal is to make vaccination widely available.”
Lille is not the only French city to address the issue of vaccination for everyone who wants to be vaccinated. Clinics in Paris and several towns along the French-Italian border follow similar protocols.
In Milan, city councilor Michele Albiani cited France’s response to pressure her country’s government to resolve the crisis.
“I may have an appointment in Milan, France to get vaccinated, but I can’t do it in my country,” he told his social media followers. “It’s a shame.”
A few days later, the Italian government announced that it would begin providing a limited supply of 4,200 rounds of ammunition to medical workers and members of the LGBTQ community considered to be at particular risk. An additional 16,000 vaccines are expected to be available by the end of the month.
As community groups are tasked with informing those most at risk about the virus, sexual health clinics with limited resources, such as those in Lille run by Chouia, are at the forefront of vaccination efforts.
Much of the public health work “falls on the shoulders of organizations that are event organizers or advocacy groups,” said Cianan Russell, who lack the infrastructure and funding to do the work. International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA-Europe).
Activists say sexual health clinics and community organizations are best placed to work with people at risk of STDs, but they need sustained support to do so.
“There is no long-term investment in the community,” said Ann-Isabella von Lingen of the European AIDS Treatment Group, who expects organizations to be ready to provide advice and support when crises arise. the funds they need. “The Commission and local authorities must invest in community emergency response,” von Lingen said.
With a report by Helen Collis.
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