“If you have an individual who’s had a known exposure to someone with active monkeypox, they’re at the top of the tier in terms of being vaccinated. But then it goes down from there, currently, to individuals who have multiple sex partners,” said Stanley Deresinski, a clinical professor of medicine and infectious diseases at Stanford University. He suspects preventative vaccination going forward will be limited to people at risk, including potentially health workers, who are regularly vaccinated for infectious diseases. But that could change depending on the course of this outbreak. “You could have a child who gets it, goes to school, wrestles with his friends, you know—things can happen. But I think those are going to be rare events,” he said.
Perhaps Köhn’s biggest frustration was the difficulty finding treatment for his symptoms. “Every single doctor’s office, if they haven’t worked out a standard symptomatic care plan, what are they doing? Come on! This has been going on for, what, two and a half months now?” he said. “I just hate that I had to run around and basically beg for care when I’m actually really ill and had to figure out all the barriers to that care and how to get over them. That’s so incredibly unfair.” It also means patients like him, with some knowledge of health care and the confidence to advocate for himself, are more likely to receive better care, further exacerbating health inequities. “There are probably a lot of people with equally severe symptoms who just don’t have the resources that I do to push for it, and that is just going to worsen inequity.”
Sexual health clinics that have long worked within the current populations at most risk are well-suited for helping stem this crisis, but they were already poorly funded and strained before this outbreak. Other components of the health system—especially primary care providers, urgent care centers, and emergency rooms—need to have a plan for treating monkeypox patients as well. And officials should get creative about reaching those at risk as quickly as possible before the virus spreads more, given that only people with active, obvious symptoms are likely to seek treatment, even though this outbreak has shown that monkeypox symptoms can appear in ways (and locations) previously thought uncommon.