NYC has almost eliminated monkeypox. An NYU biology prof on what the city needs to reach zero

As New York City gains control over the monkeypox outbreak, advocates are warning that vulnerable groups still remain at risk.

Cases citywide began dropping late this summer: After a daily average of 74 reported infections in late July, the city is now recording fewer than 10 cases per day. Last week, Dr. Ashwin Vasan, the city's health commissioner, said this progress was promising but added that it was too soon to declare victory just yet.

“We have turned a corner that I hope indicates that we now have the upper hand on this outbreak,” Vasan said. “While I'm very proud of where we are, I'd like to offer our humility and gratitude for the current situation. "The fact is that we've had real challenges.”

Part of the doubt centers around the epidemic’s lingering health disparities. While infections started out even among different racial and ethnic groups, cases are now smoldering most often in Black and Latino individuals. These two groups are also undervaccinated in New York City, even though people with shots are 14 times less likely to catch the virus in the current nationwide rollout. If this pattern holds in clinical studies of the monkeypox vaccine, it would translate to about 90% effectiveness.

Dr. Joseph Osmundson, a professor of biology at NYU and a health equity expert, spoke with WNYC host Michael Hill about where things stand with the disease. Osmundson said communities still need better access to care, especially with their sexual health, to quash monkeypox for good.

A transcript of their conversation is below. It’s been lightly edited for clarity.

Michael Hill: First, what's behind this drop in cases overall? Is it just vaccination?

Joseph Osmundson: Immunity against this virus is complex and involves immunity due to vaccination, which is the type of immunity we want; immunity due to prior infection; and behavioral changes. We saw all of those coming into effect over the summer and into fall leading to a drop in cases. I'm so proud of my community, the queer community, for really stepping up and getting vaccinated and changing our behaviors to bring cases so much lower.

You say cases remain disproportionately much higher for Black and Latino men. What lesson or message is that segment of the population missing?

They're not missing anything except for health care access. Right? So it's not about information so much as it is folks who are outside of access to health care. The very same patterns that we see in the HIV epidemic that's ongoing.

What, if anything, could officials do to better help protect those communities that are still seeing higher numbers of cases?

It really involves pulling communities into care. We have real structural issues with access to health care in this country. We need to do everything that we can do to build up access to health care — primary care, getting folks health insurance, getting folks access to high-quality sexual health care.

It's frustrating because it's the very same gaps that leave people behind in the HIV crisis that are now leaving people behind in monkeypox. But that means we actually have a roadmap to fixing it. But it is not going to be something that is a single policy. It's gonna be fixing the large gaps in health care equity and access.

You mentioned some people have developed immunity through exposure. What's known about that kind of immunity and how long might it last?

There's so much unknown in this crisis, which is really a choice that we've made.

This virus has been around in humans since 1970. And yet we've studied it so little because it's disproportionately affected people that we don’t view as worthwhile to study the sort of diseases that affect them.

Certainly immunity after infection is very strong, as strong as vaccination. It probably lasts years, but exactly how long and when those folks need to get vaccinated for ongoing protection is unknown.

Is there any concern of another monkeypox wave hitting the area in the future? Just as we've seen with COVID-19, should we expect new variants of monkeypox?

The evolution of this virus and variants is certainly troublesome and worrisome, but right now this virus is not acting like COVID at all. Right? It's not an airborne virus, it’s not spread through face-to-face contact in the air. It's spread by very close physical contact. So far the good news is we don't see it spreading in schools. We don't see it spreading sort of by incidental contact in a workplace or anything like that.

I'm not worried about a huge new wave. I'm worried about the people globally, not just in the U.S. who are already being left behind.

I'm curious about something with COVID, monkeypox and other epidemics out there. It seems that we're getting more and more exposure to what may be wrong with the health care system or the medical system because these things keep seeming to have a disproportionate impact on certain communities.

Well, that's right. We have real structural issues with health care access in this country. When you think about HIV, the people most disproportionally affected by HIV are folks in the rural South — queer folks in the rural South, especially queer Black folks.

There are people who live 80 miles from a primary health care physician. We have people showing up in the hospital with monkeypox and AIDS — not HIV but AIDS, which means that folks have been not able to get an HIV test or treatment for many years.

We've known about this issue for a long time and it's just frustrating that the political motivation to get something like universal health care isn't there to really fix those structural gaps.