health care editor
health care editor
Vaccination alone is not enough to get the monkeypox virus under control, the RIVM and the GGD in Amsterdam and The Hague tell the NOS.
The virus circulates almost exclusively among men who regularly have sex with changing male partners. It is mainly passed on during prolonged and intensive skin-to-skin contact during sex.
Experts advise temporarily limiting the number of sex partners to temper the spread of the virus. This protects the health of these people and minimizes the chance that the virus will spread more widely.
This is what people at the RAI, where vaccinations, think about a shot:
‘I will get a vaccine, but I will not change my behaviour’
RIVM has drawn up a national list of 32,000 people who are at high risk. These are homosexual or transgender people who use the drug PrEP to prevent HIV infection, or who are on the waiting list for it. Men who are HIV-positive and some of the visitors to the STI clinic can also receive a vaccine.
Vaccination got off to a slow start in the first few weeks. “Due to the speed with which we started, there was no efficient work process yet,” says a spokesperson for GGD Amsterdam. “There was no registration system, national telephone number or national appointment system and there were holidays for staff and guests.” scaled up quickly.
Vaccine protection unclear
Vaccines cannot solve everything. “Vaccination is not a panacea”, says Marion Koopmans, professor of virology at Erasmus MC and member of the expert council that advises the cabinet on monkey pox. “It is part of a whole package with which we try to stop monkey pox. Just like, for example, education, accessible testing, informing contacts, and creating a bubble with regard to sexual contacts.”
RIVM epidemiologist Susan van den Hof also says that more is needed than vaccination. “We don’t know exactly how well the vaccines protect and how many people are vaccinated, so more is needed to limit the number of infections.”
Less sexual contact is crucial, says Kai Jonas, professor of social psychology at Maastricht University, who focuses on health within the LGBTI+ community and conducts research into monkey pox. “Actually, we have to go back to the advice from the corona time: one regular sex contact. Loose contacts are now disastrous.”
‘Sex life is something fundamental’
Henry de Vries, professor by special appointment at UvA specializing in sexually transmitted infections and tropical skin diseases, endorses the importance of temporary behavioral change. De Vries, who is also a member of the expert council, adds that this is very difficult. “Certainly with something as fundamental as sex. How you want to experience sex partly stems from your identity and self-image. It is complicated to adjust sexual behavior.”
The willingness to temporarily forgo alternating sexual contacts seems low. At the beginning of July, Jonas questioned 439 gay men via questionnaires for a non-peer-reviewed study. “Eight percent planned to reduce the number of sex partners, the vast majority were unsure about that.”
According to Jonas, campaigns should aim for behavioral change. De Vries has already started this. “Many people in the gay community want to know what they can do to prevent infections,” he says. “Good information is the best way to get this community on board. Closing clubs or banning sex parties is counterproductive. Then it goes underground.”
Fear of stigma
The less the virus circulates, the less likely it is to spread beyond the current low-risk group. The GGD takes into account the scenario that the virus transfers from humans to animals. For example, if a dog comes into contact with spots on the skin of an infected owner. “Then we completely lose control,” says De Vries. “The virus can then spread much more easily.”
If that happens, De Vries fears that the gay community will be stigmatized again. “Like: we have a virus again and that is because of those gays.”
That fear also lives in the gay community. There is also criticism that Minister Kuipers decided only late to vaccinate the risk group.
“At the beginning of July, we were already talking about this virus within the gay community. Almost everyone knew someone who was infected,” says Danny*, an expat who has lived in Amsterdam for years. “I noticed then that everyone in the ‘community’ wanted to get a vaccine quickly.”
“Why does it have to take months?”
At the end of June, STI Aids The Netherlands already argued in favor of preventive vaccination. Almost a month later, on 21 July, Kuipers gave the order. Four days later the first injections were made.
“Incomprehensible”, says Danny “With the Milkshake festival and Pride on the horizon, vaccinating as soon as possible should have been a priority.”
Men who are allowed to get an injection experience the pace of the GGD as slow. “They have to prick 32,000 people,” says Berend*. “During the corona vaccinations, that number was done within a few days. Why does it have to take months now?”
According to the GGDs, the problem lies in the fact that there is no central database of people who use PrEP and are therefore eligible for a vaccine.
“You can get PrEP through your GP, local GGD or some HIV treatment centers,” says the spokesperson for GGD Amsterdam. “In Amsterdam, where 10,500 people have to get a shot, we can send 300 invitations per day. This will be scaled up to 500 per day. Building the list takes a lot of time, because of privacy legislation and because everyone has to be invited personally. do not move to injection locations elsewhere in the country, such as with corona.”
‘Right shot in the right arm’
So far, only a little over half show up, probably because a lot of people are on vacation or missed the invite. “We will take them with us in the next round, but there is little we can do about the holiday causing a delay,” the spokesperson said.
Berend: “If there are vaccinations left every day, it is best to vaccinate people who are not on the list, but who themselves indicate that they are at greater risk.”
“We don’t waste vaccines. If we had enough vaccines, we would vaccinate more widely,” the spokesperson responds. “But that’s not the case. That’s why we stick to the very specific group that is most at risk. The right injection has to be in the right arm.”
* Danny and Berend did not want to be called by their full names for privacy reasons.