San Francisco has declared a state of emergency, with the city in “desperate need of vaccines” as monkeypox cases skyrocket.
The US has seen around 4,600 confirmed cases of monkeypox across the country. Of these cases, 261 have been detected in San Francisco, representing around 30 per cent of all cases in California.
On Thursday (28 July), San Francisco mayor London Breed said: “We are at a very scary place. And we don’t want to be ignored by the federal government in our need. So many leaders of the LGBT community have also, weeks ago, asked for additional help and support and assistance.”
By declaring a state of emergency, San Francisco will be able to allocate more resources to fight the virus. Breed added that the city was in “desperate need of vaccines”.
San Francisco’s emergency declaration comes as earlier this week World Health Organization (WHO) said the accelerating monkeypox outbreak was a global health emergency, the health agency’s highest level of alert.
Monkeypox has spread around the world in recent months, however the outbreak is concentrated in Europe, and gay and bisexual men are disproportionately affected.
The health department of San Francisco, arguably the LGBTQ+ capital of America, has faced criticism for its response to the monkeypox outbreak because of a lack of public messaging and vaccine information.
The queer community and LGBTQ+ organisations have had to pick up the slack, with the San Francisco AIDS Foundation setting up a monkeypox advice hotline, and creating a vaccine waiting list, rather than forcing those at risk to queue for hours.
But state senator Scott Wiener, who represents the city, said: “San Francisco was at the forefront of the public health responses to HIV and COVID-19, and we will be at the forefront when it comes to monkeypox. We can’t and won’t leave the LGBTQ community out to dry.”
The most visible monkeypox symptom is a red rash with flat marks, with lesions soon rising and filling with puss, before falling off.
According to the NHS, other symptoms include a fever, body aches, chills and swollen glands. Symptoms can take between 5 and 21 days to show and bouts of monkeypox can last for weeks.
The head of the World Health Organization on Wednesday advised men at risk of catching monkeypox to consider reducing their sexual partners “for the moment” following the U.N. health agency declaring the escalating outbreaks in multiple countries to be a global emergency.
WHO Director-General Tedros Adhanom Ghebreyesus said 98% of the monkeypox cases detected since the outbreaks emerged in May have been among gay, bisexual and other men who have sex with men. He called for those at risk to take steps to protect themselves.
“That means making safe choices for yourself and others, for men who have sex with men,” Tedros said. “This includes, for the moment, reducing your number of sexual partners.”
Infectious individuals should isolate and avoid gatherings involving close, physical contact, while people should get contact details for any new sexual partners in case they need to follow up later, the WHO chief said.
The U.S. Centers for Disease Control and Prevention has not suggested that men who have sex with men reduce their sexual partners, only that they avoid skin-to-skin contact with people who have a rash that could be monkeypox.
WHO officials emphasized that monkeypox can infect anyone in close contact with a patient or their contaminated clothing or bedsheets. The U.N. health agency has warned that the disease could be more severe in vulnerable populations like children or pregnant women.
To date, more than 19,000 cases have been reported in more than 75 countries; deaths have only been reported in Africa.
“We know very clearly that one of the main modes of exposure for this particular illness is through direct contact, close contact, skin to skin contact, possibly even face to face contact, exposure to droplets or virus that may be in the mouth,” Dr. Rosamund Lewis, WHO’s technical lead for monkeypox, said.
Andy Seale, a WHO adviser on HIV, hepatitis and sexually transmitted infections, said experts have determined the current monkeypox outbreak is “clearly transmitted during sex,” but he said they have not yet concluded whether it’s a sexually transmitted infection.
Dr. Hugh Adler, who treats monkeypox patients in the U.K., said monkeypox was being transmitted during sex and that sexual networks and anonymous sex with untraceable partners were facilitating its spread.
“It’s just as likely that monkeypox was always capable of transmitting and presenting like this, but it hadn’t been formally reported or so widespread before,” he said.
Last week, British authorities issued new guidance advising doctors that people with just one or two lesions might be infectious with monkeypox, potentially complicating efforts to stop transmission.
The European Union’s health commissioner urged the bloc’s 27 member nations Wednesday to step up their efforts to tackle outbreaks in the EU, which she called “the epicenter of detected cases.”
In a letter to European health ministers obtained by The Associated Press, EU Health Commissioner Stella Kyriakides called for a “reinforced, concerted and coordinated action.”
“There is no time for complacency and we need to continue working together to control the outbreak,” she wrote.
On Saturday, July 23, World Health Organization Director General Tedros Adhanom Ghebreyesus declared the spread of monkeypox to be a public health emergency of international concern (PHEIC), the organization’s loudest alarm bell signifying an emerging outbreak.
Since early May, more than 15,000 cases of monkeypox have been identified across more than 60 countries. Disease caused by the monkeypox virus typically involves a few days of fever and lymph node swelling followed by a rash, which can leave scars. Most cases in the current outbreak have resolved without hospitalization or the need for medication. As of July 7, there have been three deaths, all of them in Africa.
When the WHO first convened a committee in late June to determine whether monkeypox was a PHEIC. As cases have continued to rise worldwide, the committee reconvened on July 21 — and this time, the outcome was different.
“We have an outbreak that has spread around the world rapidly through new modes of transmission, about which we understand too little and which meets the criteria in international health regulations,” Tedros said when announcing the emergency.
Tedros made the declaration despite the the WHO’s emergency committee for monkeypox, which did not come to an unanimous consensus on whether to declare an emergency. “There are uncertainties on all sides,” said Michael Ryan, executive director of the WHO’s health emergencies program, explaining Tedros’s reasoning in deciding to declare a PHEIC. “He sees a window of opportunity to to bring this disease under control,” said Ryan. The committee offers a recommendation, but ultimately it was Tedros’s decision.
The last time the WHO declared an international emergency was in early 2020, for Covid-19. While the disease caused by the currently spreading monkeypox virus is much less severe than Covid-19 and spreads far less easily, there are good reasons for the WHO to declare an emergency.
For starters, said Ana B. Amaya, an expert in global health governance at Pace University in New York, this monkeypox outbreak is just very different from past outbreaks of the disease. The vast majority of the latest cases have been identified among gay and bisexual men, and sexual contact with multiple sexual partners has emerged as an important risk factor. Scientists are now trying to determine if the virus spreads through sexual fluids like semen and vaginal fluid in addition to the ways it’s already known to spread: via skin-to-skin contact and, to a lesser degree, by respiratory transmission.
Prior to the current outbreak, monkeypox often spread throughout households via close contact and, possibly, shared items like utensils and linens. In the past few weeks, isolatedreports of infections in children, who are thought to be at higher risk for severe outcomes of monkeypox infection, reinforce the worry that without containment, outbreaks often spread beyond the populations where they start.
The prospect that the virus might be spreading in ways not seen before raises the concern that it will surprise us in other ways — for example, by causing severe disease if it reaches certain populations it has not yet reached, like large groups of immunocompromised people, said Amaya. “All of that is really alarming. And that’s why it’s very important for us to have a coordinated response that starts from the WHO level,” she said in a late-June interview, before the WHO’s first meeting to discuss issuing an emergency declaration.
But beyond that, this kind of declaration encourages countries to coordinate to stop the virus’s spread in a few different ways. Here’s how that works.
A public health emergency is not the same thing as a pandemic
To be resoundingly clear: The WHO did not declare monkeypox to be a new pandemic. There’s a difference between a pandemic and a PHEIC.
A pandemic is squishily defined as “an epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people,” according to A Dictionary of Epidemiology. Public health experts use the phrase “pandemic” to emphasize the global reach of an outbreak. They seem to agree that calling something a pandemic means it demands a coordinated international response — and potentially, that it’s too big to contain.
On the other hand, a PHEIC is a more carefully defined term. It describes a situation that has not necessarily grown out of control, but has the potential to do so.
According to the WHO’s International Health Regulations, an outbreak qualifies as a PHEIC if 1) it’s unusual or unexpected, 2) has potential for international spread, and 3) requires an immediate international response.
The WHO has only declared six PHEICs to date, including Ebola, Zika, and Covid-19.
The monkeypox outbreak easily meets the first two criteria for an emergency: the virus’s spread outside West and Central Africa and among sexual networks are both unusual patterns, and the virus has already spread internationally, with cases now present in about 60 countries. And given that spread, containing monkeypox will clearly require an international response.
Why did the WHO wait to declare an emergency?
Some experts think this outbreak easily met the PHEIC criteria when the WHO first addressed the question about a month ago. Why didn’t it declare an emergency then?
Nearly 50 percent of transgender people travel outside of their state of residence to get gender-affirming genital surgeries, according to a new study from Oregon Health and Science University (OHSU). The percentage could increase as more states put bans against gender-affirming healthcare for trans people in place, the study’s authors say.
The study, published Wednesday in JAMA Surgery, looked at 771 transgender patients who had a vaginoplasty or phalloplasty between 2007 and 2019. It found that 49 percent left their state of residence to get the procedure. People who lived in southern states were more likely to have to leave their home states in order to receive the surgery.
That’s because there’s a lack of surgeons who provide such care in the South. A 2020 studyfound that just 11 doctors in the South could provide such surgeries, and four of the doctors resided in Florida.
The number of such doctors could decrease as more Southern states ban gender-affirming care for trans youth. Genital surgeries aren’t typically performed on young trans people, but some doctors could choose to locate their practices outside of states with such bans in place because the bans increase doctors’ legal and financial liabilities if they treat young patients.
Of additional concern, the OHSU study found trans people who left their states to get surgery ended up paying up to 50 percent more in out-of-pocket medical expenses than those who were able to obtain surgeries in their home states. This included costs for post-surgical visits and foll0w-up care.
Only one of the 771 patients included in the study had their surgery paid for by their commercial health insurance provider, The Hill noted. This suggests that the life-saving surgical procedures may not be affordable for many trans people. Trans people living in transphobic states will face even greater financial and time costs just to receive gender-affirming care.
“We already knew that traveling for health care requires patients to take time off work and pay for travel and lodging on their own, and that it can make receiving follow-up care from qualified providers who are familiar with each patient’s unique needs challenging,” Jae Downing, the study’s lead author, said in a press release.
“This study helps quantify how severely we need more gender-affirming surgeons,” Geolani Dy, an assistant professor of urology and plastic and reconstructive surgery at OHSU School of Medicine, added.
On a sultry Tuesday evening in New York City, Luke Brown excitedly opened a newly delivered bottle of black-and-orange pills, popped his first dose in his mouth, and washed it down with root beer.
Having contracted monkeypox this month, the lanky, bespectacled 29-year-old project manager had been suffering from what he called “the most severe pain of my life” for over a week before he finally was able to obtain a course of antivirals — a treatment he hoped would soon clear up his lesions and alleviate his suffering.
For Brown, this was cause for celebration. But it was also a sobering moment for him to reflect on how, to gain access to this medication, he had to leverage high degrees of personal privilege, medical literacy and self-advocacy that he said he was guiltily aware most people at risk for monkeypox probably lack. Because to join the fortunate few who have obtained this prized medication, called TPOXX, he had to navigate what he characterized as the exasperatingly byzantine maze of the medical and public health system.
“Here we are in the epicenter of an outbreak primarily affecting gay men in the city,” Brown said of his hometown, New York, which as of Thursday had 778 confirmed monkeypox cases out of 2,593 nationwide. “The city that of anywhere in the world should have the most impressive and robust infrastructure to respond to the health care needs of gay men. And at every level it has fallen flat on its face.”
Luke Brown points to a monkeypox lesion on the knuckle of his thumb.Benjamin Ryan for NBC NewsAnother lesion is visible just above Brown’s right eyebrow.Benjamin Ryan for NBC News
Like many of his fellow gay and bisexual men — a demographic that comprises the vast majority monkeypox cases in the global outbreakthat has ballooned to 15,848 cases — Brown said he has grown increasingly appalled and infuriated by the nation’s response to a virus spreading so swiftly that many epidemiologists now believewill likely become endemic in the U.S. and around the world.
Supply of the antiviral is not the problem; there are 1.7 million courses in the nation’s Strategic National Stockpile, according to Dennis Hruby, chief scientific officer of the U.S. pharmaceutical company SIGA, TPOXX’s manufacturer. But the drug, also known as tecovirimat, is not approved by the Food and Drug Administration to treat monkeypox as it is by regulators in the United Kingdom and the European Union; the drug is approved only for smallpox in the U.S.
This is bad news for the Americans with monkeypox who like Brown suffer from excruciating physical pain or other severe outcomes from the infection and who are desperate for treatment to speed their healing. They, and the health care providers who care for them, are up against the U.S. regulatory system.
Even as the Centers for Disease Control and Prevention continues to reduce the red tape that impedes TPOXX access, announcing new changes Friday, public health experts pointed to a complementary means of leveraging the drug’s potential power to alleviate suffering: large clinical trials of the antiviral as a monkeypox treatment.
Plans for such trials are already in advanced stages in Canada, the U.K. and the European Union, according to Hruby. The National Institutes of Health is also planning one in the Democratic Republic of the Congo. But the federal agency’s efforts to launch such research in the U.S. are only in the earliest planning stages.
“This points to a persistent issue we saw during Covid,” said James Krellenstein, a public-health activist and cofounder of the activist group PrEP4All, “where the United Kingdom and European researchers were really able to mount much quicker clinical studies than the United States was.”
Excessive barriers to prescribing
In addition to Brown, NBC News spoke with a dozen people who have taken TPOXX, all of whom suffered from extreme pain before starting the antiviral. They generally reported that within a few days of treatment, their monkeypox symptoms — the pain in particular — began to ease, much to their relief. Most reported no bothersome side effects, or, in one case at least, not bad enough to discontinue treatment. While they all acknowledged that they could not be certain how the course of the disease might have unfolded had they not taken the drug, they generally believed it had been effective for them.
The FDA approved TPOXX as a treatment for smallpox in 2018 based on studies that had infected rabbits with rabbitpox and nonhuman primates with monkeypox. (Smallpox and monkeypox are close viral relatives, so treatments for one are expected to work for the other.) Researchers had to rely on these proxy models of similar viruses because there is no smallpox to investigate, as the virus has been eradicated; and even if there were, it would be unethical to study such a lethal pathogen in humans.
The data indicating the drug is safe for humans comes from a studyof 449 healthy people.
Typically, physicians may use their own judgment to prescribe medications off label for purposes other than those for which they were granted explicit FDA approval.
But given the lack of research on TPOXX’s efficacy in humans, federal health regulations dictate that health care providers may only prescribe the drug for monkeypox through a compassionate-use system overseen by the CDC. Physicians such as Dr. Marshall Glesby, an infectious disease specialist at Weill Cornell Medicine in New York City, said that these strict rules are excessive, including the need to review a more than 100-page treatment-protocol document to qualify as a TPOXX prescriber and to thoroughly document each case.
Dr. Marshall Glesby, an infectious disease specialist at Weill Cornell Medicine in New York City, said the strict rules around prescribing TPOXX are excessive.Benjamin Ryan for NBC News
Such burdens sharply limit the number of health care providers who are willing and able to prescribe TPOXX, according to clinicians who have gained such authority.
“It’s a cumbersome process,” said Dr. Anu Hazra, a physician at Howard Brown Health in Chicago who recently began prescribing the treatment.
“Because we don’t yet know how well this drug is going to work for monkeypox patients,” said Dr. Jennifer McQuiston, who leads the CDC’s monkeypox response, “it is important to ensure we have some data from patients who use it, so we can better understand the risks and benefits and ultimately help other people as well.”
Responding to health care providers’ recent complaints about the TPOXX compassionate-use system, the CDC has, for example, made optional previous requirements that clinicians submit photographs of patients’ monkeypox lesions and ship viral specimens to the agency.
In a July 15 letter to the heads of various federal health agencies, PrEP4All and the nonprofit Partners in Health called on the CDC and FDA to end all restrictions on TPOXX’s use and to allow health care providers to freely prescribe it for monkeypox.
Friday, the CDC announced further revisions to the compassionate-use system, including plans to reduce the 100-plus-page document to under 50; pare back the number of reports physicians must fill out about each patient from six to two; and to permit virtual appointments.
“We have reduced the data we need down to the most critical pieces,” McQuiston said “and have worked to make using this drug simpler, in order to ensure doctors can get the drug to patients who need it.”
Dr. Jason Zucker, an infectious disease specialist at Columbia University Department of Medicine whose team has prescribed the antiviral to 45 patients, said that the U.S. should launch a large randomized clinical trial including people with mild monkeypox disease. If anyone in the placebo arm should progress to severe disease, he proposed, they could be switched into a parallel compassionate-use group. This would not only address the crucial question of the drug’s efficacy but also expand access to treatment while also collecting data on people receiving it in a much more rigorous and organized fashion than he said occurs through the current system.
Jumping through hoops to get TPOXX
Luke Brown said that he first tried to gain access to TPOXX through his primary care provider, who submitted the request to New York City’s health department. The request was denied on the grounds that his case wasn’t serious enough. But then he began to suffer pain so severe all he could do was pace around his apartment for hours; even then, his physician delayed in resubmitting the request. So the well-connected Brown tapped into his contacts on social media and finally found someone who linked him to a local doctor with prescribing authority.
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“It’s infuriating,” he said of the hoops he had to jump through to obtain the drug.
Boomer Banks, an online content creator in New York City, said that he went through a maddening ordeal to obtain TPOXX.Benjamin Ryan for NBC News
“I had to fight for the TPOXX meds,” said an online content creator known as Boomer Banks, also a New Yorker, about what he said was a maddening ordeal finding someone at the city’s health department who could help him access the treatment. “I had no privilege to leverage, just my mouth,” said Banks, who did not want to use his real name used to protect his privacy. “I’m a brown immigrant, 42-year-old HIV-positive sex worker with no insurance. I didn’t take ‘no’ as an answer.”
A recent nonpeer reviewed study posted to a pre-print server found that in laboratory experiments, TPOXX was highly effective at neutralizing the monkeypox strain circulating in the global outbreak.
Under current CDC guidelines, TPOXX is reserved for those with severe disease, including those who are hospitalized or at high risk of a severe outcome because, for example, they are immunocompromised. Those suffering from a common symptom of the virus, intense anorectal or genital pain, qualify for TPOXX, Zucker said.
Brooklyn resident Sebastian Kohn, 39, who had a particularly severe case of monkeypox, said that days after he started TPOXX, the difference in his anorectal pain was “night and day.”
“I can wash myself without wanting to cry,” Kohn said.
Luke Brown holds his bottle of TPOXX pills.Benjamin Ryan for NBC News
Where is the U.S.-based clinical trial?
Asked about the NIH’s plans to back a U.S.-based clinical trial of TPOXX, Judith Hewitt, deputy director of the Office of Biodefense, Research Resources and Translational Research at the National Institute of Allergy and Infectious Diseases, said that “it’s super early days” for such plans.
“There are now just beginning to be discussions about a trial in people living with HIV or at risk of HIV,” she said.
In an email, Dr. Judith Currier, a professor of medicine at the UCLA Division of Infectious Diseases and the chair of a major HIV-related clinical trial network funded by the NIH, confirmed that a trial is being discussed. “I think the holdup is identifying the funding for this work.”
“Money is obviously the real issue here,” Hewitt said. “And so people are scrambling to do what we can do with the resources at hand.” She said the agency is debating whether, for example, to fund a study examining whether a lower dose of the Jynneos vaccine would be highly effective against monkeypox. “So that’s within the same treatment area. But then we’re still up to our eyeballs in Covid.”
Krellenstein, the activist, said, “It’s bizarre, given that we have such large supply in the strategic national stockpile and TPOXX was approved without any human efficacy data, that there weren’t ready-to-go plans for actually doing a U.S. clinical study in the event that we needed to use it.”
According to SIGA’s Hruby, the company might not even look to U.S.trial data on TPOXX to submit to the FDA. Instead, they might rely on the combined findings of the trials already primed to launch in other nations, along with safety data from compassionate-use programs worldwide.
As for how long before the company would submit the drug for FDA approval, Hruby wouldn’t speculate.
“These things always take longer than expected, especially when working with large teams,” Hruby said.
Even on a drug given priority review, the FDA typically takes six months to reach a decision.
TPOXX could help blunt monkeypox’s impact
If approved, TPOXX would offer a future in which the antiviral complements widespread vaccination among at-risk individuals to mitigate monkeypox’s impact on public health, experts said.
The virus could be treated at the very first sign of symptoms, and possibly even during the asymptomatic incubation period if testing technology advances to permit detection at that stage. Such early medical intervention would not only prevent pain and suffering, but would also very likely block transmission of the virus by shortening or eliminating the disease’s infectious period.
Treatment could also save people from the personal and financial hardship of isolating at home for what can be weeks of illness with monkeypox that’s left to resolve on its own.
What’s more, TPOXX could be used as post-exposure prophylaxis among people exposed to monkeypox, either among unvaccinated people or those who cannot be vaccinated, such as the immunocompromised, according to Columbia’s Zucker.
The U.S. Army Medical Research and Development Command does have an established study to assess such a preventive use of this drug. And while a listing of the trial indicates participants must be Department of Defense–affiliated personnel, according to Hruby, there actually is no such restriction.
Friday morning, Luke Brown said his pain had begun to subside and he was watching in wonder as his lesions were steadily sinking back into his skin — “like magic.”
Reflecting on the ordeal monkeypox has been for him, he said it had inspired him to become a public-health activist.
“I’m resolved to see that no one suffers like I did, because no one needs to,” he said.
Anticipating that the U.S. monkeypox outbreak will only continue to expand, he said, “We are just at a crest of avoidable pain unless access to this drug becomes easier.”
Greece’s parliament has banned “sex-normalizing” surgeries on babies born intersex, with atypical chromosomes that affect their bodies in a way that does not fit with the normative definitions of male or female.
Under a new law approved by parliament on Tuesday, surgeries that seek to ensure a child ascribes to traditional notions of male and female on people under the age of 15 years are banned in Greece, unless there is a court decision stating otherwise.
The bill stipulates fines and a prison term for doctors conducting such surgery.
Operations, including corrective surgeries or hormonal therapies to change face or body characteristics, on intersex people over the age of 15 years will be permitted if the teenagers consent, according to the law.
Rinio Simeonidou, mother of an intersex teenager and secretary general of Intersex Greece, told parliament before the vote that the approval of the bill would be “a truly historic moment for all intersex children in Greece” and a good start in eliminating violations of intersex people’s rights.
Malta, Portugal and Germany have already banned such surgeries, which in the past have led intersex people to sterilization, loss of sexual sensation, psychosomatic trauma and health problems, Simeonidou said.
Earlier this year, Greece banned so-called conversion therapy for minors, practices aimed at suppressing a person’s sexual orientation or gender identity and which health experts have condemned as psychologically harmful and unethical.
“I was truly saddened by the mistakes of the past that led to dramatic situations because we were lacking the knowledge and courage,” Prime Minister Kyriakos Mitsotakis, who faces elections next year, told parliament before the vote as he urged lawmakers to endorse the legislation.
Days after the U.S. Supreme Court ruled that states can prohibit abortion, Alabama has seized on the decision to argue that the state should also be able to ban gender-affirming medical treatments for transgender youth.
The case marks one of the first known instances in which a conservative state has tried to apply the abortion ruling to other realms, just as LGBTQ advocates and others were afraid would happen.
Critics have expressed fear that the legal reasoning behind the high court ruling could lead to a rollback of decisions involving such matters as gay marriage and birth control.
The state is asking a federal appeals court to lift an injunction and let it enforce an Alabama law that would make it a felony to give puberty blockers or hormones to transgender minors to help affirm their gender identity.
In its historic ruling last Friday, the U.S. Supreme Court said terminating a pregnancy is not a fundamental constitutional right because abortion is not mentioned in the Constitution and is not “deeply rooted in this nation’s history and tradition.”
In a brief filed Monday, the Alabama attorney general’s office argued similarly that gender transition treatments are not “deeply rooted in our history or traditions,” and thus the state has the authority to ban them. Alabama contends such treatments are dangerous and experimental, a view disputed by medical organizations.
Shannon Minter, legal director of the National Center for Lesbian Rights, said it is the first case he is aware of in which a state cited the abortion ruling on another issue, but added, “It won’t be the last.”
Supreme Court Justice Samuel Alito wrote in the majority opinion that the abortion ruling should not cast “doubt on precedents that do not concern abortion.” But Justice Clarence Thomas wrote that the same legal reasoning should be used to reconsider high court rulings protecting same-sex marriage, gay sex and contraceptives.
“It is no surprise that Alabama and other extremely conservative states are going to take up that invitation as forcefully as they can,” Minter said. “Justice Thomas’ concurrence was a declaration of war on groups already under attack, and we expect the hostility to be escalated.”
He said a rethinking of such constitutional protections could affect things like birth control and parental rights.
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“They are not just talking about LGBT people,” Minter said.
Alabama Attorney General Steve Marshall was unavailable for comment Thursday, a spokesman said.
Jeff Walker, who has a 15-year-old transgender daughter, said this spring that it felt as if Alabama were attacking families like his with legislation targeting transgender kids’ medication and dictating their choice of school bathrooms, locker rooms and sports teams. He said the state’s argument in this case is worrisome for everyone.
“I think everyone should be concerned by the wording of this appeal. By this logic, any health care the state feels isn’t in line with its morals or beliefs should be banned,” Walker said.
The Alabama case could become be an early test of where judges stand on the scope of the abortion ruling. The appeals court granted the state’s request for an expedited schedule for submitting briefs, and a decision could come as early as this fall.
While Alabama was already appealing the injunction in the transgender medication case, the state quickly incorporated the abortion decision into its filing.
Alabama Gov. Kay Ivey this spring signed the law making it a crime punishable by up to 10 years in prison to dispense certain medication to minors to help with their gender transition.
A federal judge in May issued a preliminary injunction blocking the measure, siding with parents who said the law violates their children’s rights and their own rights to direct their youngsters’ medical care.
Members of the LGBTQ+ community in the United States have spoken out about their own abortion experiences after Roe v Wade was struck down.
The Supreme Court overturned the landmark 1973 Roe v Wade ruling which legalised abortion across the country, on 24 June, meaning that it will now be up to individual states to decide their own abortion laws.
In a 213-page majority opinion, the Supreme Court justices wrote: “The Constitution does not confer a right to abortion; Roe and Casey are overruled; and the authority to regulate abortion is returned to the people and their elected representatives.”
he ruling mobilised protests across the US, and several LGBTQ+ people have raised the point that trans men, queer women, and non-binary people sometimes also need abortions, and they do not want to be left out of the conversation.
Nikki, a 38-year-old queer woman from Colorado, said she told her religious family members about her experience with abortion after the Roe v Wade ruling was announced. She is “terrified” that her “rights as a queer woman will be eroded next”.
She told PinkNews: “I’m livid about the ruling. I’m mad that it happened. I’m furious at the Democrats for not getting it together quickly enough to use their majority to protect Roe federally.
“I’m exhausted of having my rights and freedoms dictated by a bunch of old white men (and the occasional woman).”
Nikki added that she is now concerned that LGBTQ+ rights could be at risk, after Judge Clarence Thomas, in his legal opinion coinciding with the overturning of Roe v Wade, called on his colleagues on the Supreme Court to “reconsider” rulings that currently protect the right to contraception, same-sex relationships, and same-sex marriage.
She said: “Trans men and non-binary people have been left out of the conversation almost entirely, even by supposedly ‘progressive’ voices.
“I’m currently dating a trans woman. I worry for her safety, and I worry that I won’t be able to marry who I love unless it falls within a ‘hetero-looking’ relationship.”
(Mario Tama/Getty Images)
Theo, 20, from Minnesota, said that they are considering moving to a “safer state” after the Roe v Wade news.
Theo is trans-masculine and non-binary, and as well as going through an abortion at aged 14, they worry about further law changes affecting same-sex marriage, or their ability to access gender-affirming surgeries.
“Just because we no longer align with the gender that we have were assigned does not make us irrelevant in a conversation that regards our own bodily matters,” they told PinkNews.
Theo added: “My concern immediately came after Ruth Bader Ginsburg passed; she was a strong and ever-present voice in women’s rights… I always knew that Roe v Wade was on the docket despite what people told me.
“Since I have begun transitioning and started to pass more as man, I have lost my voice in this movement. I have had an abortion… butpeople have told me that my voice doesn’t matter… that I am safe because no one is coming for LGBTQ+ people next. Roe v Wade is just the beginning.
“I am also extremely fearful for the overturn of same-sex marriage as well… I fear that I will never be able to be with someone that I love because of this.”
Amit Paley, CEO and executive director of LGBTQ+ charity The Trevor Project said in a statement: “The Supreme Court’s decision… is causing many people to experience a wide range of concerns for bodily autonomy, LGBTQ rights, and public health, including mental health.
“The Trevor Project’s polling has found that nearly 70% of LGBTQ+ young people say efforts to restrict access to abortion often gave them stress or anxiety.
“Overturning Roe v Wade will allow states to further restrict and regulate essential health care and reduce access to the already limited number of LGBTQ+ competent providers in many parts of the country, posing a threat to the health and safety of young LGBTQ people.
“The Trevor Project will not stop fighting to establish true, lived equality for LGBTQ+ people.”
As cases of monkeypox virus surge in the U.S., the Biden administration will start distributing the monkeypox vaccine across the country, focusing on people most at risk and communities with the highest numbers of cases, White House officials announced Tuesday.
The U.S. Department of Health and Human Services will send 56,000 doses of the Jynneos vaccine immediately to areas with high transmission. An additional 240,000 doses will be distributed over the next few weeks, with even more to come this summer and fall. Officials expect to make at least 1.6 million doses available by the end of the fall.
States with the highest numbers of cases include California, New York, Illinois and Florida, as well as Washington, D.C., according to the latest count from the Centers for Disease Control and Prevention.
People lined up outside of Department of Health & Mental Hygiene clinic on June 23, 2022 in New York, as NYC makes vaccines available to residents possibly exposed to monkeypox.Tayfun Coskun / Anadolu Agency via Getty Images
“We are recommending that vaccines be provided to both people with known monkeypox exposures who are contacted by public health and also to those people who’ve been recently exposed to monkeypox,” the CDC’s director, Dr. Rochelle Walensky, said at a news briefing Tuesday.
The CDC is prioritizing initial access to the vaccine for people who have been in close contact, including sexual contact, with someone who has diagnosed with the virus. The agency will also provide vaccines to men who have sex with men who report having had multiple recent sex partners at a venue or party where the virus is known to have spread, or who have had sex with multiple partners in an area of the country with elevated spread.
The vast majority of confirmed monkeypox cases, both in the U.S. and in the global outbreak as a whole, have been among men who have sex with men.
While case numbers continue to rise in the U.S., the White House Covid-19 coordinator, Dr. Ashish Jha, seemed hopeful the U.S. could contain the outbreak and said it was important to remain vigilant.
“Monkeypox is not novel,” Jha said at the briefing. “We as a global community have known about it for decades. We know how it spreads. We have tests that help identify people who are infected. We have vaccines that are highly effective against it.”
The U.S. monkeypox outbreak was first detected in Massachusetts in May, after a person who had been traveling tested positive. Since then, the virus has been spreading around the country, with more than 306 cases in 28 states, according to the CDC. But because of limitations with testing for the virus, it’s likely the U.S. is significantly undercounting the numbers of infections, experts say.
“We’ve already lost control of this outbreak,” said David Harvey, the executive director of the National Coalition of STD Directors. “We think there’s many more cases, and we need to act now to get control of this outbreak.”
New York City and Washington, D.C., were among the first cities to begin vaccinating at-risk groups for monkeypox, including men who have sex with men reporting multiple partners or at least one anonymous partner within 14 days. With just 1,000 doses from the CDC to distribute at one clinic, New York, which began administering shots on June 23, quickly ran out.
It was a similar situation in Washington, where health officials announced Monday that they would also start vaccinating at-risk groups. The 300 available appointments were taken in less than an hour after the online booking system went live.
Health officials on Wednesday recommended that men in Florida who have sex with other men get a meningococcal vaccine following what the Centers for Disease Control and Prevention called “one of the worst outbreaks of meningococcal disease among gay and bisexual men in U.S. history.”
The CDC said in a statement that there have been at least 24 cases and seven deaths among gay and bisexual men caused by the bacteria in Florida recently. The CDC also recommended that gay and bisexual men traveling to Florida should ask their health care provider about getting the vaccine.
