“This outbreak is unprecedented.”
Dr. Demetre Daskalakis, from the CDC, discusses the latest in Monkeypox with Karl Schmid. Watch +Talk now.
Transcript below.
DR. DEMETRE
This outbreak is unprecedented.
KARL
Hello there, and welcome to Plus Talk on Plus Life, where we’re all about turning positive into a plus. Today we’re talking monkeypox and HIV, and who better to talk to us about all of that and give us the latest information than Dr. Demetre Daskalakis, who is the White House National Monkeypox Response Deputy Coordinator. Good to see you, doc.
DR. DEMETRE
Good to see you too. Thanks for having me.
KARL
This is constantly a moving thing, so I appreciate your time. We want to get down to what the latest is, what we know, what we don’t know, and I really wanna focus on HIV and monkeypox today. We know that monkeypox has been detected in all 50 states now. Are people living with HIV more likely to get monkeypox?
DR. DEMETRE
As far as we know the answer is that it does not appear as if you’re more susceptible to getting the infection. There are some data out there that say that individuals who have more immunocompromised could potentially have more severe manifestations of disease, so I think that when you’re looking sort of an aggregate, people living with HIV are definitely doing fine from the perspective of compared to others, but definitely we have data and we know from other studies that individuals with lower T-cell counts whose viral loads are not undetectable could potentially have a more severe form of monkeypox, which can include more lesions, lesions that are more confluent, that go together, and then potentially have some of the other sort of like more concerning side effects of monkeypox. I’ll say, watch this space very carefully, because there are data coming soon that will exactly speak to this.
KARL
Yeah. So just picking up on something you said there. So people who are living with HIV and who are, quote unquote, healthy and undetectable, someone like myself, for example, if I was to contract monkeypox, is it gonna be a more severe case do we think, or am I likely to get the same reaction that somebody else versus someone who has perhaps not reached undetectable status?
DR. DEMETRE
Great. So it’s a spectrum, and that’s really important to say, so I think that many people who have HIV will approximate folks who don’t have HIV, but there could be a tendency to some of the more severe manifestations. So I think that depending on not only viral suppression but sort what level of T-cells folks have, like how strong their immune system in the background is, will also figure to that. So I think that, you know, just many other infections, I think that having a much weaker immune system and being undetectable will be more likely associated with more severe symptoms or outcomes, but if you’re on the side of undetectable with T-cells that are stronger, you’re gonna be approximating more closely someone who’s not living with HIV.
KARL
Okay. So talking about the vaccine specifically, you know, I’ve read some stuff and heard some stuff and it’s always dangerous to do this online, I know, that people living with HIV may not respond as well to the monkeypox vaccines. Where are we at with finding the efficacy of the vaccine for those of us living with HIV? And, you know, I keep seeing that those of us living with HIV should receive the most effective regime as possible, but we know here in the states now, you know, I got my first shot in the back of my arm, I got my second shot the other day there. Is that considered the most effective regime for someone living with HIV? Shouldn’t we both, shouldn’t we be getting the same dose?
DR. DEMETRE
So when looking at the laboratory studies that assess people’s immune responses to monkeypox vaccine, to the JYNNEOS vaccine, the subcutaneous version, there’s really not significant difference between people living with HIV and those who aren’t, except if they have lower T-cells and, or like uncontrolled HIV. So again, like in the world, if your HIV is less well controlled and your T-cells are lower, you don’t respond very well to any vaccine, or not well enough. Now with that said, it doesn’t matter what your T-cell counts are and what your viral load is, get vaccinated, because any protection is really good. Now, the question about the intradermal, which is the vaccine between the layers of skin versus the deeper.
KARL
Right. That’s here on my forearm, right?
DR. DEMETRE
Yep. The little forearm version versus the one that’s like deeper in the back of your arm, so when you actually look at the data between the deeper dose, the back of the arm, versus the more shallow dose, the immune responses look about equivalent, and so, based on what we know about the response of JYNNEOS and people who are living with HIV, we really believe that the intradermal dose, so like the forearm dose, is equivalent to the deeper dose that people get in their arm. Now, vaccine effectiveness, so this is not something that we flip the switch to get information on, and I’ll say something else that’s really important that with this vaccine, we have a lot of really good data based on laboratory data that there is a good immune response. This outbreak is unprecedented, and in the U.S., we’ve never had monkeypox circulating like this, nor have we had so many folks who have been vaccinated with this vaccine, so we’re actually gonna be, look, as we go forward, we’ll be learning more about what the real world effectiveness of the vaccine is. With that said, based on what we know from the laboratory data, we all believe that the vaccine, that the data supports that the vaccine will have effectiveness, will have more solid information around this, and there’s an NIH study that’s gonna start that will also include people living with HIV, that will give us even more details specifically about the dosing in the forearm, which I think will be really informative.
KARL
Yeah. What about possible interactions with HIV meds that many of us are on obviously to stay undetectable and healthy? Do we know any information? Is there anything out there that shows that there might be some negative interaction with the current market of HIV meds?
DR. DEMETRE
So monkeypox vaccine is not expected to have any interaction, med interaction, with HIV medications. There’s no pathway where the two intersect. So the good news is there, that one, you should not worry about drug interactions when getting the monkeypox vaccine.
KARL
So again, Dr. Demetre, you are saying get the vaccine if you are eligible
DR. DEMETRE
If there’s one message that you take away from this, that if you qualify for the vaccine, please get it. The route in the forearm is expected to be equivalent to the deeper route. And again, don’t worry about your T-cell count. Don’t worry about your viral load, get the vaccine, if you. Definitely worry about it, to make sure that you stay connected to HIV care, but bottom line is like, just if you qualify for the vaccine, you should get the vaccine.
KARL
Yeah. And speaking of qualification, getting it out, I know that the stockpiles are ramping up and the vaccine certainly is getting out more and more. I mean, I nearly fell off my chair the other day when I got a text saying “You can go get your second dose now.” Now I was like, “Hooray!” Tell me about the new equity program that the White House announced just recently, because we know in this country, the United States, people in black and brown communities are always, or more often than not, left behind. So what’s going on to make sure that those of us who need this vaccine now are getting it?
DR. DEMETRE
Karl, thanks for the question. So I’ll talk about the equity pilots, but reminds you that there’s a lot of work happening in the equity space, happening at the local jurisdiction level. Now that we’ve addressed many of the supply issues, it is really the goal of the vaccine strategy is not to put vaccine places for people to find it, but really move it into places where people already seek care. So I’ll give you one example that doesn’t sound like a sexy pilot, but that’s really important is that we’re putting vaccine in Ryan White clinics, and so that’s a really important step, especially for people living with HIV, over 50% of people living with HIV go to those, go to those venues, and so it’s a really great place for folks to get vaccinated. I also wanna highlight the question that you’re asking which is about the equity intervention. So we have two, I kind of call them the macro intervention and the micro intervention, the big event and the small event kind of intervention. So the big event is for events that have more than 50,000 people, states and cities can sort of talk to CDC, and if they have an event that qualifies, they can get extra vaccine just so they can vaccinate folks who are going to the event, and the three examples that are important to talk about right now are Charlotte Pride, which already happened, and then the next coming soon is going to be a black gay pride in Atlanta, and then also Southern Decadence in New Orleans. We also just announced that Oakland Pride is also gonna be a part of the mix. The goal of this one is, big events that attract LGBTQAI+ people, especially people of color, are ones that are being prioritized specifically to address the issue of making sure that we’re getting vaccines to people’s arms to match more of what we’re seeing in the outbreak. Second piece is the micro version, and we’re calling the micro version of this an equity innovation pilot, and it’s really not just looking for events but like strategies that get you deeper into the community that may not be these giant events. So whether it’s working with a house in Kiki ball community, deciding to try vaccines in clinics that are based in pharmacies, things that we know work for equity interventions but that may not be like these big splashy giant events. So it’s sort of adding another dynamic. It is 10,000 vials of vaccine allocated for the large events and 10,000 vials allocated for the smaller equity innovation efforts.
KARL
Dr. Demetre, what is your advice to somebody who might be closeted, doesn’t want to talk about, perhaps that they’re a male who has sex with men, who is hesitant to go to some of these clinics purely based on stigma and worried that, “Oh my gosh, if someone sees me there.” So what does that person do? Where does that person go to make sure that they’re getting protected, they’re getting a vaccine, but they’re not out, they don’t want to be seen at one of these clinics?
DR. DEMETRE
Yeah, so the vaccine events tend to be the ones that have the sign that say you have to have multiple partners and all of that, so the effort of trying to get vaccines where people seek service and care is exactly to address that. The other thing that you’ll see is a lot of places, because of the differences that are be experienced in demand, have dropped the need for appointments. So look out at your jurisdiction. There’s also a couple of great websites where you could actually look to see where vaccine is available, but what is gonna happen is the dynamic’s gonna change, and for, you know, if you’re at any of these events, this is a great place to get the vaccine, because the whole point of it is to sort of remove some of the barriers, the online stuff, and the stigma that happens because you’re already sort of there to celebrate some things, so may as well celebrate vaccine access as well.
KARL
The virus is the enemy, not the person or the behavior. I think that’s a really important point to make, certainly when it comes to stigma, especially since we’ve experienced this before with HIV.
DR. DEMETRE
I cannot agree more than with more what you just said. It’s exactly right. It’s a virus. It’s a little piece of DNA in fat. People are people and we to respect people and we need to fight the virus, so I agree.
KARL
Dr. Demetre, thank you so much for your time. That is gonna do it for this episode of Plus Talk. Remember, if you want more information, check out our website pluslifemedia.com, and be sure to follow us across social media platforms. We are @pluslifemedia. Until next time, take care of one another. Be nice to each other. We’ll see you soon.