In June, striking black and pink posters flew up around pubs and nightclubs in Ireland, followed by an intense volunteer outreach programme. For many people this was how they first heard about the monkeypox threat.
That campaign — led by advocacy and community groups partnering with the HSE — has been recognised as best practice by the World Health Organisation and the European Centre for Disease Protection and Control.
However, more than three months since this outbreak began in Europe, these same advocates say the State is not applying the same urgency to getting vaccines into arms.
Up to Wednesday, August 10, there were 101 cases in Ireland with one in 10 hospitalised. There have been no deaths reported here.
However, the illness can bring “excruciating pain”, as a seminar hosted on Youtube by magazine heard.
An Irishman living in Berlin, identified only as Stevie and wearing an ActUp Dublin shirt, said he tested positive for the virus in mid-June, four days after symptoms first appeared.
“That was a rough weekend, I thought I was kind of OK but on the Saturday night I just had excruciating pain, going to the toilet was excruciating,” he said.
“I couldn’t really sleep that night, a mixture of discomfort and emotions.”
He was put on stronger painkillers for about a month. Skin lesions appeared late in July, but were not painful, he said.
“It’s a different ballgame to Covid, in Covid people were uploading pictures of their negative tests, or positives tests, I felt like this thing is really in the shadows,” he said, explaining why he chose to speak out.
“That wasn’t really a nice place to be in.”
The seminar reflected widely-held concerns about vaccine access here.
Programme manager with MPower at HIV Ireland Adam Shanley said: “As it stands we need urgent access to vaccines in Ireland.”
It is understood a vaccine plan could be ready next week, but for now vaccines can be given to close contacts of confirmed cases within four days of exposure. This can prevent people getting ill or decrease the severity of their illness.
A HSE spokesman said it does not have figures yet for how many doses have been used, and said advice is widely shared on its websites.
Mr Shanley said they were aware the HSE was working on a plan.
“But we are aware that access to the vaccine, in the HSE’s words, is ‘low and limited’,” he said. “And so really we need to be sure the Government is doing everything in its power to procure enough vaccines.”
Both the Imvanex and Jynneos smallpox vaccines approved for use in Europe and America against monkeypox are made by one company, Bavarian Nordic.
“We are in a situation where there’s one company making the global supplies of this vaccine, that calls into question how we allowed one company to be in control of a vaccine during a public health emergency of international concern,” he said.
“So there is a global race to access what’s there. Ireland needs to be at the table when seeking procurement.”
Director of communications with the Gay Health Network, which partners with MPOWER on advocacy, Padraig Burke shares these worries.
“It is challenging watching our neighbours and partners rolling out their programmes while we languish,” he said.
It is increasingly frustrating for the gbMSM (gay, bisexual, men who has sex with men) community here that other European countries have started wider rollouts.
Dr Ralph Hurley O’Dwyer, a registrar in infectious diseases, saw this in action while on holidays in France this week when he was able to get a vaccine quite easily.
“The pharmacy that I got it in was one of the first pharmacies to give it in France, that was done by the French government to make it more accessible and people may be more likely to get it in a pharmacy,” he said.
“I’m very grateful to France that I was able to get it. It was completely free.” This works through the Doctolib app which is usually used to book GP appointments.
“So to get the monkeypox vaccine here you type into that app and a list of all the centres in France will come up, with all available appointments,” he said.
“All I had to do was just click on the place that was most convenient for me, on a day that is convenient for me and press a button ….”
EU citizens are entitled to access healthcare in other EU countries, and the only document he showed was his Irish passport.
“Hopefully things will change soon in Ireland, and the vaccine will be rolled out. There is a huge amount of anxiety, and I know that among my own friends and patients that I’ve had as well,” he said.
He sees structural issues contributing to the slow rollout.
“I know lots of the people involved [in Ireland] in coordinating a response to this, people at the top are working very hard and have been working absolutely relentlessly for over two years,” he said.
“My own view is that we don’t have a sufficiently funded and well-structured national healthcare service and public healthcare service to be able to respond to outbreaks appropriately and at the necessary speed. We need a good national system to implement policy quickly.”
Social Democrats health spokesperson Róisín Shortall has also highlighted differences between the French and Irish approach.
“We have a vaccine that is effective against monkeypox — but communities most at risk have no idea about how they can be inoculated. This confusion is causing a huge amount of concern and frustration,” she said.
“In contrast, France has already administered 42,000 doses of the vaccine, while a dedicated vaccination centre was opened in Paris this week. Britain announced its vaccination programme as far back as June.”
Another issue of growing concern is the impact of long isolation times.
The HSE advises confirmed cases to isolate at home until their rash is healed as they are infectious until then, saying this can take up to four weeks.
High-risk asymptomatic close contacts do not need to restrict activities but they are advised to “restrict travel outside area of residence”.
Mr Burke said various supports outside the vaccine should be explored now.
“This should include psychosocial support and possibly monetary support if people’s livelihoods are affected due to isolation,” he said.
Mr Shanley agreed, saying help was not just about recovering from monkeypox.
“There are huge impacts in terms of having to isolate for 21 days or more, the impact that has on work, on family, on home structures,” he said.
A spokeswoman for the Department of Social Welfare said monkeypox was treated in the same way as other illnesses, meaning people cannot access the enhanced illness benefit, which is only available for Covid-19.
“Illness benefit is the social welfare payment available to those who are medically certified as unfit for work, including in cases of monkeypox,” she said.
This is a weekly payment with a maximum rate of €208.
These concerns are being shared against a background of Ireland having been first off the blocks with an information campaign about the risks of the virus.
This involved digital and face-to-face communications across Ireland focused on high-risk groups.
Mr Shanley presented on this to the ECDC and a meeting of the European Commission Health Directorate General, with the ECDC loving it so much they included the campaign in July guidance issued to all member states tackling the virus.
Posters went up in bathrooms of clubs and pubs frequented by the gbMSM community and direct messages were sent to the popular dating app Grindr.
Informational notices were also placed on Grindr, along with the website.
Members of the campaign include MPOWER, man2man.ie/Gay Health Network, the HSE Sexual Health and Crisis Pregnancy Programme and the HSE. Information is also available in Portuguese and Spanish.
It is too soon for data on the impact of this campaign on case numbers, but he is hopeful there is a link between its success and Irish numbers being so much lower than across the UK.
“I would really hope that has been the case, because we ramped up this campaign before the first cases were identified in Ireland,” he said.
“I do think we mobilised very quickly. And in parallel to the communications campaign, we did training around monkeypox with our volunteers, we hit all of our bars and clubs across the city. We were doing that every single day throughout the month of June.”
The Dublin Pride celebrations, which could have been the focus of a mass outbreak instead saw mass communications on the risks, he said.
Mr Shanley points out so far 98% of cases globally, outside the West and Central African countries the virus has been endemic in, are among gay and bisexual male communities.
“It has just found its way into a network of closely connected individuals.”
These communities have a high awareness of health risks and a “strong legacy” of health campaigning are helping boost understanding, he said.
WHO technical lead for monkeypox Dr Rosamund Lews has repeatedly stressed how contagious the virus is, with its data now showing household contacts among children under four.
She reported the virus can be spread in several different ways, including skin contact, talking at very close quarters, kissing, contact with infected bed-clothes or in a household setting.
“The way it is spreading in this global outbreak has never been seen before so we are seeing new manifestations of illness,” she said, referring to cases of encephalitis, inflammation of the brain, linked to monkeypox in Europe.
Declared a public health emergency of international concern on July 23 by the WHO, there were 17,897 cases across 41 European countries up to Wednesday.
Among these, 455 people were hospitalised (5.8%), with three cases reported to the ECDC as needing ICU care. Two of these people have since died.
Dr Lews also said that outside of this recent outbreak, several thousand cases are suspected in the Democratic Republic of Congo, but with limited testing facilities and health services, that remains uncertain.
She said some 16.4m vaccines were available in bulk by July 26 but needed to be finished, with manufacturing only in Denmark, Japan and America.
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