Disappointment is growing over the time lag in New Brunswick’s inadequate human monkeypox response. Despite the growing incidence of infections across Canada, the government of New Brunswick, acting under Public Health’s guidance, still restricts access to vaccination to close contacts of confirmed cases, ignoring at-risk populations.
I offer my perspective on this disappointing provincial response to a virus that disproportionately affects two-spirit, gay, bisexual, transgender and queer (2SGBTQ+) communities.
New Brunswick recently identified its first monkeypox case, and public health officials expect more infections in the coming months. This confirmed case follows another previously suspected case that was announced but later revised earlier this summer, catalyzing public attention to the monkeypox virus. The province has received an initial stockpile of 140 doses of the Imvamune vaccine and is awaiting more from the federal government.
Unlike most other provinces, New Brunswick currently restricts access to the monkeypox vaccine for anyone who is not a close contact of a previously confirmed case. In contrast, our neighbouring Atlantic province, Prince Edward Island, offers Imvamune vaccines by request. Since June, Ontario and Quebec have been offering these vaccines at a low threshold to anyone at risk-often with no health coverage card required. Manitoba and Saskatchewan now provide them, too. Likewise, Alberta recently shifted to allow preventive vaccination as some are heading out of the province for shots. These other provincial shifts in prevention strategy make me question why New Brunswick and Nova Scotia are slower to offer vaccines and decided to provide them only to close contacts of confirmed cases.
Federal health officials such as Dr. Theresa Tam are “pleading” for gay and bisexual men to consider getting vaccinated. At the same time, unfortunately, New Brunswick has made it impossible to comply with the request.
With no option to access the vaccine here at home, I recently travelled to another province to get my shot. I am not alone. More compelling reports have emerged in recent weeks of Maritimers travelling out of the province to access the vaccine. Others are contemplating doing so. New Brunswickers should not resort to medical tourism to access a needed service. This is unacceptable.
In the graduate-level university course I teach, “Social Work in Health Care,” we explore how Canadians are supposed to enjoy the “universality” and “portability” of health care services from province to province. As a population, we know this is a challenge in the best of circumstances, let alone amid a global coronavirus pandemic and chronic staff shortages in health care. Since clinics across Canada now offer eligible men who have sex with men Imvamune vaccine, denying at-risk New Brunswickers equal access alongside our national counterparts violates our human rights. Indeed, Public Health must account for this discrepancy.
For some background, monkeypox is an orthopoxvirus (like smallpox) that is not as contagious as smallpox or COVID-19. According to the government of New Brunswick, common symptoms can include fever, intense headache, muscle aches, back pain, low energy, swollen lymph nodes, and the tell-tale skin rash or “lesions.”
In terms of transmission, monkeypox is a viral disease that can spread from person to person through close physical contact, including sexual activity. It can only be diagnosed from a laboratory test of a tissue sample collected from an open sore. Sadly, not many doctors know much about the virus. Available vaccines and treatments initially for smallpox are effective if administered before or shortly after exposure.
One thousand fifty-nine new monkeypox infections have been diagnosed in Canada as of August 12. We must remember that each “case” represents a human being who lives within family and social systems and whose lives are disrupted by this challenging and heavily stigmatized disease. Since people diagnosed with monkeypox are advised to isolate themselves until they are no longer contagious, an infection could directly impact livelihood and social participation. Activists have pointed out that federal benefits like the COVID Recovery Benefit, Canada Worker Lockdown Benefit, Canada Recovery Sickness Benefit, rent relief, and eviction protections do not exist for this new health crisis. This leaves members of at-risk groups with the sense they are on their own for this new pandemic.
I am concerned with the continued lack of communication and transparency regarding New Brunswick’s public health approach to monkeypox vaccination among at-risk communities. While the province has committed to providing clinicians with guidance concerning the issue, it has offered little direction to the general public.
Before making my inter-provincial journey for the vaccine, I contacted my local public health office inquiring about it. Their response seemed disorganized and lacked empathy or substance, and I have not yet received adequate information. I was advised only to reduce my risk for monkeypox, which refers to reducing one’s number of sexual partners. This is not a very realistic or sex-positive stance. Are they telling straight people to minimize their exposure by reducing sexual partners in the same manner? What about sex workers in New Brunswick who may be unable to do so? Contacting the public health authority to arrange for a vaccination is a personal and community prevention practice that New Brunswick should be encouraging, not dismissing. How can a public policy be remiss on the coattails of a two-year global pandemic?
Public health’s web inquiry team also communicated that if I was concerned for my own risk, I should seek out testing, but the related web link did not elaborate on how to get tested outside of contacting a health care provider for advice, testing, and medical care. The cryptic message also cautioned to “avoid close contact with others until you have been assessed and additional information is provided.” This messaging takes an individualist view of health care. It is insensitive to many New Brunswickers without primary care providers and working in precarious positions that disallow absences due to prolonged isolation. This is not just a New Brunswick issue, since poor communication strategies have also been documented recently in Newfoundland.
There are stark differences in how COVID-19 vaccinations were rolled out and how monkeypox is being handled in New Brunswick. The different sense of urgency might show an unintentional bias against 2SGBTQ+ folks. When partnered with poor access to testing for HIV and sexually transmitted infections, New Brunswick’s lag behind other provinces in the roll-out of preventative technologies like pre-exposure prophylaxis for HIV (which have been available for nearly a decade in Canada), added to a lack of knowledge about or access to anal pap smears or publicly funded human papillomavirus vaccinations, a pattern of systematic neglect emerges that paints the province’s response to queer healthcare as heterosexist and homophonic.
The reality is that everyone is at risk of monkeypox despite the social stigma on queer communities. In rural provinces like New Brunswick in particular, where extreme religious and community-based homophobia exists and where many men who have sex with men may also partner with women and participate in the male-sex part of their lives in secret, it is just a matter of time before monkeypox crosses the gender barrier, just as HIV did. Focusing only on “close contacts” of confirmed cases marginalizes people who cannot verify their contacts for whatever reason. It shows poor insight into the human condition and no regard for anonymous sex.
Speaking of stigma, homophobic and racist undertones in public reporting can undermine prevention efforts. A federal official recently acknowledged that mistakes made decades ago must not be repeated when the gay and bisexual communities were “afraid and ashamed to come out” because of misconceptions about HIV and AIDS. In this sense, the government of New Brunswick’s approach is re-traumatizing because it evokes the slow response surrounding HIV decades ago.
As part of the global community, New Brunswickers must advocate for expanded access to vaccines internationally, which we often overlook and ignore. We must also acknowledge that some New Brunswick residents travel out of the province daily. It is odd that the government of New Brunswick takes our mobility for granted.
We are supposed to be enjoying Pride season festivities this month in many parts of New Brunsick. Instead, many of us feel like sitting ducks, faced with yet another viral threat impacting our communities. Our profound disappointment is growing each day that passes. I hope officials can better deliver on their responsibilities to queer people in the province.
There is a province-to-province discrepancy where people suffer. Someone could no doubt access the Imvamune vaccine by travelling to another province over the summer. However, those who experience financial precarity lack this advantage, and their health needs to be prioritized by the Higgs government.
Regardless of when our province finally distributes its supply of the Imvamune vaccine, its lacklustre response to monkeypox is a poor indicator of how much we learned about the distribution of health care and health inequities through living through the COVID-19 pandemic. Moreover, restricting vaccines unnecessarily negatively impacts an already marginalized minority. It has been a cruel summer for gay and bisexual men in New Brunswick, compared to other provinces where vaccines have been offered for months.
I recommend that the province immediately lower or eliminate its threshold for the provision of the monkeypox vaccine to prevent further disappointment and injury to our queer community. Once it distributes the 140 doses, New Brunswick will need to continue to advocate for more of its share of the federal stockpile. New Brunswickers need access to precise and accurate information concerning the risks of monkeypox and the details and risks associated with the vaccines and available treatments. Finally, in distributing vaccines, let people determine their risk and believe them when they seek the preventative medical services they deem necessary. Doing so could change the disastrous course of failing to recognize the legitimate health needs of queer people in our province.
Professor Charles Furlotte, MSW, RSW., is an Assistant Professor in the School of Social Work at St. Thomas University. He developed and teaches the MSW course, “Social Work in Health Care.”