At the end of a summer when the number of cases in the monkeypox outbreak rose sharply, the increase in reported infections now appears to be cresting amid increased public messaging and access to vaccines, prompting U.S. health officials to expand their strategy with a new equity-based effort to combat the disease.

Although the reported number of cases, according to most data from the Centers for Disease Control & Prevention, has reached 18,417 in the United States, the number of additional cases decreased from the high at the start of the month, suggesting a downward trajectory in the spread of the disease as vaccines become more readily available.

The numbers are also consistent with a new study finding a significant number of gay and bisexual men, as well as other men who have sex with men, have been limiting contact with casual sex partners, which has been the driving force in the spread of monkeypox. The report from the CDC last week found limiting one-time sexual encounters can significantly reduce the transmission of monkeypox virus, while about half of men who have sex with men are cutting down on sexual activity amid the outbreak, including one-night stands and app hookups.

With the trajectory of monkeypox on the decline, the Biden administration announced a new initiative with the goal of ensuring vaccine distribution is consistent with the value of equity, including on the basis of geographic, racial, and ethnic lines. A total of 10,000 doses of vaccines in the federal government’s supply will be earmarked for localities that have used 50 percent of their allocated supply to support equity interventions, such as outreach to Black and Latino communities, which have been disproportionately affected by the disease or a specific event and celebration for LGBTQ people, health officials announced Tuesday.

Demetre Daskalakis, the Biden administration’s face of LGBTQ outreach for monkeypox and deputy coordinator for the White House monkeypox task force, laid out the details for the new equity-based supplementary initiative in a conference call Tuesday with reporters.

“So what we mean by an equity intervention is what works in your state, county, or city to reach people who we may not be reaching, especially people of color and members of the LGBTQI+ population,” Daskalakis said. “What it means is: It can be working with a specific group or venue that reaches the right people for monkeypox prevention. Once these innovative strategies have been reviewed by CDC, vaccines will be supplied to jumpstart these ideas and accelerate reach deeper into communities.”

The additional equity-based approach to monkeypox vaccine distribution is consistent with the Biden administration’s efforts in recent weeks to distribute additional shots to localities hosting large-scale events for LGTBQ people at the end of the summer, such as Black Pride in Atlanta and Southern Decadence in New Orleans.

Louisiana Gov. John Bel Edwards joined the conference call with reporters on Tuesday and had high praise for the Biden administration for making the additional 6,000 doses of monkeypox vaccine available in time for Southern Decadence, which takes place in the final week of August through Labor Day weekend.

“This is an example — I think a really solid example — of what a federal-state-local partnership and — and then the community providers as well,” Bel Edwards said. “Because the public health folks in New Orleans have been tremendous, but also the community providers.”

Bel Edwards said health officials in the Biden administration have, in addition to providing more vaccines, sent down multidisciplinary teams to New Orleans to help the state organize and prepare as well as set up testing and vaccination sites “that are going to be convenient for the at-risk population.”

A reporter from the New Orleans Advocate on the conference call, however, asked a pointed question on the recent distribution of vaccines to New Orleans in advance of Southern Decadence: The current approach to vaccine administration requires a series of shots, and even with new distribution most people won’t have even had their second shot by that time, so how can Southern Decadence think they will be protected, especially when vaccines take time to become fully effective?

Daskalakis, while promoting the equity-based approach to vaccine distribution, said the Biden administration has been “very clear” that first shot of the monkeypox vaccine “doesn’t mean that you’re protected for the event.”

“We’re going to talk to them about lots of other strategies that they can reduce risk of acquiring monkeypox, but also make it clear that that shot is not for today; it’s for four weeks from now, plus two weeks after that second dose when you get maximum protection,” Daskalakis said.

First death of monkeypox patient reported

Although the number of cases is cresting, concern about monkeypox continues as well as the potential danger of the disease. Case in point: The death of a hospital patient in Texas who had monkeypox, but may have to succumbed to other factors, has drawn attention amid a conventional understanding the skin disease isn’t fatal. The case represents the first time in the United States that a patient with monkeypox died while having the condition.

The patient, as confirmed by the Texas Department of State Health Services on Tuesday, was an adult resident of Harris County who was “severely immunocompromised” and state health officials reviewing the case said it is under investigation to determine what role monkeypox played in the death.

Jenny McQuiston, a CDC official who specializes in research on zoological diseases that spread from animals to people, said in response to a question on the casualty that health officials are also evaluating the death and the role monkeypox played.

“I think it’s important to emphasize that deaths due to monkeypox, while possible, remain very rare,” McQuiston said. “In most cases, people are experiencing infection that resolves over time. And there have been very few deaths even recorded globally. Out of over 40,000 cases around the world, only a handful of fatalities have been reported.”

Despite the cresting in the number of cases, many health experts aren’t sold on the new approach to vaccines announced earlier this month by the Biden administration, which sought to expand existing doses of vaccines fivefold as supply hasn’t met demand. The new vaccine approach calls for injecting the JYNNEOS vaccine from the subcutaneous route (delivery of the vaccine under the fat layer underneath the skin) to the intradermal route (delivery of the vaccine into the layer of skin just underneath the top layer).

Bob Fenton, a regional administrator for FEMA and the response coordinator for the White House task force, said about 75 percent of jurisdictions have already adopted the new approach to vaccine injection, while an additional 20 percent are working toward a “fully operational intradermal method.”

“We continue to be laser-focused on doing everything within our power to help jurisdictions and clinicians get shots in arms,” Fenton said. “We’re seeing more and more jurisdictions adopt the intradermal administration.”

Data of this new intradermal approach, critics have said, is insufficient to support the idea it will be as effective as subcutaneous injections, although the Biden administration continues to give assurances the new route for injections is tested and safe. According to a report earlier this month in the Washington Post, the manufacturer of the JYNNEOS vaccine in Denmark, Bavaria Nordic, privately threatened to cut off supply of the shots based on a conversation with health officials on objections the vaccine hasn’t been approved for intradermal use.

McQuiston, in response to a question on whether or not U.S. health officials are collecting newly available real-world information on the results of the new vaccine approach, said U.S. health officials continue to receive data on monkeypox and soon onboard information from additional states.

“CDC operates a system called VAERS — or the Vaccine Adverse Event Reporting System — and we’re actively looking at…different types of events that might be reported post-vaccination,” McQuiston said. ” And we are actively gathering information from the different jurisdictions and states and cities about which vaccines they’re administering — whether it’s subcutaneous or intradermal — and we are gathering those data now, as we speak.”

Campus Pride this month released its annual list of the best colleges and universities for LGBTQ students. 

Every institution on the list had received a five out of five score on the Campus Pride Index, an assessment tool described on Campus Pride’s website as “a continuum of progress for inclusive LGBTQ and ally policies, programs, and practices.” This year, reaching five-star status meant achieving an overall score of 93 percent or higher on the organization’s assessment.

Towson University in Maryland made the 2022 list, as did George Mason University in Fairfax, Va. No schools located in D.C. participated in the 2022 Campus Pride Index, according to search results from the Campus Pride website.

San Diego State University in California also ranked high.

Genny Beemyn, coordinator of Campus Pride’s Trans Policy Clearinghouse, said that more institutions are earning a five-star rating due to increasing support for transgender students. This year’s “Best of the Best” list is made up of 40 schools, an increase from the 30 that received the top rating in 2021. 

“The work Campus Pride does every day to foster safer, more welcoming campuses across the country is creating positive change for students, staff, and faculty,” board chair Tom Elliott said in a press release. “At a time when LGBTQ+ rights and other civil rights are under assault in states across the country, including Texas and Florida, it is as important as ever to recognize the campuses in these states working to create spaces where the next generation of LGBTQ+ leaders can learn and flourish.”

As college students around the country return to school for the fall — and potential students begin the application process — Campus Pride describes itself as a benchmarking tool available to LGBTQ+ students looking for accepting campuses. 

“Campus Pride created the Best of the Best List to recognize the outstanding accomplishments of these colleges and universities, creating safer, more welcoming campuses for LGBTQ+ people,” Campus Pride Executive Director Shane Windmeyer said. “Students, prospective students, and their families, along with faculty and staff members, deserve to know whether they will be safe on campus, so they can make the best choices for their own academic success — and by creating inclusive, safe environments these colleges are taking responsibility for all students.”

Children’s National Hospital has become the target of threatening phone calls, email messages and social media postings after a widely read far-right Twitter account known as Libs of TikTok posted an incorrect report claiming the hospital routinely performs hysterectomies on transgender patients under the age of 18.

Libs of TikTok founder Chaya Raichik included in her Aug. 25 posting audio recordings of two Children’s National Hospital telephone operators who the hospital says incorrectly stated that a trans boy as young as 16 would be eligible for a hysterectomy.

“We do not and have never provided gender-affirming surgery for anyone under the age of 18,” according to an email statement the hospital’s media office sent to the Washington Blade.  “In fact, in D.C. you cannot perform a hysterectomy in a minor without a court order,” the statement says.

“We do not provide hormone therapy to children before puberty begins,” the statement continues. “Care is individualized for each patent and always involves families making decisions in coordination with a team of highly trained pediatric specialists,” it says.

“None of the people who were secretly recorded by this activist group deliver care to our patients,” says the statement. “The information in the recording is not accurate. To reiterate, we do not and have never performed gender affirming hysterectomies on minors,” it says.

The statement added, “Since the spreading of misinformation on Twitter, we have been the target of a large volume of hostile phone calls, social media messages and emails.”

The Washington Post has reported that the harassment encountered by the hospital has included social media posts suggesting that it be bombed, and its doctors placed in a woodchipper.

According to the Children’s National Hospital’s statement; “Children’s National Hospital is committed to fostering a welcoming and inclusive environment for all and to serving our LGBTQ+ patients and families in the full spectrum of their care.”

Threats and harassing calls and email messages were directed at Boston Children’s Hospital earlier this month over what the hospital says were similar false claims on social media that it was performing hysterectomies on transgender youth under the age of 18.

Libs of TikTok, which has often promoted “groomer” discourse that falsely linked LGBTQ teachers and parents to pedophilia, began to make a variety of false claims regarding Boston Children’s Hospital. One allegation included the lie about the hospital offering gender-affirming hysterectomies to children under 18 years old.

Journalist Martha Bebinger with WBUR,  Boston’s NPR news station, noted the campaign started last week with criticism of a video posted on the hospital’s website about hysterectomies. Several conservative social media accounts shared posts about the video on Twitter. The hospital performs hysterectomies on patients 18 and older, but not on children as some of the posts claimed.

“We condemn these attacks in the strongest possible terms, and we reject the false narratives upon which they are based,” Boston Children’s Hospital said in a statement. “We are working with law enforcement to protect our clinicians, staff, patients, families and the broader Boston Children’s Hospital community and hold the offenders accountable,” the statement added.

For more than two years, a Brooklyn real estate agent and fanatical adherent of far-right extremist ideology, Chaya Raichik, has wreaked havoc via her social media accounts ‘Libs of Tik Tok’, attacking LGBTQ+ people with special emphasis on spreading lies and propaganda about transgender people.

When Raichik attacked Boston Children’s Hospital, spreading lies and falsehoods about the healthcare facility’s treatment of trans youth. Her ‘call to arms’ was then joined by conservative journalist and anti-LGBTQ activist Christopher Rufo and the Daily Wire’s Matt Walsh, a vehement anti-Trans pundit.

The resulting chaos including death threats against Boston Children’s Hospital clinicians and staff was acknowledged by a spokesperson for the Boston Police Department who told the Blade that officials had stepped up security to augment the efforts by the hospital to protect its staff and that an investigation had been launched.

The U.S. Justice Department has also launched an investigation into the threats according to an announcement by the U.S. Attorney for the District of Massachusetts, Rachael Rollins.

In a lengthy statement issued by GLAAD, the organization wrote:

“Libs of TikTok is synonymous with maliciously targeting LGBTQ organizations, people, and allies by posting lies, misinformation, and blatant hate,” said a GLAAD spokesperson. “Meta and Twitter continue to profit from accounts like Libs of TikTok as doctors and staff members of Boston Children’s Hospital, and other providers of healthcare to transgender people, receive death threats and hate. These companies are complicit in hosting content which expresses malicious falsehoods and which incite anti-LGBTQ hate. This is the latest in a long pattern of blatant inaction from the platforms to content that directly leads to the recent rise in real world violence and harassment facing LGBTQ people.”