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The unvaccinated are 14 times more likely to contract monkeypox: health officials

Guidance updated to allow shots in places other than forearm

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U.S. health officials are celebrating data finding the monkeypox contraction is lower among people who are vaccinated.

U.S. health officials are celebrating preliminary data on the vaccine used in the monkeypox outbreak, which has led them to conclude eligible persons who didn’t get a shot were 14 times more likely to become infected than those who are vaccinated.

The new data, as described by health officials on the White House monkeypox task force during a call with reporters on Wednesday, comes as the overall number of new cases of monkeypox is in sharp decline, although considerable racial disparities persist in the remaining cases as Black and Latino people are overrepresented in the numbers.

Rochelle Walensky, director of the Centers for Disease Control & Prevention, said during the conference call the preliminary data — collected from 32 states between July 2022 and September 2022 — provides an early shapshot of the effectiveness of the vaccine and cause for optimism on the path forward.

“These new data provide us with a level of cautious optimism that the vaccine is working as intended,” Walkensky said. “These early findings and similar results from studies and other countries suggest even one dose of the monkeypox vaccine offers at least some initial protection against infection.”

Walensky during the conference call admitted the data is incomplete in numerous ways. For example, the data is based on information on individuals who have obtained only the first shot as opposed to both shots in the two-shot vaccination process. (The data showing positive results from individuals who have only one shot contradicts previous warnings from the same U.S. health officials that one shot of the monkeypox vaccine was insufficient.)

The data also makes no distinction between individuals who have obtained a shot through subcutaneous injection, a more traditional approach to vaccine administration, as opposed to intradermal injection, which is a newer approach adopted in the U.S. guidance amid the early vaccine shortage. Skeptics of the new approach have said data is limited to support the idea the intradermal injection is effective, particularly among immunocompromised people with HIV who have been at higher risk of contracting monkeypox.

Not enumerated as part of the data were underlying numbers leading health officials to conclude the unvaccinated were 14 times more likely to contract monkeypox as opposed to those with a shot, as well as any limiting principle on the definition of eligible persons. Also unclear from the data is whether individual practices in sexual behavior had any role in the results.

Despite the positive data on the monkeypox vaccine based on one shot, U.S. health officials warned during the conference call the two-shot approach to vaccine administration is consistent with their guidance and more effective.

Demetre Daskalakis, the Biden administration’s face of LGBTQ outreach for monkeypox and deputy coordinator for the White House monkeypox task force, made the case that for individuals at risk obtaining a second dose is “really important.”

“So we see some response after the first [shot] in the laboratory, but the really high responses that we want to really get — that you know, level 10 forcefield as opposed to the level five forcefield — doesn’t happen until the second dose,” Daskalakis said. “So the important message is this just tells us to keep on trucking forward because we need that second dose at arms that people haven’t gotten the first should start their series of two vaccines.”

Also during the call, health officials said they would be expanding opportunities for vaccines as pre exposure prophylaxis, as opposed to practices in certain regions granting vaccines in their limited supply to individuals who meet certain criteria or have had risk of exposure.

The Centers of Disease Control & Prevention, officials said, is also updating its guidance to allow injection of the vaccines in places other than a patient’s arm.

Daskalakis said fear of stigma about getting a noticeable shot in the forearm after obtaining a monkeypox vaccine was a key part of the decision to issue the new guidance on implementation.

“Many jurisdictions and advocates have told us that some people declined vaccine to monkeypox because of the stigma associated with the visible but temporary mark often left on their forearm,” Daskalakis said. “New guidance from CDC allows people who don’t want to risk a visible mark on their forearm to offer a vaccine on their skin by their shoulder or their upper back. Those are areas more frequently covered by clothes.”

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U.S. Supreme Court

Supreme Court hears oral arguments in 303 Creative case

Dangerous implications for LGBTQ consumers

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U.S. Supreme Court (Washington Blade photo by Michael Key)

The U.S. Supreme Court on Monday heard oral arguments in 303 Creative v. Elenis, a case that could carry broad implications for whether and in which circumstances states may enforce certain nondiscrimination rules against purveyors of goods and services.

The case was brought by website designer Lorie Smith, who sought to include a disclaimer that her company 303 Creative would not develop wedding announcement websites for LGBTQ couples, but discovered that such a notice would violate Colorado’s anti-discrimination laws, which include sexual orientation as a protected class.

Her lawsuit against the state of Colorado, argued by counsel from the anti-LGBTQ group Alliance Defending Freedom (ADF), reaches the Supreme Court following the ruling against Smith from the 10th Circuit Court of Appeals, which created a circuit split with decisions from the 8th Circuit and Arizona Supreme Court. A ruling is expected to come in June.

The fact pattern in 303 Creative closely mirrors the 2018 case Masterpiece Cakeshop v. Colorado Civil Rights Commission, where the Supreme Court declined to rule on the broader legal questions because it found the Commission exhibited hostility toward the religious views of the bakery that refused to design a custom wedding cake for a same-sex couple.

The high court has since moved substantially to the right, with a 6-3 conservative supermajority. Colorado is one of 20 states that enforces laws prohibiting businesses from discrimination based on sexual orientation, and a ruling that would allow for broadly construed exemptions to be carved out for firms based on their First Amendment protections would carry implications well beyond the context of same-sex marriage.

Monday’s oral arguments focused on preexisting and hypothetical cases that were presented by counsel from both parties as well as by the justices, examples whose scope and fact patterns reinforced the breadth of the legal issues at play in 303 Creative.  

Colorado Solicitor General Eric Olson and U.S. Principal Deputy Solicitor General Brian Fletcher pointed to the Supreme Court’s ruling in Rumsfeld v. Forum for Academic and Institutional Rights, 2006, which found that the federal government may withhold funding from universities that, based on their objections to “Don’t Ask, Don’t Tell,” refuse to grant military recruiters access to their resources.

ADF CEO, President and General Counsel Kristen Waggoner cited the Supreme Court’s decision in Hurley v. Irish American Gay, Lesbian, and Bisexual Group of Boston, 1995, which upheld the right of private organizations to exclude participation by certain groups without interference by the state, even if that intervention by the government was for the purpose of preventing discrimination.

Much of the discussion during Monday’s oral arguments centered on what kinds of goods and services may be considered public accommodations and which constitute artistic speech or expression by the business provider. Also at issue were questions such as whether their refusal to accommodate certain events – i.e., same-sex weddings – are tantamount to refusing goods and services to members of a protected class of people under the state’s non-discrimination laws.

LGBTQ rights groups fear the implications of a ruling in favor of 303 Creative  

ADF is designated an anti-LGBTQ extremist group by the Southern Poverty Law Center. An amicus brief was filed in support of the government by the corporate law firm White & Case along with a coalition of LGBTQ rights groups and legal advocacy groups: the National LGBTQ Task Force, GLAD, the National Center for Lesbian Rights, Lambda Legal, and the Human Rights Campaign.

“Just two weeks after a shooter killed 5 people, injured 18, and traumatized so many others at Club Q in Colorado Springs, the United States Supreme Court prepares to hear oral arguments in an anti-LGBTQ public accommodations discrimination case from Colorado,” wrote the National LGBTQ Task Force in a statement addressing Monday’s oral arguments.

Liz Seaton, the group’s policy director, highlighted the importance of public accommodations laws and condemned efforts by the opposition to legalize discrimination and segregation in the marketplace. “The brief’s most important argument lifts up the powerful amicus briefs of the NAACP Legal Defense and Educational Fund and of the Lawyers’ Committee for Civil Rights Under Law,” Seaton said. “Those two briefs by venerable civil rights organizations provide a detailed history of public accommodations discrimination against Black and Brown people in this country.”

HRC’s statement on Monday touched on similar themes:

“Granting the unprecedented ‘free speech exemption’ sought by petitioners in 303 Creative v. Elenis would be a dangerous change to long standing constitutional and civil rights law. It would inevitably lead to increased discrimination not only related to LGBTQ+ people or weddings, but also for other vulnerable populations including women, people with disabilities, and people of minority faiths. It’s crucial that justices of the Supreme Court reject discrimination and affirm the equal dignity of every American.”

Likewise, the Congressional LGBTQ+ Equality Caucus released a statement exploring the broad implications that could result from the Court’s ruling on 303 Creative:

“…the Supreme Court could issue a broad ruling that not only implicates nondiscrimination laws’ applications to graphic designers but to a wide range of businesses providing goods and services that have an artistic component. A broad ruling for the graphic designer could not only provide a constitutional basis for discriminating against same-sex couples, but also for discriminating against all marginalized people currently protected by public accommodations nondiscrimination laws.”

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Congress

Jim Kolbe dies at 80

Former Ariz. congressman first openly gay Republican House member

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Rep. Jim Kolbe (R-Ariz.) speaks at a press conference on Feb. 28, 2013 for the filing of an amicus brief supporting the overturning of the Defense of Marriage Act. (Blade file photo by Michael Key)

Former Republican Congressman James (Jim) Thomas Kolbe, who represented Southern Arizona in Congress for 22 years, died Saturday of a stroke at the age of 80 his husband Hector Alfonso confirmed to Arizona media outlets.

“He belongs to so many people,” his husband said through tears on Saturday. “He gave his life for this city. He loved Tucson, he loved Arizona.”

Republican Arizona Gov. Doug Ducey ordered flags at all state buildings be lowered to half-staff until sunset Sunday in honor of the former congressman. In a series of tweets the Arizona governor lauded Kolbe’s record of public service.

Kolbe was the first openly serving gay Republican in the U.S. House of Representatives having served from 1985 to 2007.  During his 22-year tenure he served as chair of the Subcommittee on Foreign Operations, Export Financing and Related Programs of the House Appropriations Committee.

Former congressman Jim Kolbe (R-Ariz.) (Blade file photo by Michael Key)

In 1996, Kolbe held a press conference and outed himself after his vote for the Defense of Marriage Act. This, according to political journalist Jake Tapper, was owed to the fact that Kolbe was under the impression he was about to be outed by a gay publication.

Addressing a gathering of Log Cabin Republicans and other gay Republicans in 1997, he said he didn’t want to be a poster child for the gay movement.

“Being gay was not — and is not today — my defining persona,” Kolbe said during his first speech as an openly gay GOP lawmaker. He also sat on the national advisory board of the Log Cabin Republicans.

In 2013, however, Kolbe was a signatory to an amicus brief in support of overturning California’s Proposition 8.

In a private ceremony in 2013, after being together for eight years, Kolbe and Alfonso were married.

Alfonso, a Panamanian native who came to the U.S. on a Fulbright scholarship to pursue studies in special education, had been a teacher for two decades. The couple’s nuptials were held at a private event at the Cosmos Club on Massachusetts Avenue.

“Two decades ago, I could not have imagined such an event as this would be possible,” Kolbe told the Washington Blade in an interview in May 2013. “A decade ago I could not imagine that I would find someone I could be so compatible with that I would want to spend the rest of my life with that person. So, this is a very joyous day for both of us.”

The couple had to endure a year-long separation when Alfonso returned to Panama while immigration issues were being sorted out, although he was granted U.S. residency, also known as a green card.

Kolbe also battled his friend and fellow Republican, U.S. Sen. John McCain (R-Ariz.), who opposed the repeal of the Clinton-era “Don’t Ask, Don’t Tell” policy, which barred military service by gay and lesbian Americans. He repeatedly co-sponsored a bill to scrap the military’s “Don’t Ask, Don’t Tell” policy at odds with others in his party over the issue.

After he left Congress he continued to be active in Republican politics in 2012 endorsing former Massachusetts Gov. Mitt Romney in his race for the presidency against then incumbent President Barack Obama.

In an interview with the Blade at the time, Kolbe responded to the anti-gay language in the draft version of the Republican Party platform. In addition to endorsing a Federal Marriage Amendment, the platform criticized the Obama administration for dropping defense of DOMA in court and judges for “re-defining marriage” in favor of gay couples.

Kolbe predicted the 2012 Republican platform will be the last one to include such language.

“That’ll be the last time that will be in the Republican Party platform,” Kolbe said. “It won’t be there four years from now. It’s got its last gasp. I don’t believe it’ll be there four years from now; I wish it weren’t there now, but I don’t believe it will be four years from now.”

The issue over the rights of same-sex couples to marry ended with Obergefell v. Hodges, 576 U.S. 644, the landmark civil rights case in which the U.S. Supreme Court ruled that the fundamental right to marry is guaranteed to same-sex couples by both the Due Process Clause and the Equal Protection Clause of the 14th Amendment to the Constitution.

Just this week prior to his death, the Respect for Marriage Act passed the Senate by a vote of 61-36.

That legislation requires the federal government to recognize a marriage between two individuals if the marriage was valid in the state where it was performed and guarantee that valid marriages between two individuals are given full faith and credit, regardless of the couple’s sex, race, ethnicity or national origin. It is expected to pass the House again this week after which it heads to President Joe Biden for his signature.

Early in his career, Kolbe in 1976 ran for a seat in the Arizona Senate in the Tucson-Pima County district and defeated a one-term Democrat. In mid-1982, he resigned from the state Senate to run in the newly created Arizona’s 5th U.S. congressional district, but lost to Democrat Jim McNulty.

He ran again in 1984 winning the seat that he went to hold for over two decades.

According to his biography Kolbe was born in Evanston, Ill., a suburb of Chicago, but when he was five, his family moved to a ranch in rural Santa Cruz County, Arizona. It was there he attended Patagonia Elementary School and Patagonia Union High School, but graduated from the U.S. Capitol Page School in 1960 after serving for three years as a Senate Page for Arizona Republican U.S. Sen. Barry Goldwater.

He matriculated first at Northwestern University and then at Stanford University earning a master’s degree in economics. During the Vietnam era from 1965 to 1969, he served in the U.S. Navy, including a tour in Vietnam as a member of the Navy’s “Swift Boat” force. 

After military service Kolbe served as a special assistant to Republican Illinois Gov. Richard B. Ogilvie. He then moved back to Arizona settling in Tucson where he worked in business.

Accolades for the former congressman included many from Arizona political and business fields of endeavor.

“Pima County and southern Arizona could always count on Jim Kolbe,” Pima County Board of Supervisors Chair Sharon Bronson said in a statement.

Matt Gress, who was recently elected to the Arizona Legislature, called Kolbe a political pioneer.

“Today, because of Jim Kolbe, being a member of the LGBT community and serving in elected office has become irrelevant,” he said in a statement.

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District of Columbia

HHS secretary discusses federal overdose prevention efforts at Whitman-Walker

Officials held round table with clients, ‘community stakeholders’

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U.S. Health and Human Services Secretary Xavier Becerra (Public domain photo)

U.S. Department of Health and Human Services Secretary Xavier Becerra and four other high level federal health officials held a roundtable community meeting followed by a press conference at D.C.’s Whitman-Walker Health headquarters on Friday to discuss what they said were “groundbreaking” efforts to address and end the nation’s epidemic of deaths from the overdose of opioid drugs.

A statement released by HHS says Becerra and the other officials, including Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy, reached out to Whitman-Walker, which, among other things, operates one of the D.C. metro area’s preeminent substance abuse treatment programs, to commemorate the one-year anniversary HHS’s Overdoes Prevention Strategy program.

“Now, one year after the release of this strategy, our nation is in a much stronger position to treat addiction and save lives,” Becerra said. “We didn’t get here by accident. Thanks to decades of work by advocates, coupled with an unparalleled people-first strategy and unprecedented investment by the Biden-Harris administration, we have made a great deal of progress,” he said.

The officials, including Gupta, pointed out that the Overdose Prevention Strategy over the past year and an updated effort launched this month have focused on greatly expanding availability of the drug overdose antidote medication naloxone.

“Deaths caused by opioids like illicit fentanyl are preventable with naloxone, and today’s announcement means more life-saving naloxone will be in communities across the country,” Gupta said. “The latest data continue to show a hopeful trend of a decreases in overdose deaths, so we must remain focused on fully implementing President Biden’s National Drug Control Strategy that will save tens of thousands of lives by expanding care for substance use disorder, making naloxone more accessible, and dismantling drug trafficking operations,” he said. 

In addition to Gupta from the White House, Becerra was joined at the community meeting and press conference by Dr. Miriam Delphin-Rittmon, assistant secretary for the Substance Abuse and Mental Health Services Administration (SAMHSA), which is an arm of HHS; Dr. Debra Houry, acting principal deputy director of the U.S. Centers for Disease Control and Prevention and Dr. Robert Califf, commissioner of the U.S. Food and Drug Administration. 

Also participating in the roundtable session and press conference was U.S. Sen. Tammy Baldwin (D-Wis.), the nation’s first out lesbian member of the Senate. 

Becerra said he invited Baldwin to participant in the day’s events, among other things, because of her record of advocacy and support for funding of federal substance abuse and overdose prevention programs. 

“One area I’ve championed in Congress is increasing access to overdose reversal medication like naloxone,” Baldwin said. “We know that when you increase access to this safe and effective treatment that you save lives,” she said. “And I’m thrilled to see the Biden administration and especially the Food and Drug Administration taking steps to increase access to naloxone.”

Califf told the gathering one of the FDA’s recently launched efforts is to work with drug manufacturers to arrange for naloxone to become an over-the-counter drug that would further expand its availability. 

From left, HHS Secretary Xavier Becerra, Dr. Rahul Gupta, Sen. Tammy Baldwin (D-Wis.), Dr. Robert Calif (at podium) and Dr. Miriam Delphin-Rittmon at Whitman-Walker Health in D.C. on Dec. 2, 2022. (Washington Blade photo by Lou Chibbaro, Jr.)

The roundtable discussion session, which included close to 50 participants, including Becerra and the other federal officials, was closed to the press, according to an HHS spokesperson, because among those participating were Whitman-Walker clients and others who receive services and support for what the officials called substance use disorder.

During the press conference that followed, Becerra spoke of how some of those participating in the roundtable discussion were part of Whitman-Walker’s success stories in helping people overcome substance use problems 

“We’re here because a year ago we decided to go in a different direction at the federal level,” he said at the press conference. “We decided that we’re not moving fast enough, we’re not moving close enough to where we need to be to try to help communities and those folks at Whitman-Walker who are trying to not just get folks into treatment but to save lives,” Becerra said. 

“And that was the great thing about the round table that we just had,” he said. “We heard about how people thrive,” he said, adding, “And one of the clients, Deborah, spoke about how she’s on the verge of getting her degree from college … That’s what we want to see … I want to thank the folks at Whitman-Walker for letting us come today to see how people can thrive and be part of that success.”

Whitman-Walker Health CEO Naseema Shafi told the Washington Blade after the press conference that Whitman-Walker has a long history of partnering with federal government agencies in addressing health issues, including Whitman-Walker’s role as a healthcare facility welcoming the LGBTQ community. 

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