Opinions
Biden administration must overhaul monkeypox response now
We need a plan emphasizing equity in vaccination, testing, treatment
The Biden administration needs to overhaul its response to monkeypox. Now.
For many who were around during the height of the AIDS epidemic, the Biden administration’s missteps around monkeypox are pale but haunting reminders of past battles. That’s particularly galling for LGBTQ+ Americans as more than 95% of monkeypox cases in 2022 are striking men who have sex with men (MSM).
The Centers for Disease Control and Prevention (CDC) estimates 1.6 million Americans are at risk, requiring 3.2 million doses. But outreach has been ineffective. Not even 10% are fully vaccinated.
It’s imperative that the White House implement a comprehensive plan emphasizing equity in prevention, vaccination, testing, and treatment. In August, the administration irresponsibly decided to withhold monkeypox vaccines from Americans whose health agencies aren’t using a newly mandated injection method. Washington theorizes the more efficient intradermal (ID) method will quintuple doses from vials.
Health officials from D.C. to Seattle report averaging 3.5 doses per vial amid significant disruptions. The Association of State and Territorial Health Officials echoed their claims.
Using flawed assumptions that healthcare providers will extract five doses from each vial, the Biden administration is sending one-fifth of the vials previously allotted. That eliminates 100% of their imagined increase, but Washington is sending around 30% fewer usable doses compared to pre-mandate allotments. “The federal government has patted themselves on the back for how they’re accelerating the delivery of vaccines,” reflected DC Department of Health Senior Deputy Director Patrick Ashley. D.C. has nearly the highest case rate in the nation. “What they did is they moved numbers around.”
We urge President Biden to reinstate original vial allocations. The point of doing ID, noted Johns Hopkins scholar Caitlin Rivers, was to “benefit from the increase in supply.”
While we hope JYNNEOS’s two-shot course proves safe and effective, data is scant for subcutaneous use, and more so for ID – particularly for people who are immunocompromised, including those living with HIV. One study, reported STAT, showed one dose providing nearly undetectable protection. And some agencies still aren’t scheduling second injections. Even its manufacturer documented reservations about the administration’s approach.
Contends one writer in The Atlantic, “The FDA is now playing a high-stakes game with the health and trust of people most vulnerable to monkeypox…” It typically causes rash and flu-like symptoms, but lesions around the anus, genitals, or mouth are excruciating. An oft-cited study shows JYNNEOS’s efficacy, but it’s based on a 2010 trial of approximately only 175 mostly young, white, healthy straight men receiving ID.
The reduction in doses has forced some jurisdictions, like Philadelphia, to scale back vaccine outreach, complicating plans for required second doses. While cases are disproportionately high among Black and Hispanic individuals, vaccination among Black people remains exceedingly low. Reasons include distrust, stigma, and less accessible vaccine centers.
The White House has allocated 10,000 vials for local networks to vaccinate under-vaccinated demographics, especially people of color. It should be 100,000. Still needed: a detailed commitment to vaccinate incarcerated and un-housed individuals.
Up to 15% of Black and Hispanic individuals – populations most at risk of contracting monkeypox – and 5% in Asian communities are prone to keloid scarring, which causes skin discoloration. For those affected, ID would be ineffective and likely harmful, and damaging to trust of the public health community.
ID’s smaller doses are also deepening skepticism in vulnerable communities. The shrunken supply and over-emphasis on intradermal injections will exacerbate existing racial and socioeconomic disparities in vaccination. We must not allow this. Promoting the subcutaneous option is critical to encourage vaccination, especially for those ineligible for ID.
Demetre Daskalakis, White House Deputy Coordinator for monkeypox, anticipates “real-world” data from health agencies on “actual doses from vials.” After issuing the mandate?
Daskalakis and CDC Director Dr. Rochelle Walensky indicate jurisdictions can request more vials, including for subcutaneous injections, but their vagueness has prevented some agencies from scheduling second shots.
Monkeypox was confined to Africa, where health resources are poor. Out of our sight, it was out of mind — until 27 countries where it hadn’t existed reported 780 cases in May. The World Health Organization declared a public health emergency on July 23. President Biden didn’t until Aug. 4. Five weeks later, domestic cases had more than tripled to 21,274.
Biden has often said, “Help is on the way.” It’s taking the long route. In his first joint address to Congress, Biden told transgender Americans – who are at high risk of contracting monkeypox – “Your president’s got your back.” As we advocate for speedier, more equitable vaccination, that assurance could use its own booster.
Dennis Jaffe of D.C. is an active member of PrEP4All’s monkeypox advocacy project. He has 40 years of professional experience in grassroots advocacy for social justice causes.
Opinions
ROSENSTEIN: Chavous for Democratic D.C. Council-at-Large
Committed to fighting for statehood for our 700,000 residents
Kevin Chavous said, “I’m running for D.C. Council At-Large because Washingtonians deserve leadership focused on improving their everyday quality of life. Throughout my career, I’ve worked on the practical business of city government, and public policy, focused on solving real problems, and making government work better for the people it serves.”
Kevin’s experience spans safer streets, affordable housing, early education and school readiness, workforce and economic opportunity, support for seniors, and the day-to-day operations of city government. The knowledge he brings to the office is grounded in experience, clear-eyed oversight, and a commitment to delivering results. His platform outlines his priorities and approach, but as he has said, “it’s not the end of the conversation. I believe the best solutions come from listening and working together.”
Kevin believes safe streets are the foundation of strong neighborhoods. He is committed to having Washingtonians feel secure in their neighborhoods, and working to ensure all public safety efforts are smart, fair, and effective. To Kevin that means an approach focusing on enforcement that works, prevention that matters, and a range of services to stop crime before it happens. Kevin supports smart, effective policing, with a focus on violent crime, and getting repeat offenders off the streets. To do this he will work to strengthen community policing with the aim of rebuilding trust in every community, which will improve neighborhood-level safety. He will introduce legislation to expand targeted mental health and crisis-response services. The goal again, to prevent violence before it occurs. He will work to see government coordinates youth diversion, workforce, and support programs, which can intervene early, and reduce recidivism.
Kevin understands housing stability is essential for families, seniors, and workers, to stay and thrive in D.C. His housing priorities focus on increasing the supply of affordable housing, helping people build long-term stability in the neighborhoods they call home. He will work to increase the affordable housing supply through zoning updates, ADUs, and adaptive reuse of vacant properties. He will submit legislation to strengthen programs that help first-time, and longtime homeowners, buy and then stay in their homes. He will work to expand permanent supportive housing and targeted rental assistance for vulnerable residents, and protect tenants ensuring housing laws are enforced clearly, and consistently.
Kevin believes “every child should enter school ready to learn, with the support needed to succeed from day one. Early investment pays lifelong dividends – for families and for the District.” He will work on the Council to expand early childhood education, and school-readiness programs, citywide. He supports quality and affordable childcare for all children, birth to three, including seeing students begin the school year healthy, by supporting access to medical and dental screenings for all children.
Kevin knows economic opportunity allows families and communities to thrive. He will fight to see D.C.’s growth creates real pathways to good jobs, strong local businesses, and long-term stability for residents in every ward. His approach connects workforce training, worker protections, and neighborhood investment, so that growth benefits the people who live here. He will work to expand job training, apprenticeships, and career pipelines tied to high-demand fields, including construction, healthcare, and infrastructure. He will fight to strengthen First Source and local hiring requirements, so D.C. residents benefit directly from major development projects such as the new RFK site. He will demand the government protect workers by enforcing wage, safety, and labor standards, and holding bad actors accountable. He will introduce legislation to invest more in neighborhood-based economic development, including small businesses, BIDs, and commercial-to-residential revitalization.
Kevin has spoken out for the seniors in our city saying, “seniors built this city – and D.C. must ensure they can age with dignity, security, and independence.” Kevin will work to expand property tax relief and housing supports, so seniors can age in place. He will work with the AG to strengthen protections against fraud, exploitation, and predatory practices targeting seniors. He will support and work to expand nutrition, transportation, and community-based programs, that reduce the isolation many seniors face.
Kevin’s experience working for the Council, in the oversight role he had, gives him a practical understanding of what works, what doesn’t, and how to fix it – without delay. He will use that experience as he works to strengthen agency oversight to ensure laws are implemented as intended, and to improve service delivery by fixing bottlenecks, and outdated processes. Ensuring clear standards and accountability in inspections, enforcement, and permitting. Kevin will demand government use technology responsibly to improve efficiency, while protecting residents from fraud and abuse.
For all these reasons and more, I support Kevin Chavous. The more includes the fact Kevin has spoken out clearly, about the need to fight the antisemitism, Islamophobia, racism, sexism and homophobia, all once again rearing their ugly heads in our society. He will fight to keep ICE out of our city, and to keep immigrants safe. He is committed to fighting for statehood for the 700,000 residents of the District of Columbia, while fighting for budget and legislative autonomy as we work toward statehood.
Again, I urge the voters of D.C. to cast their ballot for Kevin Chavous for DC Council-at-Large.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
The state of Tennessee has a long history of political discrimination against its 225,000 LGBTQ citizens. In 2019, a district attorney remarked that gay people should not receive domestic violence protections, and in 2023, for five months in Murfreesboro, homosexual acts in public were illegal, prompting a federal judge to have the ordinance removed.
In 2022, I briefly lived in Tennessee and played rugby with the LGBTQ-inclusive Nashville Grizzlies, who welcomed me with open arms as an ally, teaching me that rugby isn’t always about winning or losing – it’s about creating a safe, inclusive, and joyful space for people looking to feel welcome.
In Tennessee, where 87% of the LGBTQ community has experienced workplace discrimination, and where, each year, countless bills that target their identities are introduced, it can be difficult to feel welcome. The Nashville Grizzlies played rugby with the exuberance of newly liberated people who were finally able to be their authentic selves. I was inspired by their brotherhood.
When I read about the Charlie Kirk Act being passed last week, I felt a visceral need to write about it.
While the bill is presented as legislation that strengthens free speech and encourages greater public discourse on campuses, it would effectively allow a school to expel a student who felt compelled to walk out on a speaker with hateful views, forcing marginalized groups to sit through existentially harmful rhetoric.
And ironically, it doesn’t seem like free speech goes both ways — a Tennessee University administrator lost their job last year for sharing negative views on Charlie Kirk, and countless LGBTQ books have been banned not only in schools, but even in adult libraries.
We like to think that as time moves forward, progress is inevitable, but this isn’t always the case. In a 2023 study, 27% of LGBTQ Tennesseans and 43% of transgender people in the state have considered relocating, forcing them to reckon with leaving home in pursuit of a better life. Nashville Grizzlies Captain Ethan Thatcher told me, “I’ve thought about leaving Tennessee. Hard not to when the government does not want you here. What has kept me here is the Grizzlies community, and the thought that existence is resistance.”
Everybody in our country deserves to feel safe. I thought that was a core value of the American ethos, but apparently, in some states, certain groups are welcome while others are ostracized.
Tennessee Gov. Bill Lee should reject the Charlie Kirk Act.
Tyler Kania is a 2025 IAN Book of the Year nominated author and civil rights activist from Columbia, Conn.
Opinions
The latest Supreme Court case erasing LGBTQ identity
Chiles v. Salazar a major setback for movement
In its recent decision in Chiles v. Salazar, the U.S. Supreme Court invalidated Colorado’s law prohibiting licensed counselors from engaging in efforts to change the sexual orientation or gender identity of minors. The decision, which puts into question similar laws in 22 other states, relied on the First Amendment to hold that the law violates counselors’ free speech rights. But the decision also strikes a blow against LGBTQ dignity, a point the court’s opinion does not even address.
The eight-member majority, which included Justices Elena Kagan and Sonia Sotomayor, who usually side with LGBTQ groups, justified its reasoning by suggesting that the law was one-sided: it permitted treatment that affirms LGBTQ identity but forbade treatment that seeks to change it. But the law is one-sided, as Justice Ketanji Brown Jackson’s lone dissent pointed out, because the medical evidence only supports one side: reams of research show that “survivors of conversion therapy continue to suffer from PTSD, anxiety, and suicidal ideation.” And major medical associations all agree, no evidence demonstrates the efficacy of conversion efforts. This isn’t surprising. Medicine often take sides — some treatments work, and some don’t.
But particularly concerning is the vision of LGBTQ identity that undergirds the majority opinion when compared to the dissent. Justice Jackson’s dissent explains that LGBTQ identity is simply “a part of the normal spectrum of human diversity” — not something to be “cured.” By contrast, for the majority, how best to help LGBTQ minors is “a subject of fierce public debate.” That can hardly be the case if LGBTQ identity stands on equal ground with straight, cisgender identity, or if LGBTQ people are as deserving of safety, rights, and dignity.
Indeed, the LGBTQ rights movement only began in earnest when advocates in the 1960s decided to end the “debate” over gay identity. Until then, community leaders would routinely cooperate with psychiatrists who were interested in researching homosexuality as a medical condition. A new generation of activists, led by Frank Kameny, a key movement founder, began arguing that this got the issue upside down: Rather than wondering if they could be “cured,” LGBTQ people had to assert a right to their identity. As Kameny put it—“we have been defined into sickness.” Only once the case was made that it was society that had to change, and not LGBTQ people, could LGBTQ consciousness, LGBTQ pride and LGBTQ rights develop. Their activism led to the first Pride parade in New York, and the official declassification of homosexuality as a disease in 1973.
The Supreme Court’s conservatives don’t just want to reignite this half-century old medical “debate”; they also treat medical claims that undermine LGBTQ identity very differently from those who support it. Last year, in an opinion backingTennessee’s law that banned gender affirming care for minors, the court sympathetically marched through the reasons Tennessee offered for “why States may rightly be skeptical” of such care, and cited three times, in some detail, to “health authorities in a number of European countries” (that is, some Nordic countries and the UK) that had curbed pediatric care. It failed to mention that most of Western Europe and every major American medical association provides access to this care.
In Chiles, by contrast, the court cites none of the evidence that Colorado amassed that conversion therapy harms LGBTQ children. None of the countries that the court had invoked to justify anti-trans policies allow conversion therapy in their health care systems (indeed, one of them criminalizes such practices). So rather than cite medical evidence, the court simply asked — why trust medical evidence at all? “What if,” asks the court, “reflexive deference to currently prevailing professional views [does] not always end well?” and cites an infamous 1927 Supreme Court case, Buck v. Bell.
In Buck, the Supreme Court embraced eugenic reasoning, backing a eugenic state law that allowed the sterilization of individuals with mental disabilities, on the grounds that such disabilities were hereditary. As Justice Oliver Wendell Holmes opined, “three generations of imbeciles are enough.” Look at what happens when we listen to medical expertise, today’s court seems to say, as an excuse to disregard the LGBTQ-affirming medical evidence they don’t like.
But the court has missed the key lesson of Buck. The law at issue in Buckdiscriminated against a certain group, seeking, through sterilization measures, to erase it from existence. Indeed, LGBTQ people (whom doctors of the day would have referred to as sexual “inverts”) were exactly the kind of people that the eugenic program of Bucksought to eliminate. Conversion therapy seeks similar erasure.
The lesson of the 1960s LGBTQ rights movement remains as relevant today as it was then. Without an unapologetic LGBTQ identity, LGBTQ Pride, LGBTQ rights and the LGBTQ movement itself can all founder. By supporting only the anti-LGBTQ side in this medical saga — and by suggesting that LGBTQ existence is subject to medical debate at all — the court is reaffirming, rather than repudiating, minority erasure.
Craig Konnoth is a professor of law at University of Virginia School of Law.
