This 1997 image was created during a investigation into an outbreak of monkeypox, which took place in the Democratic Republic of Congo (DRC), 1996 to 1997, formerly Zaire, and depicts the palms of a monkeypox case patient from Lodja, a city located within the Katako-Kombe Health Zone, of the DRC. (CDC via Bay City News)

San Francisco supervisors on Thursday lambasted the public health response to the ongoing global monkeypox outbreak, calling for improved communication with at-risk groups and an influx of vaccine doses.

San Francisco currently has 141 confirmed cases, more than half of the 266 that have been confirmed statewide as of Tuesday.

The vast majority of the city’s cases have been confirmed in gay or bisexual men between the ages of 25 and 54, and some 42 percent of the confirmed cases have been in Asian, Black or Hispanic residents.

Dr. Stephanie Cohen, the medical director of the San Francisco City Clinic and director of HIV and STI prevention within the city’s Department of Public Health, said the city requested a conservative estimate of 35,000 monkeypox vaccine doses, but has only received roughly 7,700 doses.

“Vaccines are the most effective tool in our toolkit to fight this virus and the best way to protect people,” Cohen told the San Francisco Board of Supervisors’ Government Audit and Oversight Committee during a hearing on the monkeypox response.

“Unfortunately, the federal response has been slow and bottlenecked and the supply is extremely limited and is way outstripped by need and demand,” she said.

The virus is generally spread through skin-to-skin contact or bodily fluids via kissing, breathing at close range, sexual activity and sharing bedding or clothing. Local, state and federal health officials have stressed that the virus is not airborne like COVID-19 or the flu.

Symptoms can include a rash or sores on the skin anywhere on a patient’s body. Contraction of the virus often begins with flu-like symptoms as well.

The virus has been confirmed globally in many men who identify as gay or bisexual, but public health officials have stressed that the virus is not exclusive to men who are attracted to men, and anyone can contract monkeypox via close contact with an infected person.

Supervisor Rafael Mandelman, one of two LGBTQ members of the board and the supervisor who called for the hearing, compared the response to the monkeypox outbreak to the HIV/AIDS epidemic of the 1980s, calling it “eerily familiar” for those who remember the epidemic’s early days.

Mandelman also called the federal effort to provide more doses of the two-dose Jynneos vaccine for monkeypox and smallpox “totally inadequate” for the scope of the current outbreak, pointing to the rapid and successful effort to vaccinate some 40 million people against COVID-19 in the first three months after the vaccines became available in late 2020.

Federal health officials have stated that they plan to fully vaccinate some 3.5 million people against monkeypox by mid-2023, a goal that Mandelman called “abysmal.”

“We have nearly 6 million, maybe more, men who have sex with men and trans folks living in the United States,” he said. “This is all assuming that this monkeypox outbreak stays within the queer community. There’s no reason to believe that at some point it doesn’t spread out, so this is kind of a travesty.”

Some 6,100 people in the city have received at least one dose of the monkeypox vaccine as of Wednesday, according to the SFDPH, but Cohen said the dearth of vaccine doses will require the city to hold off on the administration of second doses for most people, even if they are given a date and time to return for their second shot.

“We do intend that everyone will receive a second dose, but the guidance right now from the state is to prioritize first doses to ensure that we get as many people a first dose as possible, and as soon as we have the supply to administer those second doses, they will be administered,” Cohen said.

State officials have also called for an influx of Jynneos vaccine doses as soon as possible.

In a letter sent Tuesday to the U.S. Centers for Disease Control and Prevention, state Health and Human Services Secretary Dr. Mark Ghaly and California Department of Public Health Director Dr. Tomas Aragon said the state needs at least 600,000 to 800,000 doses, which they said was a conservative estimate.

Even with the lack of doses, the city expanded its eligibility for the vaccine to all men who have sex with men who have had multiple sexual partners in the previous 14 days as well as sex workers of any sexual orientation or gender.

Mandelman relayed an anecdote from Hans How, a member of the city’s Housing Stability Fund Oversight Board, who sought a vaccine dose and was forced to wait in hours-long lines at Zuckerberg San Francisco General Hospital, only to be turned away twice because the hospital had run out of doses.

He also said that former aide and current Equality California political director Tom Temprano had sought information from SFDPH about getting vaccinated but ultimately learned about how to access a vaccine via Twitter because officials with the department did not return his calls.

Mandelman called the logistical issues “pretty unforgivable,” and called on Cohen and other SFDPH officials to remedy them.

“These are two people with extraordinary access who have been involved in city government. We’re talking upper percentiles of ability to access public services,” he said. “So I can only imagine how great the frustration and feelings of powerlessness are for thousands, if not tens of thousands of other folks who ought to be getting this vaccine.”

San Francisco AIDS Foundation CEO Tyler TerMeer said that while his organization has vaccinated 761 people as of Wednesday, the foundation has just 127 vaccine doses on hand and some 5,300 people on its vaccination waitlist.

TerMeer also said the foundation recently launched a hotline for monkeypox information that is receiving roughly one-to-two calls per minute, which he said pointed to a need to educate members of the public about the virus and how to prevent its spread.

“We have just seen an incredible demand for access to information, for people to talk to about their concerns and fears as monkeypox has continued to spread in our community,” he said.

Cohen said the Department of Public Health has also been inundated with calls and voicemails from people seeking information about the virus, but the department’s communications team has struggled to keep up.

“I think not only have we been giving out bad information, but we’ve actually been making things worse by telling people to call these numbers where, at least from the folks I’m talking to, they’re not getting calls back,” Mandelman said.

Cohen suggested that the city’s current state of trying to quell the outbreak is due in part to “failures at multiple levels,” and an overly optimistic view by federal health officials that monkeypox could be contained by only vaccinating those who are at the highest risk of contracting and spreading it, a strategy known as ring vaccination.

With better preparedness, she argued, vaccines could and should have been distributed in large quantities some six weeks ago.

For now, local public health officials are wondering along with San Francisco residents when more doses will be delivered.

“I think we’re trying to hope for the best and plan for the worst around the allocations,” Cohen said. “But we’ll continue to keep everyone updated because we are also on the edge of our seats around that.”