Monkeypox: 1-on-1 With the White House's Response Deputy Coordinator

Since he was named White House national monkeypox response deputy coordinator, Dr. Demetre Daskalakis, or Dr. D for short, has been logging long hours at the office, getting very little sleep.

"First, I'm excited to be here, and to be working with Robert Fenton, the national monkeypox response coordinator, who brings so much experience from [the Federal Emergency Management Agency] as an emergency management leader," Daskalakis says. "We are in an emergency, and I think everyone at the White House realizes that it's an all-hands-on-deck moment. There is an urgency to the work we are doing."

Daskalakis says he was chosen for the deputy role to specifically work on ramping out outreach to the LGBTQ+ community. "My primary responsibility is doing right by the LGBTQIA+ community and to make sure that there is a higher level of coordination on all fronts moving in the right direction," he says.

Daskalakis, a leading public health expert, has been director of the Centers for Disease Control and Prevention's Division of HIV Prevention. since 2020. He is widely known as an expert on health issues affecting LGBTQ+ people. He previously oversaw management of infectious diseases for the New York City Department of Health and Mental Hygiene, one of the largest such departments in the nation -- including serving as incident commander for the city's COVID-19 response.

"I want to be really clear here. MPV is nothing like COVID, and that includes the fact that it is less transmissible than COVID, which is important to understand," Daskalakis stresses. "And we have tried-and-true strategies to fight the MPV virus, including vaccines and treatment, unlike what we had for COVID."

"However, they are similar in one way, and that is that they don't discriminate based on sex, race and other factors," he continues. "At the moment, gay, bisexual, and men who have sex with men are being most infected. But monkeypox is anything but a gay disease. It just so happens it's prevalent in our community now, but other communities, races, genders are also at some risk."

"Our main mission here is to accelerate control over the MPV virus," he adds. "At the present time 90 percent of the infections are with gay, bisexual, and men who have sex with men. The virus is full of twists and turns and pivots, and we want to be there to address the pivots."

What follows is an edited version of a Q&A with Dr. Daskalakis.

The Advocate: First, there's been some discussion about changing the name of the virus because of the stigma and racial overtones around monkeypox. Do you agree that that needs to be done?
Daskalakis: Yes, I agree. Earlier this summer, the [World Health Organization] director said they agreed with a name change and that they would be working with their partner organizations on renaming the virus. There is a subcommittee at WHO, the International Committee on Taxonomy, that is responsible for naming the different poxviruses, and they are working on a proposal to reconsider the name.

How safe is it for gay men to travel?
It is safe to travel, and that includes airplanes and mass transit. Remember, while we're working to increase vaccine access -- making a breakthrough this week to take five vaccines out of one vial -- the number 1 objective for gay men who might be traveling, attending large events, or having sex with multiple partners should be to get the vaccine and develop your own plans for protection.

Is there anything else gay men should be doing? What if you're sitting next to someone on an airplane who might have MPV?
MPV can be transmitted skin to skin, so you want to reduce skin-to-skin contact, but what we're finding is that most of the cases are prolonged exposure with an open sore or wound from someone who has MPV.

If you're traveling, be sure to have your own strategy for protection. What does that mean? First, get vaccinated. It might be making sure that your skin is covered. That if you are in a large crowd, you move to the side and away from large groups of people. Use your own strategy about what level of protection you are most comfortable with.

What if someone travels to many places and where there might be MPV outbreaks occurring. Do they need to take their own sheets, for example, if they are staying in a hotel?
I don't think you need to go to that extreme. In other words, don't do things that are that disruptive to your trip. Before you travel, make sure to be vaccinated. But travel as you would. I would check on infection rates in countries you might be traveling to, but regardless, take those precautions about avoiding prolonged skin-to-skin contact and protecting yourself in large crowds, particularly at big events.

Should gay men be avoiding big events?
Well, again, I can't emphasize enough that you develop your own plan for protection. If you're going to be indoors and dancing or congregating in a crowded place, it's probably a good idea to keep your shirt on. And maybe you choose not to have sex with anonymous or new partners. Maybe it's wearing a long-sleeve shirt on public transportation. And getting vaccinated, of course, is the main way to protect yourself.

These are merely suggestions. To that end, the CDC has published a guide, "Safer Sex, Social Gatherings, and Monkeypox," about how to lower your risk of getting MPV. It's a great idea to check that out on their website if you are putting yourself in at-risk situations.

The last thing we want to do is create lots of fear. Just protect yourself and urge people in your social network to protect themselves too.

What about men with HIV getting MPV?
When MPV first popped up and we saw gay men were making up many of the cases, at the CDC, all the folks who work on HIV were pulled in, so that's been a part of the population where we have really focused. With an HIV background, we also know how not to build stigma, which requires deliberate public health language and guidance.

We have a way of protecting yourself from HIV with PrEP, but HIV prevention medication does not protect against MPV, and we have to make sure that the message is getting out. It's also about making sure people with HIV get the vaccine. Finally, be more self-aware about protecting yourself if you are a person living with HIV. It also goes back to developing your own personal protection plan. Again, the CDC guidelines offer very thoughtful ways about how to reduce your risks.

How do we gauge our own risks?
I hate to keep repeating myself, but try to adhere to the guidelines the government and the CDC recommend. When the first Morbidity and Mortality Weekly Report started showing that the first cases of transmission of MPV was through sexual contact with gay, bisexual, and men who were having sex with men, we knew we had to start building awareness with that LGBTQIA+ community about gauging their risks. And then those who were sort of stuck in the middle, not having sex with multiple partners but were part of the community. It just comes down to checking your own behavior, getting the vaccine, and again, developing your own strategy. Following the data provides the clearest guidance and information to keep out of harm's way.

What if you are a queer woman who is in spaces with gay men? Are they at risk?
As I stated before, MPV doesn't discriminate with race or gender. If you're going to be at a crowded event, keep your skin covered, perhaps maintain a distance from packed groups, get vaccinated. Same holds true really for anybody; just make sure you have your own personal protection plan.

What about handshaking -- should that have been left behind from the COVID days?
I can't say it's zero risk. Just be aware. If you see an active MPV lesion on someone's hand, it's best to not shake hands; however, there's really little risk if you're shaking someone's hand since the episodes of infection primarily involve prolonged skin-to-skin contact. And keep shaking hands so long as you sanitize them,and wash them vigorously. That's the lesson from COVID, and I'm a huge believer in sanitizing your hands and washing them always. We should all be doing that without or without COVID or MPV.

For more information about monkeypox, visit the CDC's website here.