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Demetre Daskalakis, White House deputy coordinator for the national monkeypox response, joined the Los Angeles Blade for an exclusive Zoom interview on Wednesday to discuss the latest challenges health officials are facing in the fight against monkeypox virus (MPV) — from combating misinformation and educating the public to switching to intradermal vaccine dosing regimens.

Daskalakis previously served as medical director for New York-based Mount Sinai Health System and was then appointed deputy director of the Division of Disease Control at the New York City Department of Health and Sanitation. In late 2020, when the U.S. was reporting thousands of new daily Covid deaths, Daskalakis moved to the Centers for Disease Control and Prevention's Division of HIV/AIDS Prevention.

Daskalakis is a gay man and leading expert on LGBTQ health. During his tenure as a New York City health official, his work leading HIV and sexually transmitted disease health programs helped reduce the rate of new HIV infections among the city's gay and bisexual men by 35 percent.

While he points out that the United States has never experienced an outbreak of monkeypox like this before, Daskalakis' career before taking office in the White House had already accumulated extensive experience as both a clinical provider and public health official, including advocating against LGBTQ prejudice and stigma. This is critical because men who have sex with men are overrepresented and often have sex with other men.

In terms of messaging, Dr. Daskalakis and his team have chosen the more difficult but effective route, namely focusing on the way in which people come into contact with MPV, “and then working really hard to [messaging] through the right channels” to the right groups based on their relative risk.

This involves working with a variety of different partners, whether they be medical provider associations or groups like the Ryan White HIV/AIDS program and community-based organizations that serve LGBTQ patients, Daskalakis said. The goal is to “walk the line between giving people an open message and avoiding stigma,” he added.

As new data arrives, the communication strategy will be adjusted accordingly, he said. This flexibility has become a cornerstone of the coordination of the federal government's response because “we have been able to point out much more clearly specific risk factors that potentially increase or decrease a person's risk.”

This has led to the recommendation to gay and bisexual men to “reduce their circle of partners and, if possible, avoid anonymous sexual partners” being based on solid scientific data on the transmissibility of MPV, said Daskalakis.

Another ongoing challenge, of course, is the spread of misinformation and disinformation on social media. Last month, far-right U.S. Rep. Marjorie Taylor Greene (R-Ga.) asked on Twitter why children are contracting MPV if the virus is sexually transmitted.

Groups such as the Anti-Defamation League called the move an example of how “disingenuous questions about the origin and spread of the disease” can create an “explicit link between monkeypox and 'homosexual child abuse'” – thereby giving “oxygen and reach” to dangerous lies about LGBTQ people.

“Stigma is stigma and homophobia is homophobia,” Daskalakis said. And while these problems are older, more persistent and more comprehensive than the public health messages surrounding MPV, it is important “not to link an infection to an identity.”

“Stigmatizing a disease and creating a stigma really leads to rabbit holes that prevent people from [figuring out] how to respond to an infectious disease – and the way to respond to infectious diseases, the focus on community, the focus on knowledge and the focus on data that should guide,” he said when it comes to getting messages out to people, whether through online social platforms or other channels.

Daskalakis compared this approach to communications around HIV. “Focus on education,” he said, explaining that “anal intercourse is the most common way HIV is transmitted” and then make sure the message “gets to the people who need to hear it.” That way, men who have sex with men can understand the best harm reduction strategies and “gay sex” or gay and bisexual men are not unnecessarily associated with the virus, which could worsen or reinforce stigma.

On Monday, the New York Times reported on concerns raised by state and local health officials about the delivery of the MPV vaccines, many of whom blamed their federal counterparts for problems such as shipments arriving with vaccine doses spoiled by high temperatures or improper handling.

Daskalakis acknowledged the challenges, but reiterated the CDC and White House's commitment to working with state and local partners in these efforts.

“The CDC has provided technical support, even down to a video that I think countries are now actually using to teach. [the proper administration of] intradermal injections, that's really exciting,” he said. “But all of this is really designed to support the jurisdictions, and I think we're really spending our time with the jurisdictions throughout this whole response.”

Daskalakis also praised the work of local and state health authorities: “It is really important to recognize that the challenges are real, and [also] the creativity with which they are addressing these challenges at their legal level to really achieve what everybody wants, which is more vaccinations… That is sort of the issue of public health in general, particularly in emergency response.” He added that it was encouraging to see “how people are using the federal government’s guidance [including] the support we provide to move things forward.”

Despite the many challenges ahead, Daskalakis is optimistic about the future, in part because more data will be available to health authorities in the future. “I think we're really working to accelerate the efficacy, monitoring and safety of vaccines – with the studies that are being done – to make sure we have a sense of how these work.”

When asked whether coordination efforts at the federal level continued to focus on exploring possible ways to reduce bureaucracy and paperwork, Daskalakis again expressed a positive attitude.

“As far as bureaucracy goes, I think that's one of the most important parts of our coordination efforts,” he said. We're working with partners at all levels to figure out how to make the process of vaccinating and treating as many people as possible less burdensome, with less paperwork, and more efficient.

A promising sign of such a breakthrough in MPV response came last week when the FDA cleared the intradermal injection method of the JYNNEOS vaccine for emergency use authorization.

Not only is this method of administration safer and has a better side effect profile than subcutaneous injection, it also allows for the administration of higher doses, Daskalakis said.

When it comes to rolling out the MPV vaccine's intradermal injections, Los Angeles is a “race car driver,” Daskalakis said. “It's happening at lightning speed. It's inspiring.” It hasn't been easy for such a large city to adapt to a new vaccination method so quickly, he said, but health officials in the region have gotten creative and “got it right.”