Anil T. Mangla, the state epidemiologist at D.C. Health, said the dashboard was “in the works for a while” but that he wanted to wait until he was sure the data was “clean and accurate” before publishing. It will include demographic data, including the age, gender, race and ethnicity, and ward of residence of people who test positive and those who receive doses, he said.
The lawmakers’ request, detailed in a letter signed Monday by eight of the council’s 13 members, comes at a time of great transition for the agency: Longtime health director LaQuandra Nesbitt stepped down last month, and Mayor Muriel E. Bowser (D) appointed Sharon Lewis, previously a senior deputy director at the department, to lead during the search for a permanent replacement.
But as monkeypox infections rise across the region, the council — which at times butted heads with D.C. Health during the coronavirus pandemic over vaccine equity and public information — asked Lewis to strengthen the department’s messaging for residents who are not in the highest-risk populations. That includes some parents of young children — who the legislators wrote: “do not feel they have sufficient information to know what their own risk is or how to protect themselves and their family members.”
The letter urged Lewis to work with public schools on messaging around safety as well as provide lawmakers with details on vaccine distribution, mirroring data the department shared publicly at the height of the coronavirus pandemic. Council members have also asked about how D.C. Health is relaying information about monkeypox to residents who don’t use social media, a primary communication tool for the department.
“There’s a desire for more information, there’s a concern about spread, concern about equitable distribution of the vaccine,” said Council member Elissa Silverman (I-At Large), who led the effort. “This letter was really to establish a relationship with the new leadership to say let’s communicate well with our residents … and make sure we’re learning from covid, where the equitable distribution of the vaccine was a big issue.”
D.C. Health’s messaging around monkeypox was initially geared toward groups widely recognized as the most at-risk: gay and bisexual men who had recently had multiple sexual partners. Last week, the agency expanded monkeypox vaccine eligibility to people of any sexual orientation or gender who have had multiple sexual partners in the past two weeks — in part to reduce stigma surrounding the virus that may have discouraged some residents from getting vaccinated.
But with the city’s public schools starting back up at the end of the month, Silverman and other lawmakers say they’re increasingly hearing from parents seeking information about how monkeypox is transmitted, and how the virus could spread between children who play and interact with physical touch.
The District continues to have more monkeypox cases per capita, than any state, with 341 as of Sunday, but Mangla noted only one case occurred in a minor. The median age is 34, he said. He added that 98 percent of cases in the District were transmitted through skin-to-skin contact or kissing with respiratory secretions; without contact with lesions, he said, the possibility of transmission is low. Like with coronavirus, practicing hand-washing and good hygiene is key, he said.
But mindful of parents’ concerns, Mangla said he meets weekly with school district leaders and the health department will issue an FAQ to schools after ensuring that it does not conflict with back-to-school guidance they are awaiting from the Centers for Disease Control and Prevention.
“I want to make sure they have the right information rather than misinformation,” he said.
Last week, Council member Christina Henderson (I-At Large) said she had asked D.C. Health for a breakdown of monkeypox cases by race, gender and ward, and had pushed for the information to be published and regularly updated online. As of Tuesday, D.C.’s monkeypox website redirects users to a CDC map of the country that only shows the raw number of cases in the District.
Earlier this week, I asked @_DCHealth for monkeypox surveillance data disaggregated by a number of factors. The response is below.
I’ve also asked for this info to be published on the website & updated on a regular cadence. pic.twitter.com/WxQRKXHUvG
— Christina Henderson (@chenderson) August 12, 2022
Henderson, who said she did not sign onto Silverman’s letter because it was duplicative of her own request, said her ask was fueled by the fact that other jurisdictions, like Virginia and New York City, already published detailed monkeypox surveillance data.
“I realized I didn’t know what was going on in D.C. beyond a specific case count,” Henderson said. “It shouldn’t have to be an ask … there are a lot of scars from how information was transmitted or not at the beginning of the pandemic.”
Mangla said D.C. has made strides in vaccinating Black residents in its Friday walk-up clinics, which do not require preregistration, and starting Aug. 19 will not require a name or date of birth either.
Almost 50 percent of monkeypox cases in the city occur among White men, compared with 36 percent among Black men, he said. Among people who preregistered for a vaccination via the city’s website, 21 percent are Black, but that number jumped to 54 percent for the walk-up clinics, Mangla said.
In addition, the city reserved 35 percent of its doses for Black residents and 20 percent for immunocompromised individuals, including those who are HIV-positive. “This was to assess and address some of the equity concerns we were seeing in cases and at the vaccination clinics,” he said.
Public data reporting is inconsistent across the D.C. region. While Maryland does not publish monkeypox data online, the Virginia Department of Health maintains a dashboard, which is updated daily, with case counts as well as data on the outbreak by region, sex, age group, and race and ethnicity.
As of Tuesday, Virginia reported 213 cases, including 150 in Northern Virginia. Men in their 20s and 30s make up about 80 percent of cases. About 35 percent of cases have occurred in Black men and 32 percent of cases in White men, data show. State public health officials say they are working with 35 health departments to gather information on who is accessing the vaccine and plan to post that online soon as well.
“Covid reminded us of the importance of understanding the different populations that are impacted by a condition and the importance of looking at data through an equity lens in order to make sure we have the resources, prevention strategies and vaccines, we need to [serve] populations that are being impacted,” Laurie Forlano, deputy director of the office of epidemiology, said in an interview Tuesday.
The Virginia health department is also considering holding listening sessions with clinical providers and town halls to make sure people at highest risk have all the information they need to decide whether to get vaccinated as well as equitable access to appointments, Forlano said.
Back in the District, Monday’s letter marks the latest example of lawmakers pressing the health department on its vaccination strategy and data reporting.
During a contentious call with D.C. Health early in the pandemic, lawmakers pointed out that residents from affluent wards were monopolizing scarce vaccine appointments to the detriment of hardest-hit wards. And in May, council members pressed Nesbitt to update case data more frequently, prompting her to write in a letter obtained by Axios that their public critiques risked “undercutting trust in DC Health and public health.”
In the council members’ letter, they asked Lewis how the department was employing lessons it learned during the coronavirus pandemic, specifically with communication and vaccine distribution.
“We didn’t know there was an inequitable distribution of the coronavirus vaccine until we saw the data, then we saw it was lopsided,” Silverman recalled. “It only helps increase public trust when you disclose information — maybe D.C. Health has done a great job and we cheer them on.”
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