Thousands of Coloradans are still on a waiting list to receive a monkeypox vaccine, state officials said Thursday, and the state has reported more cases in August than it had in the previous three months combined. 

LGBT organizations that have partnered with the state say there’s anxiety and frustration among their communities because of the limited availability of vaccines and the federal government’s response.

There are more Coloradans waiting to get vaccinated after being exposed to monkeypox, for instance, than have been inoculated thus far, state data shows.

“The truth is that there is a high demand and low availability,” said Gillian Ford, the communications director for One Colorado, an LGBT advocacy organization. “That is a fact.”

Nearly 500 Coloradans on monkeypox vaccine waitlist as state plans more clinics

Still, officials from those organizations praised Colorado’s efforts and said things have improved in recent days: The state has emphasized partnering with advocacy groups and it recently expanded vaccine eligibility to include transgender and non-binary people. An emergency federal action approved last week has also expanded vaccine availability significantly.

The limited availability of vaccine is nothing new: It’s been a problem since the outbreak began several months ago, and states have clamored for more doses from the federal government as cases have spread. Colorado officials and their partners at LGBT community organizations say the state is essentially at the mercy of federal supply and planning in terms of vaccine availability.

As of Thursday morning, 168 Coloradans have tested positive for monkeypox, or MPV. More than half of those cases — 94 — have been identified this month, after 66 were reported in July, six in June and two in May. Rachel Herlihy, the state’s epidemiologist, told reporters that after a near-daily increase in cases in July, August has seen a consistent flow of cases. 

Six of those people have been hospitalized, state officials said, though they did not characterize the severity of those cases. There have been no MPV deaths reported in the United States thus far. The bulk of cases have been in the Denver metro area: Fifty-nine have been in Denver itself, with 50 more scattered between Adams, Arapahoe and Jefferson counties. El Paso County has had 10 cases.

The outbreak has primarily affected men who have sex with men; according to state data, 66% of cases self-identified as being gay or lesbian; more than 10% identified as bisexual. Eighty-five percent of cases in the state have been in men. Herlihy said men who have sex with men are currently at greatest risk, but officials have stressed that anyone can get MPV through close physical contact with someone who has the virus. 

Colorado's monkeypox cases increase as counties outside of Denver metro report first patients

To best reach that community, state health officials have worked with LGBT-centered groups. Rex Fuller, the CEO of The Center on Colfax, which is an LGBT community center, said he’s worked closely with the state health department since late May. 

“I think the outbreak caught a lot of people by surprise — nobody was expecting it to happen,” he said. “I do think there has been a challenge because at the beginning, there was a lack of available vaccine, and it was simply that people were caught unaware.”

The limited vaccine availability “has been really hard,” added Mardi Moore, the executive director of Out Boulder County. “There’s anxiety.”

Vaccines are available only for a handful of groups, all of whom must be over the age of 18. They include people who’ve had close physical contact to a known monkeypox case within the past 14 days; “gay, bisexual, or other men who have sex with men, or transgender, non-binary, or gender-diverse people” and have multiple or casual sexual encounters in the past 14 days; and others identified by health officials as being at risk of exposure, like health care workers.

The doses are still available for post-exposure cases. State health officials told The Denver Gazette that more than 4,400 people are on a wait list for vaccines. Scott Bookman, the director of disease control and public health response at the state health department, did not say how long it would take the state to vaccinate those people, nor did a spokesman for the agency.

That spokesman did say the state will receive allocations in late August and in September, though he said the state does not know how many doses it will receive. Still, the wait list is longer than the number of people vaccinated: According to state data, roughly 4,200 Coloradans have received at least one dose. The MPV vaccine is a two-dose regimen, like some COVID-19 vaccines, but the state has said it’s prioritizing giving as many first doses as possible. 

Bookman said Thursday that the state won’t turn away anyone seeking a second dose. 

Last week, the federal government changed how the vaccines can be administered. Now, the doses can be injected between layers of skin, rather than into fat tissue. That means, officials said, that a dose can be one-fifth the quantity, expanding the number of available doses by a factor of five. Ford, of One Colorado, praised that move.

Colorado to prioritize first-dose monkeypox vaccines as cases nearly double

But she also said the arrival of MPV is frustrating because the LGBT community, alongside the rest of Colorado and the nation, has spent the last two and a half years dealing with the COVID-19 pandemic. 

“Our resources are depleted. Our emotional and mental and physical capacity is depleted as a community in general,” Ford said. “And so to be faced with needing to respond to this type of risk, at this point in time, is frustrating. It is not the type of thing that you want to be dealing with.”

Still, she said, members of the community are taking the risk seriously.

“They’re maintaining a high level of responsibility for it, and they are wanting to really know what is critical about keeping themselves individually safe, keeping their close community safe and protecting the larger community,” she said.

Moore, of Out Boulder County, criticized the federal response and said the feds were “botching” it, and she said the future of the response will depend on the supply of vaccines. She said messaging should go up on dating apps to better improve messaging about vaccinations.

Fuller said The Center is hosting vaccine clinics each Friday for the next few weeks. The organization’s first clinic, held last week, administered well over 100 doses, he said.

There’s a heightened level of concern among the LGBT community about homophobia, Fuller and others said, because of increased anti-LGBT sentiment and violence across the country. But he and Moore said the MPV outbreak and its outsize impact on the LGBT community — and the resulting media and public health attention to it — has not further escalated stigmatization or hate.

“That’s definitely part of the reason that (the state health department) came to us, was trying to avoid stigmatization,” Fuller said. “And I think that they’ve been very conscientious in trying to avoid that. I do think, because this initial outbreak happened in a population that 30, 40 years ago was also horribly, horribly affected by the HIV-AIDS epidemic, that there’s echoes of that, and people within the LGBT community have felt concern.

“But the response is night and day from what it was all those years ago,” he continued. “There may be people who disagree, but in my view, I think some of that concern has started to wane.”