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Regina de Heer: What life choices, if any, have you ever made due to monkeypox outbreak?

Speaker 2: I think that's a very loaded question.

Speaker 3: It definitely impacts my readiness to be really social. My sex life has definitely changed.

Speaker 2: It definitely started with ensuring that I had access to the vaccine. That's the first line of defense.

Speaker 4: I am a Black gay man and a single one. I'm not in a partnership where I have certain agreements around my potential exposure and my sexual behaviors.

Speaker 5: It definitely reduced my going to places like leather bars, or nightclubs, or things like that.

Speaker 6: I feel like I have to push back violently against the stigma associated with being a member of a sexual minority group, especially the one that's centralized in this conversation.

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Kai Wright: This is The United States of Anxiety. I'm Kai Wright and welcome to the show. Those voices you just heard are from a listening session we held with a group of LGBT community leaders in the Metro Atlanta area who work in public health. Because as we started thinking about monkeypox this week, we wanted to hear from this unique group of people, experts in public health, but who come at that work as people inside the community most affected by monkeypox right now.

Quite honestly, as a queer man in New York City, I certainly have a very personal stake in this conversation as well. We've been a geographic epicenter of this outbreak and it has been scary and confusing, and ultimately, enraging honestly. After all, we've been through with COVID here's another outbreak in which I'm forced to scramble around trying to understand what my risk really is, how I get tested if I've been exposed, and entering this just truly insane competition to get a vaccine appointment.

How can all this be after all we've been through over the past three years? The Biden administration declared monkeypox a health emergency earlier this month, as have a number of cities and states including New York. This step should bring more resources and urgency to the response. Even if it does, why has it taken so long to ramp up on this, and what has this experience taught us again, about our society in general, and our lives alongside viruses in particular?

To pursue these questions, I'm joined by someone who has also a unique voice in this conversation about viruses and pandemics and who's been a real go-to source for a lot of people in queer communities who are looking for information on monkeypox. Joseph Osmundson is a microbiologist at New York University and He's author of an unfortunately well-timed book called Virology: Essays for the Living, the Dead, and the Small Things in Between. Hey, Joseph, thanks for joining us tonight.

Joseph Osmundson: It's so good to be here. Thank you so much for having me, Kai.

Kai: Your book, I want to call it fun, but I don't think that's the right word to describe this. The essays are poetic and often weird. Yet, I'm learning about microbiology, which is not something I am often looking to do. You write that you've been obsessed with viruses since middle school. What sparked that really obsession?

Joseph: Well, I was born in 1983, the same year that HIV was found to be the causative agent of AIDS, and in a world where I was a little proto queer boy. AIDS seemingly was everywhere. Then came the slate of hot zone [unintelligible 00:03:46] films and books. Viruses are tiny, little invisible things, relatively simple things genetically, but they are quite profound, and they can impact our life. There's nothing more profound to life than ending it. Growing up in the shadow of HIV, coming out, having my first experiences, a broken condom, the wait to get HIV test results back, I've never not lived in the shadow of virus, and I've never not had certain pleasurable things like sex in my life, without considering the infectious disease that that act could bring.

Kai: As you write, you say, "I'll never not be a queer person born in 1983. Born into what viruses meant then." Do you think that kind of intimate relationship with viruses is an inescapable part of our lives as queer people born after AIDS?

Joseph: I think it's an inescapable part of every human life. I think that that is one of the big points I make in my book. There are more viruses on planet Earth than there are stars in the sky. Viruses came along before humans on this planet and when humans exhaust ourselves as a species, viruses will last well beyond that time, they are a fact of life, it's like being mad at the ocean. It's also true that 99.99, I can't even go out far enough, percent of viruses on earth can't infect humans at all.

The majority of viruses are the type of viruses that I studied in my PhD, which we call bacteriophage, which are viruses that only infect bacterial cells. There, they can actually be used as therapeutics, like if you have a virus that kills a staph bacteria, well, that virus can save your life if the staph bacteria is threatening it. We make so much meaning from viruses to the exceptions to the viral rule, to the HIV, the monkeypox, the COVID the viruses that not only can infect us but can make us so ill.

It was very funny to all the queer people I knew when everyone was talking about COVID fatigue, which is a real thing. It's like, I've been having HIV fatigue since before my first sexual encounter.

Kai: For 30 years.

Joseph: Exactly. I think it's a mistake to imagine that viruses only impact one community, even if, for a particular outbreak or a particular epidemic, we see certain types of people who are more at risk.

Kai: This point you were making about most viruses don't kill us. We tell ourselves these stories about viruses. Why is that an important point for you to make, the stories we're telling ourselves about viruses, what are you getting out there?

Joseph: Well, those stories can change, and we can change them. I argue in my book that HIV today doesn't mean what it meant in 1993, or in 2003, or even in 2013. PrEP changed what HIV means. PrEP is medication that you can take as an HIV-negative person to protect yourself against [unintelligible 00:07:57] conversion for HIV without using condoms, you equals you the notion that someone who is HIV positive, but who's controlling that infection with medication and is therefore undetectable, that they it is impossible for them to transmit the virus.

An HIV-positive person who knows their status and is controlling the infection with drugs is the safest sex partner for HIV transmission. These are transformative to the stories that we tell ourselves, and to how we view ourselves as HIV negative or HIV positive. If we view HIV as a normalized, a fact of life, and I think we've spent so long stigmatizing folks. In the last 10 years, I've seen a huge shift in my community that HIV-positive people are awesome to have sex with, that there's nothing to be afraid of there.

I just think, changing our relationship to viruses in these ways that make it easier to live. I'm not so afraid of HIV anymore, both because I have better tools to prevent it and because we've invented biomedicines that make the virus. Such that the virus can be a normal part of a fully lived human life.

Kai: We can think about it differently. As we turn to monkeypox here, let's just level set for folks very quickly for the people who are not, for one reason or another, fully aware of what's going on with monkeypox. One on one, from a biological perspective, briefly, what is Monkeypox? What does it do? How is it transmitted?

Joseph: Monkeypox is an orthopoxvirus that is related to smallpox, it actually has a somewhat similar presentation as smallpox. When the WHO was doing this huge public health push to eradicate smallpox from the planet, which was successful, monkeypox was a big problem for that because every single monkeypox outbreak in the endemic region, and I'll go over that in a bit, that a team from WHO had to go there and make sure that it wasn't smallpox.

It's an infection that typically starts with flu-like illness and proceeds to a rash and that rash can be quite painful. It typically lasts two to four weeks. It is spread mostly by close physical contact, so we're talking about directly touching a skin lesion, is the highest risk for contact for transmission.

In the context of this current epidemic, it is traveling, the virus is spreading mostly in the sexual networks of gay men through mostly close physical contact, so there's a lot of layers to the stigmatization of the virus and also helping people get access to the care that they need.

Kai: It is not a new virus. This is something that has been around since 1970 as I understand it.

Joseph: It was first described in humans in 1970. That's correct.

Kai: We're going to just get started on this and have to come back to it after a break, but tell me about the beginning of this, and why that beginning is important.

Joseph: I actually want to tell two stories and those two stories are HIV and monkeypox. It is around 1920 to 1940 when HIV first begins transmitting from human to human, this is in the context of colonial Congo, which liberates itself in 1960. When Congo is liberated in 1960, there are zero doctors, zero engineers, zero lawyers who are Congolese because the Belgian colonial rulers would not let people get educated past middle school.

It is of no surprise that HIV was spreading undetected in the context of Congo, because although certainly, a country with a medical infrastructure would recognize young people dying of very rare diseases, Congo did not have that. It did not have that for a reason. Because there was no professional class, the UN built a program to bring other Francophone professionals to Congo, largely Haitians. Wherever people travel, so to travel will travel a virus.

HIV travels to Haiti from Congo, and from Haiti to New York in 1969, and from New York to queer folks all around the world. We have colonial neglect, and then homophobic neglect, leading to the spread of a virus. Okay, now 1970 monkeypox, the same endemic region. Congo is still lacking biomedical infrastructure due to post-colonial neglect. They had a leader who was allied to the US and essentially, no medical infrastructure. Monkeypox comes in and out of humans from an animal reservoir and as smallpox vaccination gets further and further away, smallpox vaccination protects against monkeypox, smallpox was eradicated, we stop.

We do not continue vaccinating to protect folks in Congo, Ghana, Nigeria from monkeypox, which is a horrible disease. As the smallpox immunity wanes, the virus becomes more and more common starting around 2017. In Nigeria, there is consistent human-to-human spread of monkeypox and from there, it gets into global sexual networks of gay men and we have the same patterns of neglect playing out over and over again.

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Kai: We will pick this back up after a break. I'm talking with Joseph Osmundson, a microbiologist at New York University and author of Virology: Essays for the Living, the Dead, and the Small Things in Between. We'll be right back.

Kousha: Hi, this is Kousha. I'm a producer. A few weeks ago, we did an episode about the culture of gun violence in our country, and why that's got to change to make any political progress on gun control. You should check it out. We covered a lot, including what's driving folks across the political spectrum to purchase guns. Does it actually make you safer or is that a myth? We receive messages from you about the episode including this one from Kevin in Connecticut.

Kevin: Hi, I'm a lifelong gun owner and a political mutt in Deep Blue America. I thought the point made in the podcast that people are buying more guns based on a myth that they'll make you safer is more than a little condescending honestly. We've seen system after system failure since COVID from the judicial system to law enforcement to public health and I can assure that the start of the pandemic, two of the smartest most liberal friends I have reached out to me, one to ask if she could borrow one of my guns if society collapsed. The answer was no.

The other asked if I could go with him to a gun show to exploit the quote gun show loophole and was also a no. These are not a rational people but people seeing that the structures they've always trusted just may not be worthy of that trust anymore. I think that's a bigger factor than believing a myth.

Kousha: Thanks for that, Kevin. Thanks to all of you who are listening and talking to us. If you've got a message for us about anything you've heard, send us a voicemail, you can record yourself on your phone and email us. The address is anxiety@wnyc.org. That's anxiety@wnyc.org. All right, thanks, talk to you soon.

Callie: We have to get more information that's accurate and digestible out to people in a timely fashion. We have to do that better but we also have to figure out how to balance the public health emergency with the humanity. How can we learn from monkeypox and figure out how we raise the priority while it's how you take the humanity of men who have sex with men, gay men, same gender loving men, queer men, however, they identify and hold them in a place of comfort and safety.

Larry: Black and brown, gay men, and gender non-conforming people need to be included in the response. As an organizer and as leaders of the science. Very often individuals who are not impacted by these outbreaks, these epidemics, create strategies that may not be the most effective or the most informed by community. I definitely think Black and brown leadership is crucial as we continue to respond to monkeypox.

Daniel: We really appreciate how 40-plus years since the HIV epidemic, the country has come around to respond to the HIV epidemic in a very different way and weren't able to say HIV or gay men in the Reagan administration but today, we are able to have that talk about language that we have a coordinator and Dr. Daskalakis at the White House who's coordinating the monkeypox response that we need to continue to demonstrate that the lives of the LGBT community are valuable, and they matter. The way that the government has continued to respond to HIV needs to be pulled through. It's been a slow start but we're getting closer.

Kai: That was Callie, Larry, and Daniel, who are Black LGBT community leaders at the forefront of the monkeypox response in the Atlanta metro area. They were part of a listening session we held last week, we wanted to hear from this particular subset of people, experts in public health who come to that work as people in the community most affected by monkeypox right now. I'm joined by Joseph Osmundson, who also fits that bill. Joseph is a microbiologist at New York University and author of Virology: Essays for the Living, the Dead, and the Small Things in Between.

As Joseph and I continue to talk, we can take your calls and questions. I'm particularly interested in hearing from you if you've had an experience with monkeybox, whether you've had the virus or you had an exposure to it and you had to try to figure out how to get tested, or even if you've had someone in your life who's had it. What's been your experience? We can also take just any questions you've got about monkeypox or other viral outbreaks, for that matter.

Joseph, before the break, you gave us this very good history ranging from colonialism through to monkeypox showing up in 2017 in the United States, how the choices we made as a society led to that, our refusal to care about people in Central Africa. In the book, you point out that much of the national scientific infrastructure for responding to viral outbreaks is housed in the military, which is something I didn't realize. That's because it's seen as a national threat and you say that shapes our mindset on stuff like this. How so? Can you explain that because that's related to the history you were giving us before the break?

Joseph: Yes. We see that in a way, monkeypox should have been an easy virus to contain, because the United States government invested in tests, treatment, and vaccine, not for monkeypox but for smallpox as a bioterrorism threat. The real biological agent that was actually making people sick on planet Earth was a threat, less worth investing in than a theoretical terrorist threat. I write in the book in an essay with my friend, Patrick Nathan that war is the only place in the American imagination, that we don't worry about budgets, we don't worry about the deficit, we invest.

If this agent and not smallpox, but monkeypox had been used as a bioterrorism agent, we would have contained that sucker in a day because there would have been the political will and an enemy to fight against. Militarism is so deeply embedded in the cultural DNA of this country, that even our investment in care, such as inventing a brand new vaccine that is hopefully very effective against monkeypox, is made through the military. This stockpile of vaccine and treatment is run by a government agency called BARDA. That is, again, a part of the national security infrastructure. What's remarkable to me is when 20 million doses of the JYNNEOS vaccine for monkeypox expired in a freezer in Denmark. We did not say it is in our national security interest to actually use that in the place where the virus is currently spreading. Not only is it the morally and ethically correct thing to do because that human suffering matters. That choice to use this vaccine to protect people in Congo, Nigeria, Ghana, et cetera, would've almost certainly stopped this global epidemic from occurring.

Kai: Just to clarify, the United States said, okay, we'll just let it expire instead of giving it away.

Joseph: That's right. Not only did we let it expire, but then we did not replace it. That is why we've had such horrible vaccine scarcity in the response to this epidemic.

Kai: I want to pick up on something that you heard one of our people in the listening session say just there because there's been some back and forth about who is really at risk for monkeypox. It has been talked about as a thing affecting a very particular group of gay men, people who go to circuit parties. Then people said, no, you got to think about it in a much-- You got to talk about it in a much broader sense about queer people and sexually active queer men, and transgender people in general.

Then there's this question of why are we limiting this conversation to queer people. I've had an increasing nearly number of, particularly cisgender straight women ask me, "Hey, what do you know about this monkeypox thing? Should I be worried?" How do you think we should be talking about this in terms of who's at risk?

Joseph: I mean, it is brought out an Intercommunity debate amongst gay men and our social networks that lasts surfaced around the use of PrEP, which is a medicine to prevent HIV that is more effective than condom use. Condom use over a long period of time is purely not 100% effective at preventing HIV transmission. You've seen these decades of emphasis on use of condoms every time, and yet HIV rates are-- People zero convert every year.

A lot of us viewed PrEP as a really important tool to prevent new HIV infection. Then there were people who called it a party drug and again, used it to stigmatize the types of gay folk who go to circuit parties or go to saunas as frivolous or unserious or as though those activities cannot be healthy sexual activities that give people pleasure. We have worked really hard, and by we, again, I'm so grateful for you mentioning that we have experts within the community.

We have epidemiologists, clinicians, biologists, who also are part of the social and sexual networks that are the most impacted right now, who are open about not just saying sex-positive things, but being sex-positive ourselves and believing sex is an important part of my queerness. I want medicine to be able to intervene and make that sex possible with this low as possible risk of any infection, really leading in the community and saying 90% plus of infections right now are being spread through sexual contact.

Kai: You feel like it's important to just say that and not worry about all the rest of it, that it's important to just say, listen, this is the mode of transmit. Not that it can't be transmitted other ways-

Joseph: That's right.

Kai: -but this is where 90% of the data is right now.

Joseph: The most risky contact you can have is sexual contact. There is so much vaccine scarcity, folks who are really, really at low risk. Again, we have good epidemiology on this virus because it's been in humans for so many decades. We do not see clusters of infections being spread by a toilet seat at a school. Now we need to continue to be curious and continue to have really good protocols to study the epidemiology in the context of this outbreak.

Based on all the best science right now, if you are not in a queer sexual network, you are at very low risk for viral transmission. That being said, there are bisexual men and there are cis straight women who have sex with bisexual men and they should probably have access to vaccine. The CDC and other governments have been moving toward more inclusive language for that type of person who might buy their identity seem not at super high risk, but who are actually engaged in the behaviors and the networks where we see most of the viral spread right now.

Kai: We have a question on YouTube. Somewhat Jose Godea asks, how can you tell the difference between just a pimple and a rash of this sort? I will say, I had a freak out recently where I had a zit. I was convinced it was monkeypox. I had absolutely no idea what to do next. Let me add to Jose's question. One, how do you know the difference? Then, two, how can I get tested?

Joseph: That's a great question. I heard a doctor say this week, everyone has it's summer. Everyone has one red bump on their body-

[laughter]

Joseph: -at all times. I had a little ingrown pubic hair, and I had a full-on meltdown. I will also say I have looked at more dick and hole picks in the last couple of weeks because the scientific literature in this is publishing pictures of the lesions. There is no shortage in the media of pictures of the lesions. It is a good idea to know what lesions look like. They are not exactly like a pimple, it typically has this white-capped and they leak a lot of fluid. The great news here, it came too late, but the great news here is we have diagnostic tests that are very, very good, once you have a lesion. You can't get tested in the flu-like illness, but once you have a skin lesion, that is the material that your doctor will collect for testing.

Kai: You can confirm if you're like this is pretty clear a lesion, you can go to the doctor and get that confirmed.

Joseph: You should. If you had [crosstalk] that worried about, that's right.

Kai: Prior to that [unintelligible 00:26:34]

Joseph: If you have a pimple and you're really worried, go see your primary care provider, if you have one. If you're in New York City and you don't have insurance, the sexual health clinics are the spot that can take care of you. The clinicians there certainly have been seeing a lot of monkeypox cases. They can probably look at your skin and get a pretty good indication.

Again, the great news is we do have tools in our toolkit immediately unlike SARS-coV-2 and COVID, we have those diagnostic tests. It's just a real shame they didn't get scaled in May and June like we were asking, and we let the epidemic grow to this size.

Kai: Another question from YouTube. Someone asked, does my smallpox vaccine from about 1960 still offer protection from monkeypox?

Joseph: That is such a good question. The answer is maybe, but if it does, not a ton. There are tons and tons of recorded cases from the endemic region in Central and West Africa of household transmission including household transmission to people who had been vaccinated for smallpox in their childhood. I have to add that the JYNNEOS vaccine that folks are actually getting right now is a great vaccine, very safe but we don't know its measured vaccine efficacy in the context of this outbreak of this pathogen.

Because smallpox was eradicated from planet Earth, all of the studies of these new vaccines are based on what's called immuno-bridging. It's not actually protecting you against the virus because the virus doesn't exist, it's actually just looking at your immune response. Again, because of global racism, we did not think to test these vaccines against monkeypox in the countries where they exist. We didn't mount clinical trials until now. We will get good science about the true vaccine efficacy of these vaccines for this pathogen in this context, but that isn't yet settled science.

Kai: That's so disturbing. On the topic of vaccines, I want to play a comment and a question we heard during our listening session last week. As I said, these are with folks who work in public health, inside Black communities in Metro Atlanta. There was recently a big important conference on HIV AIDS in Montreal that many of them intended and they had a striking experience that is still on their minds. Listen to this.

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Michael: Getting a vaccine has been really hard in Georgia. I actually got vaccinated when I went to the International AIDS Conference in Montreal. Compared to people not being able to get an appointment in Atlanta or I'm from New Orleans, so I know people who haven't been able to get appointments in New Orleans or Atlanta and they were doing walk-up vaccines just out in a tent, in a gay village when I went to Montreal. It was like a stark contrast and my peers and my experience trying to get vaccinated here in the US, especially in the South.

Justin Smith: What are the reasons why it's so easy to get a monkeypox vaccination in Canada, where it is almost the equivalent of a hidden lottery here in the US? What explains the differential and beyond just the fact that Canada has this more robust public health system. Maybe it is as simple as that, but I wonder what are all the reasons why they seem to have a much better response than we do in the US.

Kai: That was Michael who works at PrEP4All and Justin Smith who's the Director of the Campaign to End AIDS at Positive Impact Health Centers in Atlanta. Can you answer Justin's questions in two parts? The first, I think you've gotten that, why it has been such a struggle to get vaccines here in the US, and then why are they not a struggle in Canada? Is it just because they have a better health system than ours?

Joseph: This is a real question of how much vaccine did you have stockpiled ready to go into arms in May of 2020, and Canada is the best place in the world at that. They were prepared for this crisis and anyone of any nationality can walk up and get a vaccine. We know in the American context, who has the most access to healthcare along racial geographic, and class lines.

The only data that has been published so far to my knowledge about the racial demographics of vaccination is from North Carolina. It came out last week. 70% of monkeypox cases were in Black people, 19% of monkeypox cases were in white people, and yet 67% of vaccinations had gone into white arms.

Kai: Wow.

Joseph: This was predictable. We were trying to shout about this from the beginning of vaccination campaigns that equity had to be built in from the ground floor. I do not expect this data to be an outlier. This is what we're going to see everywhere. Now that we're going to a one-fifth dosing regime to spread the remaining doses out where the shot will be given intradermally in the skin where there's a stronger immune response, so you need less vaccine, the folks who have not yet gotten vaccinated will be predominantly Black and brown, more geographically in rural areas and more working class, and they will get less.

Kai: I'm talking with microbiologist, Joseph Osmundson about the ongoing monkeypox outbreak and what we are learning about ourselves from it. We'll take a break and take more of your questions. We'll be right back.

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Welcome back. I'm Kai Wright, and I'm talking with microbiologist, Joseph Osmundson about the ongoing monkeypox outbreak and what we are learning about ourselves from it. He's the author of Virology: Essays for the Living, the Dead, and the Small Things in Between. We can take your calls and questions about it. We've got maybe another 10 minutes left in this conversation.

Joseph, we have a question on YouTube that you alluded to earlier, but I just want to give you an opportunity to really come right at it. Somebody mentions that my friend who is a teacher said someone has tested positive for monkeypox in one of the high schools. She doesn't know if it was a teacher or a student. It actually isn't a question, but it's a comment that I want to turn into a question, which is just about the modes of transmission. There's been a lot of talk about schools coming back, should people be scared or concerned, or what should they be thinking about as school returns?

Joseph: It's such an important question. Number one, fear is never a good place to make risk reduction plans from. We want to be vigilant and thoughtful and careful and curious. This is a virus that spreads by extended skin-to-skin contact. It is not going to be like COVID in schools, or at least that is incredibly unlikely and really would be a major shift in the epidemiology of how this virus spreads.

That doesn't mean that there aren't higher-risk situations within schools. I'm thinking about football teams or wrestling teams or dance or drama or I was in marching band and you take your uniform and the uniform manager handles 200 sweaty children's outfits. These are places where we do need to just keep our eye, parents of students or students themselves need to-- I'm in a dance class, I'm touching bodies.

If I see a rash, monkeypox should be in the front of your mind, and you should ask your clinician for a test. We do not see any evidence that most folks who are not on a wrestling team who are going to schools and using public bathrooms and taking public transport, that there would be a real call for alarm at this point.

Kai: This is not a casually transmitted virus.

Joseph: That's right.

Kai: Let's go to Nick in Hell's Kitchen. Nick, welcome to the show.

Nick: Hi, thank you. I guess my question was if you could discuss a bit about-- There's so much fear in the greater queer community about the virus and about transmission, and so a lot of people have just been abstinent and nobody really knows at what point, like with any other sexually transmitted infection that's circulating, does harm reduction become a bigger focus than just full abstinence. At what point do you think that's going to become clearer as we learn more? Or do you think that's already clear now? Thank you.

Kai: Thank you, Nick.

Joseph: That's such a great question. I think people need options because long-term abstinence is a failed public health policy. We know that a lot of us have been having different types of sex or way less sex. This has been all the way back from the beginning of our friends getting sick. I had a close friend who was one of the first cases in New York.

When I saw how painful his infection was, a lot of us said to ourselves, "We need to reduce the risk for this in ways that still allow us to have all of the positive aspects of a healthy sex life." The real question, number one, is how effective are the vaccines going to be in practice against the sexual spread of this virus are spread by sexual contact? Number two, how soon can we get everyone who needs one-two shots?

Then if we're giving people a fifth the dose in the skin, is that just as effective? We have real scientific questions that need to be addressed, and that we need to insist that they are addressed as rapidly as possible, but this is going to be a continued conversation around what risks actually are as science fills in that information.

Kai: Do you feel like in the world of scientists, you amongst virologists that there is a sense of urgency now around answering those questions? Does it feel like, oh, yes, the things churn and we're going to know are we still where we were a couple months ago?

Joseph: I'm concerned. I'm concerned that there is a little bit of fatigue in the Fed. We need federal government funding and we need to set up very good rapid clinical trials. It is just going to be a mess because some people will have one full dose and then another fifth dose, some people will have two full doses, some people will have a fifth dose, and a fifth dose at different sites.

I do not see the urgency at really queuing all of those people into good clinical trials to observe the waved vaccine efficacy of these shots. We really, really need that. We need a strong research agenda. That is something that is a major point of advocacy because that will take also financial investment, which might take either the Defense Production Act at the federal level or congressional funding.

There are going to be real financial needs. I also just want to say before we end, patients have real needs. We are asking people to isolate for four to six weeks. Freelancers can't do that without potentially losing their apartment. Everyone I know who's recovered is afraid to touch people again afterward. I got to give my friend a big hug last night for the first time in over a month. The mental health ramifications of being isolated so long, the stigma, the pain are real and people need material help. We have huge advocacy pushes moving forward, both around research and around patient support.

Kai: Another YouTube question. Do you get immunity from having the virus?

Joseph: You do. Again, we don't know how long and at what level, but yes, having the virus definitely gives you very strong immunity at least for a period of years.

Kai: Let's go to Clifton in Inwood. Clifton, we're getting close on time, so if you could just quickly get your question in.

Clifton: My question is if the guest thinks that the city should be making vaccines available to people on Rikers island, given the poor sanitation conditions and closed quarters and the fact that we saw major outbreaks of COVID in Rikers and other prisons. That's my question.

Kai: Thank you, Clifton.

Joseph: Yes. We also know that people who are in gay sexual networks are also in prison, so there is a major need. The city has not done this. The LA Department of Health actually has kept some doses for people who are high need and who are incarcerated. It is an urgent need.

Kai: It is an urgent need. In the book, just to come back a bit to the stories we tell ourselves about viruses, you spent a lot of time thinking about just the metaphors we use with them. One thing you talk about is that we use competitive metaphors about viruses, them fighting us and each other and access to life and all of that, and you want us to find metaphors about cooperation and care, and I just want to prompt you to unpack that for me a little bit.

Joseph: This came a lot from my thinking about HIV. When someone becomes HIV positive, the virus literally cuts your DNA open and inserts itself inside. The virus becomes you, and unless you're one of the five people who have been cured through really severe cancer treatment, that virus will be a part of your molecular content until you die. Really, hating the virus is like hating yourself. It is you. It's a part of you.

The biology of viruses tells us so much about how they live and pass through us. HIV is an RNA virus that puts itself in you for life. Monkeypox is a DNA virus, but it's an acute infection. It will come, replicate and when it is done replicating and your immune system has cleared it, you no longer have that virus in you anymore. The DNA is not there. The proteins are not there, so it lives in you for a time and then will leave as your immunity comes up.

My friends who have been ill have felt so repulsed by their body as it grows these lesions that are painful, they feel like their body is turning against them. I'm just curious about whether we can think about this virus is living in me for a time and then we'll also go away and I will actually be protected from another infection by my own body. There's a conversation between my body and the virus, and I deserve the best care, which includes TPOX, which is an antiviral that will stop the virus from talking so loudly in the time it's in my body. Viruses aren't horrifying, they're scary.

They can literally kill us. HIV with nine genes can end a human life. We have 20,000 genes and 40 trillion cells, but I just ask us to be much more thoughtful about the language we use when we use language of competition or war, because again, viruses are inevitable and then we also need to act with urgency around biomedicine to help everyone who is sick, whether it's with a virus or not anywhere on the planet as a moral act, an ethical act, and also an act of self preservation because infectious diseases show us over and over again, that nobody is separate from all other bodies.

Kai: In the last 30 seconds we have for folks, who are just saying, "Okay, now what for me? I've got all this information, this thing is out there. I'm a gay man. Now what for me?" What is your parting advice?

Joseph: Girl, same, we are going to learn about this together. I'm still doing pretty strong risk reduction around my sexual practices, and I hope that we learn that these vaccines are incredibly effective and that then we can insist that they are used globally to protect everyone in need of care, which is everyone.

Kai: Josephson is a microbiologist at New York university, an author of Virology: Essays for the Living, the Dead, and the Small Things in Between. Thanks, Joseph.

Joseph: Thank you so much for having me.

Kai: The United States of Anxiety is a production of WNYC studios. You can follow us wherever you get your podcast or @wnyc.org/anxiety. Sound designed by Jared Paul, live engineering by Matthew Miranda. Our team also includes Emily Botein, Regina de Heer, Karen Frillmann, Rahima Nasa, and Kousha Navidar. I am Kai Wright, and you can follow me on Instagram or Twitter at Kai_Wright. That's K-A-I _Wright like the brothers. Otherwise, I will talk to you here next week. Thanks for spending time tonight.

 

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