When Jackson Hern asked his primary care doctor about getting the monkeypox vaccine in Seattle last week, he was surprised by the lack of information she had to offer.
Concerns about a rising number of monkeypox cases among gay men in Seattle had been all over Hern’s social media accounts.
But Hern, 29, found out he wouldn’t be eligible for a vaccine against the virus in Seattle until the fall.
That is, until a friend told him he’d been able to get one in Vancouver, and sent Hern the link to book an appointment.
“He said they were welcoming Americans with open arms and encouraging them to tell our friends in Seattle,” recalled Hern.
So on Wednesday, he and four friends drove across the border and got their first doses of the monkeypox vaccine, known as Imvamune in Canada, at a Fraser Health clinic in Burnaby.
“I knew being in Seattle, with a really active and tight-knit gay community, it was inevitable we would have an outbreak here… and I was not willing to wait until the fall,” said Hern in an interview with The Tyee.
Dozens of Washingtonians are coming to British Columbia to get vaccinated as monkeypox spreads on both sides of the border and around the world, particularly among men who have sex with men.
It’s a reverse version of the steady stream of Canadians who have been making their way south for third and fourth COVID-19 vaccine doses in recent months.
While there is no official count, Hern and two others told The Tyee they knew over 100 people who had travelled from Seattle to the Lower Mainland for the monkeypox vaccine in recent weeks as vaccine access remains limited in Washington state.
And while B.C. health authorities say they don’t encourage people in the U.S. to come to Canada for their vaccines, Hern and others say they have been welcomed with “open arms” at Lower Mainland vaccine clinics.
“It’s very unfortunate we don’t have the infrastructure or support we need today in King County,” said Hern, referring to the Seattle area.
About 6,000 vaccine doses have been administered in B.C., according to a statement from the BC Centre for Disease Control.
A “small number” of those are from out of province, but it is unknown how many of those people came up from the U.S., a spokesperson said.
By contrast, King County currently has about 1,420 doses to immunize 710 people with the two-dose vaccine. The state department of health attributed that to supply being diverted to states with higher case counts, the Seattle Times reported.
Monkeypox disease is caused by the monkeypox virus.
It is not a sexually transmitted infection. But it is spread through close physical contact with someone with sores and lesions and through items like bedding, towels and utensils. Transmission also occurs via respiratory droplets during prolonged, face-to-face contact with someone who is infected, including during sex.
The virus can infect anyone regardless of their sexual orientation or sexual habits, as it has in the central African countries where it is more common.
Symptoms include fever, rash, swollen lymph nodes, open lesions on the genitals and hands, and headaches. The symptoms can develop anywhere from five to 21 days after infection, and sores can spread all over the body.
Canada has reported 745 confirmed cases to date, with 58 of those in British Columbia.
In Washington state, at least 100 people have tested positive, with 90 of the confirmed cases in King County, which includes Seattle.
The World Health Organization declared the current outbreak a "public health emergency of global concern" last week.
Monkeypox is currently primarily affecting men who have sex with men because an initial superspreader event took place in this community, Vancouver Coastal Health chief medical officer Dr. Mark Lysyshyn told The Tyee in June.
But the vaccine is much more difficult to access south of the border in Washington, where only people with a confirmed direct exposure are eligible at this time.
Antonio Leon, 29, considered driving up to Vancouver when he realized he couldn’t get vaccinated in Seattle. Luckily, a friend referred him to a small clinic that had a handful of doses to administer before he made travel arrangements.
“It does feel like public health has dropped the ball,” said Leon, who knows as many as 20 other people who have driven to Vancouver for their vaccines.
Meanwhile, B.C. health authorities recently expanded eligibility. Anyone 18 or over who is “transgender, or self-identif[ies] as belonging to the gay, bisexual or other men who have sex with men community” and has had or plans to have more than one sexual partner is eligible.
But Hern and one other person who travelled here said there were no questions asked about their lifestyles. “It seems like as long as you consider yourself at heightened risk, they didn’t ask anything else.”
There is no identification or MSP number required to book or receive a shot at one of the province’s 11 immunization clinics. No one is charged for the vaccine.
Matt, 37, started looking around for a vaccine last week when someone he knew in Seattle was infected. “It moved from being just the numbers on the map, to someone within my circle,” he said in an interview. (The Tyee is not using Matt’s last name to protect his privacy.)
Faced with the same barriers as Hern and Leon, he eagerly agreed when three friends invited him to join their carpool to Vancouver. Dozens of his other friends had already been turned away from vaccination in Seattle and he wanted to be protected.
All four of them got immunized “quickly and easily” at a clinic in Vancouver’s West End and enjoyed brunch before heading back home. He says he knows of about 100 people who have done the same in recent weeks.
He is grateful he could get protection, but frustrated he had to cross the border to get it.
“I think it feels a bit Reagan-esque,” said Matt, referring to the U.S. president who ignored and then dismissed concerns in the early years of the HIV-AIDS crisis.
“It’s an illness primarily affecting LGBTQ+ people right now, but it’s being treated as not an emergency until it breaks that [general population] wall.”
It’s not unexpected that Americans are flocking to B.C. for vaccines, say two experts, and it’s heartening to see health authorities welcome them in.
“That totally makes sense given what we know about the slower rollout in the United States,” said Michael Kwag, knowledge exchange and policy development director at the Community-Based Research Centre in Vancouver.
“When the communities most impacted by infectious diseases aren’t getting the care they need, we are willing to take measures into our own hands,” he added. “It reflects the resiliency of the community.”
That knowledge, Kwag, Matt and Leon said, is rooted in learnings from the devastation of the HIV-AIDS epidemic among gay men.
“This isn’t the first time my demographic has been left alone,” said Leon. “And so previous generations who watched their friends die know what to do.”
But not all people at risk in Washington state have the money, vehicle, work flexibility or passport privileges to make a day trip or longer for a vaccine, Kwag added.
Kwag wants to see a comprehensive and global vaccine rollout that is accessible to everyone regardless of citizenship, income, race or ability.
The Community-Based Research Centre has also been outspoken in advocating for increased government supports for people infected and forced to isolate, including housing, income support and wound care materials.
“Prevention is very important, but we’ve really overlooked the care and support end of this issue,” said Kwag.
Health Initiative for Men executive director Aaron Purdie said it makes sense for B.C. to vaccinate anyone at heightened risk right now, regardless of their citizenship or location. The initiative aims to strengthen the health and well-being in "communities of self-identified GBQ men and gender diverse people in B.C."
“At an epidemiological level, there is a huge amount of transmission between Seattle and Vancouver, two major urban centres, so health-care providers are being logical and knowing people would come across the border and access the vaccine,” said Purdie.
Purdie says despite initial concerns about supply, the vaccine rollout in B.C. has so far been a success. The initiative has partnered with health authorities to co-ordinate clinics and spread the word about how to prevent monkeypox in community venues and events.
And it will continue welcoming Washingtonians until the same is available south of the border.
“Queer men are connected in ways that go beyond borders,” said Purdie. “Disease prevention would be a lot easier if there was less restriction and more of a global plan.”