Last Call for the Monkeypox Vaccine Van

Michael Doshier was on his way to a party at the House of Yes, a graffiti-splashed dance club in Bushwick, last Thursday night when he got a text. “We actually didn’t go in yet,” his friend wrote. “They’re giving out monkeypox vaccines so we’re getting them!”

With a vaccine van right outside the club, the decision was easy for Mr. Doshier, 31, a gay man who was worried that he could be at risk of getting monkeypox but who had not yet gotten vaccinated.

He registered with a city health worker and stepped into the white van that was serving as a mobile clinic.

“I think it’s an amazing service,” he said afterward.

It was also the van’s last night outside the club.

The city’s mobile vaccination program for monkeypox, which has placed vans outsidecommunity centers, nightclubs and sex parties since late summer, has lost its funding and is coming to an end. The mass vaccination sites that the city set up this summer also closed on Nov. 14.

With monkeypox cases in the city now at an average of three per day, down from more than 70 a day in late July, both New York City and state governments have quietly ended their monkeypox states of emergency, though the federal government has continued its emergency declaration.

Monkeypox vaccinations are being moved to outpatient and sexual health clinics run by the city hospital system and private providers. The city, which funded the response without federal aid, says it is now moving to make monkeypox vaccination part of routine health care, banking that those at risk will still get both doses of the two-dose vaccine even if it is less convenient.

Dr. Ted Long, executive director of the Test and Treat Corps at the city’s public hospital system, said he was working on a proposal to bring back the vans — which administered 3,330 doses at 72 different sites — to offer both vaccines and other sexual health care in the future. The city has classified monkeypox as a sexually transmitted infection, because it has been spreading primarily through sexual contact, particularly among men who have sex with men.

“Our goal with the mobile units is always to use them to tear down every conceivable barrier that we can to make it as easy for you to get vaccinated and as easy for you to get protected as possible,” he said.

The city health workers who have spent months visiting clubs expressed mixed emotions as they worked last weekend. Showered with gratitude by those getting doses, they said they would miss helping and educating people about the disease. But they also said the numbers of people getting doses had fallen as the outbreak receded.

At the House of Yes, 11 people got vaccinated Thursday night. On Sunday night at the Eagle NYC, a leather bar in Manhattan, 14 people did.

Among them was Karim Walker, 43, who lives in East New York, Brooklyn, and works in a law firm in Lower Manhattan. He had to travel to the Bronx to get his first dose in July, and had a one- word answer for why he had not yet gotten his second dose.

“Timing,” he said.

“While we would love for anything to be extended, this was an emergency operation, and emergencies end,” said Jennifer Medina Matsuki, who normally does H.I.V. outreach work but since June 18 has been spending nights educating people about monkeypox. Still, she said, she was relieved “that this emergency didn’t become something larger.”

When monkeypox was first diagnosed in New York at the end of May, it was not clear it would go this way. The federal government had developed a new smallpox vaccine that would work against monkeypox, but most of it was in a Danish factory, not ready to be shipped. Testing was hard to access, and health providers needed to be educated about a disease that had never spread globally at this scale.

As for the vaccine, there was limited research showing how well it would work against monkeypox. The city’s initial vaccine rollout was marred by glitches and doses went disproportionately to white residents. But the combination of voluntary behavior change, vaccine doses and immunity caused by infection has dramatically slowed cases, both in New York and nationally.

Across the nation, there are now about 25 cases a day being reported, down from a peak of about 450 per day on Aug. 7. Even so, the White House has not declared victory.

“While we are seeing decreases nationally, there’s still some areas where we’re seeing some embers that are glowing,” said Dr. Demetre Daskalakis, the deputy coordinator of the White House’s monkeypox response. “We’re not done with the work that we need to do to really get us to the goal of no domestic transmission in the United States.”

Case rates remain higher among Black and Hispanic men than among white men, and some southern states, like Texas, have had less success in reducing cases than New York, according to Centers for Disease Control data. Monkeypox is also causing serious disease in people with H.I.V. and has led to at least 11 deaths across the country. The concern is that the disease will continue to circulate among those most vulnerable and occasionally flare into outbreaks.

In New York City, the news is largely good. The flood of patients that sexual health clinics saw this summer has slowed to a trickle, said Dr. Jason Zucker, an infectious disease specialist at Columbia University Irving Medical Center.

But racial disparities remain in who has been vaccinated, and Black men in particular are behind. Health care providers also still have to reach tens of thousands of people who need second doses, which cannot be given until 28 days after the first.

To date, the city has administered about 100,000 first doses and 50,000 second doses of the vaccine, enough to help bring the city’s outbreak to “the tail end,” said Peter Meacher, chief medical officer at the Callen Lorde sexual health clinic.

Still, the city estimated in July that 150,000 New Yorkers were at high-risk for the disease, so tens of thousands of them remain unvaccinated. New York City, the early epicenter of the national outbreak, has recorded about 3,800 virus cases since May. Nationally, there have been about 29,000 cases since the outbreak began, and the disease continues to spread globally.

A particular focus of the mobile units was commercial sex parties, which represent some of the highest-risk settings for monkeypox transmission. Most gay bathhouses in New York City shut their doors during the AIDS epidemic, but over the years, they were replaced by sex parties that operate in low-key or clandestine venues.

As the city’s gay population was hit hard by monkeypox this summer, the main sex parties voluntarily closed their doors for between six weeks and two months, said Joseph Osmundson, a microbiologist at New York University, who helped to act as a liaison between the parties and the city. When the parties reopened in early September, the city stationed vaccine vans a discreet distance away.

Partygoers flocked to the vans. At one party, Inferno, about 60 percent of attendees lined up to get shots on the first night, Dr. Long said. At a G.B.U., or Golden Boys University party, 102 people got a vaccine dose when the party reopened on Sept. 9, said Garline Almonord, the supervisor of the vaccine minibus that night.

“It was exciting to see that many people around,” she said.

Infection numbers did not spike as the sex clubs reopened, said Dr. Long. As the weeks passed, traffic to the vans lessened as most attendees said they had already been vaccinated. By last weekend, at G.B.U.’s clandestine Brooklyn location, only four people had received doses by 1 a.m.

For those people, however, the presence of the van was a relief. Ronald Cortez, 38, came to get a shot at about 11:30 p.m. He said he had the first shot in August, but lost track of time and did not get the second.

Hieronimo Torres, 26, who works at the door checking IDs, got his first dose, knowing it was the van’s last night at the party. “I’ve been meaning to do it,” he said.

Nate Schweber contributed reporting.