Originally Published: 03 SEP 22 08:11 ET

By Jen Christensen, CNN

(CNN) -- The organizers of Atlanta Black Pride, an LGBTQ celebration held each Labor Day weekend, have big plans. There will be parties and performances, workshops and financial literacy classes, brunches and a boat ride. This year also brings an event that no one ever expected would be necessary: a vaccination clinic.

"We actually got a head start, and we started early, even before the festival, with monkeypox vaccinations for people that are here in Atlanta," said Melissa Scott, one of the organizers.

The festival will also offer Covid-19 vaccines on location.

The monkeypox vaccines won't protect people right away, because two doses are needed, but Scott said the festival is the perfect opportunity to reach a large group of people who have been disproportionately affected by the outbreak.

As of Friday, there are nearly 20,000 probable or confirmed cases of monkeypox in the US, according to the US Centers for Disease Control and Prevention.

The virus is spread through close contact and can infect anyone. But cases in this outbreak have mostly been among gay, bisexual and other men who have sex with men, and no one's been hit harder than those who identify as Black or Latino/Hispanic.

Nearly 38% of monkeypox cases are among Black people, yet they represent only 12% of the US population. Hispanic or Latino people make up 19% of the US population but account for 29% of the cases as of August 27, according to the CDC.

Trends in the hardest-hit cities

Not all US cities keep or publish demographic data. But among those with the most monkeypox cases, people of color are often overrepresented among the sick and underrepresented among the vaccinated.

In Philadelphia, for example, 55% of monkeypox cases are in Black people, 16% are in people who identify as Hispanic, and 24% are in those who identify as white. Yet 56% of the shots have gone to white individuals, 24% to Black people and 12% to Hispanic people, according to the city's website.

In Atlanta, as of mid-August, 71% of monkeypox patients identified as Black, 12% as white and 7% as Hispanic, while 44% of the vaccines have gone to white people, 46% to Black people and 8% to Hispanics.

And in Houston, Black people are overrepresented among the sick, making up 32% of all the cases, but they are only 23% of the population. Only 15% of people who have gotten the vaccine identify as Black, according to the Houston Health Department.

However, while Hispanic people account for 21% of the cases in Houston, they make up 45% of the city's population and 32% of those who have been vaccinated. White people are 24% of the population, 17% of the cases and 39% of those who have been vaccinated against monkeypox.

In Los Angeles County, the health department says 40% of cases are among Hispanic people, yet only 32% of first vaccine doses have gone to members of that community. Hispanics make up 49% of the county's population.

White people are the most vaccinated against monkeypox in Los Angeles. They've gotten 41% of the first doses, and they account for 29% of the cases. White people make up a quarter of the population of the county.

Black people are overrepresented among the cases. They make up 9% of the population in the county but 11% of the cases. Only 9% of those who got their first vaccine dose identify as Black.

It is not totally clear what's driving the differences, but this isn't the first disease to see such inequities, said Dr. Chyke Doubeni, chief health equity officer at Ohio State University. Unless something drastically changes, he said, we'll see the same pattern in the next outbreak.

"I would say as a public health community, we're very good at repeating the same mistakes multiple times," he said. "It's the same story, the same underlying causes. There are barriers to care and information. Systems that require people to stand in line for hours for a vaccine do not work for people with hourly jobs, for instance."

Administration efforts

For months, community leaders have repeatedly called on the Biden administration to step up its efforts to protect this population. On Tuesday, the administration announced that it was launching a pilot program aimed at LGBTQ communities of color.

"It's important to acknowledge that there's more work we must do together with our partners on the ground to get shots in arms in the highest-risk communities," said Robert Fenton, the White House national monkeypox response team coordinator.

"Equity is a key pillar in our response, and we recognize the need to put extra resources into the field to make sure we are reaching communities most impacted by the outbreak."

The administration will send thousands of vaccine doses to organizations that work with Black and brown communities. The initiative will also work with state and local governments to set up vaccination clinics at key LGBTQ events that attract hundreds of thousands of people, such as Atlanta Black Pride, Oakland Pride in California and Southern Decadence in New Orleans. They will send enough vials to vaccinate up to 5,000 people at each event.

Federal health officials say they also will work with local leaders to identify smaller gatherings for pop-up vaccine clinics, like house and ballroom events that are popular with younger people. They've set aside an additional 10,000 vials for those equity initiatives.

Pride Month events in June went by without pop-up clinics. One pilot vaccination program that the administration launched with local public health organizers at the Charlotte Pride Festival and Parade last weekend ended up administering only about a quarter of the doses allocated, but officials still called it a "great success."

"It's important to also respect sort of the strategy that Charlotte may have had in terms of how to get the word out," Dr. Demetre Daskalakis, the White House's assistant monkeypox response coordinator, said Tuesday. "And so, 500-plus vaccines is a great success -- it's not a clinic, and so really, going to Pride and getting vaccinated -- any number, especially that, I think is remarkable."

Outreach efforts paying off

The outreach seems to be working in Fulton County, Georgia, which includes Atlanta and several large suburbs.

Black people make up 79% of monkeypox cases there but are only 42.5% of the population, according to the last census. Since the start of the outbreak, the county Board of Health said, it has initiated its own efforts to engage directly with organizations that work with Black and brown communities. Officials have set up clinics, posted QR codes in bars that link to appointment information, and extended hours at clinics so people don't have to take time off from work to get vaccinated.

As a result, nearly 70% of the monkeypox vaccines that the county has given have gone to people of color, the board said. In comparison, only 10% of doses nationwide have gone to people who are Black, 22% went to Hispanic or Latino people, and 44% went to people who identify as white, according to the Biden administration.

"Communities of color have been hit particularly hard by monkeypox," said Dr. Lynn Paxton, Fulton County's district health director. "So efforts targeting health equity have been especially crucial for the Board of Health."

The Biden administration said equity is a key priority with its monkeypox strategy.

"Our vaccine strategy is to meet people where they seek services, care or community, especially in communities of color," Daskalakis said.

Obstacles to access

The extra efforts have been prompted by several obstacles to access to treatments, vaccines and culturally sensitive education material, public health experts say.

Sean Cahill, director of health policy research at the Fenway Institute in Boston, a health organization that works with sexual and gender minorities, says he has been frustrated by these unnecessary barriers.

For example, the monkeypox treatment Tpoxx is still considered experimental, so patients and doctors have to fill out paperwork required by the CDC to get it. For months, not one of the forms was translated into a language other than English. The CDC made the Spanish-language form available on its website in the second week of August.

"For patients who speak Spanish or Chinese or don't speak a lot of English, it can be a real challenge for them to complete these forms," Cahill said. It's even harder for people who don't have access to a computer or printer.

"There's just some logistical issues that have been a constant challenge to help patients, and there needn't be," he added.

Throughout the outbreak, organizers have been critical of the Biden administration's response to the public health crisis, especially where people of color are concerned.

"As soon as we started receiving a vaccine, we should have had a conversation with Black and brown community-based organizations to lead the way to vaccinate the most at risk," said Daniel Driffin, an HIV patient advocate and a consultant with NMAC, a national organization that works for health equity and racial justice to end the HIV epidemic.

To get a vaccine appointment, particularly in the beginning of the US outbreak when vaccines were in much shorter supply, people essentially had to follow their local health department on Twitter to find out when they were available, Driffin said. The appointments would often fill up in minutes.

"Your health status should not be dictated by Twitter or Instagram," Driffin said.

He added that it's especially difficult for some people to get appointments to get tests or treatments.

"Especially here in Georgia, where many individuals, especially men, Black and brown people, may not have access to regular medical care. So where are they supposed to go?"

Echoes of other outbreaks

This is not, of course, the first health outbreak to disproportionately affect Black and brown communities.

Black people account for a higher proportion of new HIV diagnoses and cases compared with other races and ethnicities. Hispanic and Latino people are also disproportionately affected by HIV.

The CDC says racism, stigma, homophobia, poverty and limited access to health care continue to drive these disparities.

These same communities are overrepresented in the Covid-19 pandemic. People of color have a disproportionate number of cases and deaths compared with White people when accounting for age differences, according to the CDC.

The CDC has regularly said that more needs to be done to help these communities, and public health officials' inclination to want to help is good, Doubeni said.

"But typically, they don't say 'Oh, we have a problem. Let me see how I can work with the community to see what is beneficial for them,' and they especially don't do this from the beginning," Doubeni said.

On more than one occasion, Doubeni said, he has watched government public health officials spend months to create education materials in English. Only after those materials come out will they start working on a Spanish version.

"I think it's all well-intentioned, but unfortunately, it doesn't always begin with an end in mind," he said.

He tells people that because of institutional racism, and for social and economic reasons, those who are in communities of color may have to be persistent to get the treatment they need.

"Don't take no for an answer," Doubeni said. "People should not be ashamed to have to seek treatment for monkeypox. It has nothing to do with them as a person per se. We can control this outbreak and keep it from running out of control. And it's your right to get the answers you need."

Atlanta Black Pride organizer Scott said she's been pleased with the local public health department's targeted outreach. One of the event's goals has always been to strengthen the community's health while encouraging everyone to have fun.

"We're trying to make sure we reach the people who need it most," she said.