As with the lines for Zuckerberg San Francisco General Hospital’s monkeypox vaccine clinic, the queue outside Steamworks, a gay sauna in Berkeley, was several hours long on Wednesday. Except, in the case of Steamworks, there were not one but two lines of people hoping for a jab from the bathhouse’s 500-dose allocation.
One line served the general public—essentially, anyone who wanted to get vaccinated between noon and 8 p.m. The other, shorter line, was for paying club members to use the facilities. If they wanted a vaccine as well, then they could wait for one, but they wouldn’t have to do so in that other, hours-long line.
This is, at least in part, because Steamworks is not actually a health clinic, but a private entity—one that was open for business as usual on Wednesday, arguably one of its more popular days. But the two-tiered system revealed the conflict that arises when a public-health emphasis on equity collides with a scarce, hotly coveted resource.
Texting after receiving their shot, one person told The Standard that “people were MAD…It was just very confusing at the time and annoying. Plus it didn’t really make it go faster for anyone.”
Making matters worse, numerous witnesses reported that Steamworks employees offered—or at least touted the existence of—one-day memberships that would enable people in the longer line to skip ahead. (Reportedly, they cost $24, but some quoted other dollar amounts.)
To many grumbling observers, this policy felt elitist—if not outright profiteering off a crisis—like VIP access for something that ought to be purely democratic. The Standard spoke to half a dozen people, and although some details contradicted one another—specifically, estimates of how many people got in on the shorter, members-only line—the composite picture was one of confused resignation mixed with trauma-bonding.
Dr. Tyler TerMeer, the CEO of the San Francisco AIDS Foundation, said that “vaccine equity is a large priority for us, and we’re encouraging both clinics and non-community-health organizations who may end up with [vaccine] access to think through their approaches to vaccine distribution.”
While this situation appeared without precedent to him, TerMeer noted that sex clubs like Steamworks have been used since the earliest days of the HIV/AIDS crisis as trusted partners to get important public-health messaging out and make testing accessible.
Zose Newell, Steamworks’ general manager, spoke with The Standard as he shuttled groups of five to the medical tents behind the venue. (Another group of clinicians and administrators had set up inside as well.) Having worked for 12 straight hours, he disputed the term “VIP line” and insisted that everyone holding a blue ticket would be seen.
“There’s not a VIP line, there’s a line for customers who go into the business that we run and there’s a line for vaccinations,” he said. “If you’re a customer and you check in and you happen to want to get vaccinated, you’re still going to wait in line. … It’s now 6:30, and we’re going through everyone in line. All 500 people who got a ticket will be vaccinated between noon and 8 p.m.”
By 6 p.m., after waiting more than seven hours, Alexei Othenin-Girard had reached the front of the line, holding a blue ticket that Steamworks staff distributed to indicate that he would definitely receive his shot.
“I was 150th in line when I got here at 10:20 a.m.,” he said. “I got to know the people around me, having stood creeping very slowly around the corner to the front of Steamworks. They were supposed to be open at noon. I figured I’d be here until two.”
A gay resident of Oakland, Othenin-Girard ventured that the very first people in line had arrived between 8 and 9 a.m.
“Given the rate at which they’re going, I have no idea how they will vaccinate the 350 people behind me,” he said. “They started an hour late.”
Regarding Steamworks’ dual-line system, which Othenin-Girard called “extremely effed up,” he expressed doubt that it had even worked as intended for everyone, noting that even those who paid still waited at least a few hours.
“There has been a lot of scuttlebutt about whether that was an effective strategy, but one of the people here talked about a friend of theirs who got here an hour and a half after we did. He got here at three and out before six.”
Farther back in line, a mellow, 39-year-old Oakland resident who declined to give his name because of employment concerns had also been waiting for seven hours, but wasn’t certain if his blue ticket guaranteed he would be seen. This was his first attempt at procuring a monkeypox vaccine. Was he upset at the logistics?
“It’s complicated,” he said. “Steamworks is a private institution. They’re not a public health institution. They’re doing a community benefit, so they are taking somewhat of a hit. If it’s like, ‘OK, we have to look out for our team and our business,’ then maybe that’s the calculation that has to work out.”
There is some degree of economic privilege inherent in standing in line all day, he added. And $25 is hardly scalping, either.
Newell said the clinic would happen every Wednesday, assuming Steamworks could obtain vaccine doses, but that he would probably operate with a single line. He had also heard his share of complaints throughout the day.
“We’re trying to be a public service, but I get it: There are all sorts of personalities and not everyone’s going to be happy,” he said. “It’s a game of telephone, too. Someone said, ‘If you’re checking in, get in line. When it got to the end of the line, it was ‘We’re giving away free Ferraris.’”
The presence of trained medical clinicians implies official approval. However, the Berkeley Department of Public Health did not respond to requests for comment by phone and email. Alison Hawkes, the director of communications for the San Francisco Department of Health, declined to address a situation that was outside her department’s jurisdiction.
“The monkeypox vaccine is currently in limited supply and it has been recommended by the State to vaccinate those at highest risk,” the Alameda County Public Health Department said in an emailed statement. “We have been performing targeted vaccination clinics in high-risk settings. Vaccinations are free and there is not a charge. We are working with the sites to improve clinic operations.”
Access aside, another thorny monkeypox question concerns who is truly eligible for vaccination. Strictly speaking, only people with suspected exposure are allowed; those simply being cautious have been asked to wait. But “exposure” can be a very loose term.
“Unfortunately, in our case in San Francisco, it’s a very large group if you attended one of the parties with known exposures during Pride weekend,” TerMeer of the San Francisco AIDS Foundation said. “Also, in a moment of very valid fear and concern, people are wanting a preventive vaccine as quickly as possible, so they’re using all their means necessary at walk-in clinics. It’s a free-for-all.”
Strut, the foundation’s wellness center in the Castro, is down to its last 500 doses, all of which are scheduled to run out by the end of day Friday. TerMeer confirmed that as of Thursday morning, the wait list has some 2,769 names.
Astrid Kane can be reached at firstname.lastname@example.org