We Have a Mission to Complete: Mpox is Not Over
Mpox is not an infectious disease that lives in isolation, it is a part of a “syndemic” of interacting epidemics and negative social determinants of health. Mpox is an outbreak that interacts with other epidemics such as HIV and sexually transmitted infections. It is then intensified by social forces such as racism, homophobia, transphobia, and poor housing access creating a force greater than the sum of its parts leaving a painful, and at times deadly, impact on many, including many in LGBTQI+ communities, particularly people of color. As we look back to the history of the mpox outbreak in the United States, we must acknowledge the fault lines in public health that this outbreak followed and work to address them. We saw the worst outcomes for Black men with HIV who were out of care, many of whom experienced homelessness.1
We must also celebrate the way our community rose up to respond. The “muscle memory” created by infectious disease challenges such as HIV/AIDS and COVID-19 and non-infectious disease challenges such as the fight for LGBTQI+ liberation and marriage equality served the community that compelled the government to move faster in our response to the mpox outbreak. Heroes from outbreaks past and new voices, with notable leadership by queer people of color, accelerated the response by catalyzing the already significant political will to serve the LGBTQI+ community by the Biden/Harris Administration. The multifaceted government response this generated wove together resources from Ryan White, HIV and STI programs at the Centers for Disease Control and Prevention (CDC), drug user and mental health programs at the Substance Abuse and Mental Health Services Administration, and housing benefits from the United States Department of Housing and Urban Development to create a community-directed syndemic response to the challenge posed by mpox. Great progress has been made, with few cases currently being reported every week. Our work, however, is not done.
CDC modeling forecasts that we need to vaccinate more people at-risk for mpox or else we may be faced with a future of more and potentially larger outbreaks in the United States.2 Efforts to improve vaccine equity were only marginally successful, with vaccine-to-case ratios more than 4 times greater for White than Black people.3 To control mpox and reach for equitable domestic elimination of transmission, we must rekindle the passion of Spring/Summer 2022. As of the end of March 2023, only 23% of people who could benefit from mpox vaccination have been fully vaccinated.4 We must mobilize and act now to finish the mpox mission as we approach Summer 2023. With adequate vaccine supply, we need public health and medical providers to keep mpox on their radar. That means testing people with suspect lesions, even if they have been vaccinated or had prior infection, educating people on how to avoid contracting mpox, and vaccinating people to protect their health and to increase population immunity. When we think mpox, we need to think HIV testing, treatment, and prevention to prevent the worst outcome of both diseases. We must work to embed mpox services in the comprehensive sexual health services we offer LGBTQI+ people as we approach summer and the Pride celebrations that we all cherish. The time to act is now! Let’s finish the job!
Demetre C. Daskalakis, MD, MPH
Deputy Coordinator
National Mpox Response
The White House
More
about this journal
Be notified
as new articles are published