Mpox: Lessons Learned
While mpox isn’t completely gone, the average number of daily new cases has dwindled to the single digits. Still, many questions for public health officials remain.
- By Trudie Mitschang
The U.S. Monkeypox (mpox) public health emergency formally ended in early 2023. Yet, while mpox isn’t completely gone, the average number of daily new cases has dwindled to the single digits. Still, many questions for public health officials remain.
Ambiguous Messaging
The 2022 outbreak of mpox in the United States primarily affected men who have sex with men.1 This led to a difficult time for U.S. public health officials in terms of messaging, which needed to be geared toward an at-risk population that had previously been stigmatized during the HIV/AIDs crises. The Centers for Disease Control and Prevention (CDC) released a statement saying “infection could occur during close physical contact, and also through contact with contaminated surfaces like sheets or towels.” They stopped short of naming mpox a sexually transmitted disease (STD).1
“People felt that if they called it an STD from the get-go, it was going to create stigma, and because of the type of sex that was occurring — oral sex, anal sex, anal sex between same-sex male partners — there may not have been the same kind of federal response,” said Jeffrey Klausner, MD, MPH, a clinical professor of public health at the University of Southern California’s Keck School of Medicine. “It was actually a political calculation to garner the resources necessary to have a substantial response to be vague about how it spread.”2
However well-intentioned, the purposeful ambiguous messaging created confusion that likely led those in the impacted populations to continue engaging in risky sexual behavior during the height of the outbreak. “I think there was a balancing dance of not wanting to create stigma, in terms of who is actually the highest rates of transmission without being forthright,” added Tony Hoang, executive director of Equality California, a nonprofit advocacy group for LGBTQ civil rights.2 Hoang’s group eventually launched its own public information campaign, stressing that sex was the risky behavior and clarifying that light brushes or touches weren’t likely to pass the infection.
Vaccines Versus Behavior Change
According to CDC, people who were unvaccinated were almost 10 times more likely to be diagnosed with the infection than those who got the recommended two doses of the Jynneos vaccine.3 During the summer of 2022, demand for the vaccine escalated in the gay community amid widespread reports of vaccine shortages. In the end, CDC estimates that while two million people in the United States were eligible for mpox vaccination, only about 700,000 received even a single dose.1 Looking back at the trajectory and dramatic tapering off of the virus, experts say inoculation is almost certainly not the entire reason for decline, simply because not enough people were vaccinated. Instead, CDC suggests behavior change may have played a substantial role in curbing the spread.
In an online survey of men who have sex with men conducted last year, half of participants indicated they had changed their behavior out of fear of infection.4 If that shift proves to be a significant factor in curbing the spread of mpox, some worry the United States could see a another surge when behavior patterns shift once again.
A Look at What’s Next
Education about mpox and access to vaccination seem to be key to curbing a future outbreak. Since nearly 40 percent of cases in the United States were diagnosed in people who also have HIV, CDC plans to ensure mpox vaccines are available as a routine part of care at HIV and STD clinics. Officials are also planning to attend LGBTQ events to offer onsite vaccinations and study people who’ve been vaccinated and/or infected to see whether they remain immune.1
“We’re starting to see some data that suggests asymptomatic infection and transmission is possible, and that certainly will change how we think about this virus,” said Anne Rimoin, PhD, MPH, an epidemiologist at the Fielding School of Public Health at the University of California, Los Angeles.1
In terms of addressing disparities, Hoang says Equality California is pushing for change: “We’ve learned that we have to take health into our own hands, and I do think that we will remain vigilant as a community for this outbreak and future outbreaks.”
References
- World Health Organization. 2022-23 Mpox (Monkeypox) Outbreak: Global Trends, April 11, 2023. Accessed at worldhealthorg.shinyapps.io/mpx_global/#section-fns2%E2%80%982022%20Monkeypox%20Outbreak:%20Global%20Trends.
- Goodman, B. Mpox Is Almost Gone in the U.S., Leaving Lessons and Mysteries in Its Wake. CNN Health, Jan. 31, 2023. Accessed at www.cnn.com/2023/01/31/health/mpox-public-health-emergency-lessons/index.html.
- Payne, AB, Ray, LC, Cole, MM, et al. Reduced Risk for Mpox After Receipt of 1 or 2 Doses of JYNNEOS Vaccine Compared with Risk Among Unvaccinated Persons — 43 Jurisdictions, July 31-October 1, 2022. Morbidity and Mortality Weekly Report, 2022 Dec;71(49):1560-1564. Accessed at www.cdc.gov/mmwr/volumes/71/wr/mm7149a5.htm.
- Centers for Disease Control and Prevention. Impact of Mpox Outbreak on Select Behaviors, updated Aug. 22, 2022. Accessed at www.cdc.gov/poxvirus/mpox/response/2022/amis-select-behaviors.html.
