Public health emergency for mpox officially ends

The public health emergency for the mpox outbreak that began last year is officially ending as of Tuesday, with the number of reported cases continuing to dwindle and advocacy groups declaring the emergency’s conclusion a victory for the LGBTQ community.

The Biden administration announced in December that it was not expecting to renew the public health emergency (PHE) for mpox, previously referred to as monkeypox, that was first declared in August 2022. The PHE was renewed once in November.

“From the outset of the mpox outbreak, the Biden-Harris Administration – working through HHS and many of its agencies – pulled every lever to stop the spread of this virus,” a Department of Health and Human Services spokesperson said in a statement.

“Given the low number of cases today, HHS did not renew the emergency declaration. But we won’t take our foot off the gas – we will continue to monitor the case trends closely and encourage all at-risk individuals to get a free vaccine,” the spokesperson said.

The most recent data from the Centers for Disease Control and Prevention (CDC) shows the seven-day moving average for mpox cases to be three, a steep drop from when cases peaked in August with more than 400 being reported daily on average.

Over the course of the outbreak, more than 30,000 cases and 26 deaths were reported in the U.S. The vast majority of cases were among men.

Unlike the COVID-19 pandemic, treatments believed to be effective against mpox were already available at the beginning of the outbreak and were readily deployed to high-risk populations, namely men who have sex with men.

The first cases detected outside of nonendemic countries were in Europe, and it is believed that the virus, belonging to the same family of viruses as smallpox, spread through the social networks of gay and bisexual men.

Due to the closely related nature of mpox and smallpox, treatments and vaccines for smallpox were deployed, albeit with some bumps in the road. Jynneos, a newer smallpox vaccine, became the preeminent vaccination option for men who have sex with men to protect against mpox. Antiviral treatments such as TPOXX, or Tecovirimat, were also made available.

Many clinics found themselves inundated with concerned community members, however, and were unable to meet the demands for vaccinations and testing. The smallpox vaccine shortages became so dire that the U.S. eventually adopted a reduced vaccine strategy in which a fifth of a normal two-dose vaccine would be administered intradermally to stretch supply.

As of the most recent CDC data, about 1.18 million doses of smallpox vaccines were administered during the monkeypox outbreak.

During the vaccination campaign, health experts noted that the LGBTQ community was primed for handling viral outbreaks due to the HIV crisis. Many gay and bisexual men were knowledgeable about mitigating the spread of viral diseases.

Federal health authorities would later attribute the early progress made in combating the virus to the changed social practices of men who have sex with men. A CDC survey found that half of men who have sex with men said they reduced their levels of sexual activity in response to the mpox outbreak.

The Human Rights Campaign (HRC) lauded the LGBTQ community for its efforts in bringing down the mpox outbreak on Tuesday.

“Today, we enter the next phase in the continuing fight to end Mpox and maintain the health and well-being of LGBTQ+ people everywhere,” HRC President Kelley Robinson said in a statement. 

Sean Cahill, director of health policy research at the LGBTQ health advocacy organization the Fenway Insitute, similarly applauded the actions of community members in reducing mpox transmission.

“We commend the thousands of gay and bisexual men who advocated for themselves, fought hard to get vaccinated and treatment for mpox, and took other steps to reduce transmission of mpox,” Cahill said. “We also commend health care providers and public health officials at the local, state and federal level who worked hard to end this outbreak.”

However advocacy groups cautioned that the end of the PHE did not mean the end of the issues associated with the mpox outbreak.

“Make no mistake, Mpox is still with us – and much the same with other health issues, it disproportionately impacts Black and Brown LGBTQ+ community members. We will work tirelessly to make sure as many people as possible remain healthy,” Robinson said.

Cahill noted that “in the early months it was too hard to get a test, a vaccine, or treatment” and advised the U.S. to hold on to the lessons of this outbreak.

A coalition of public health and LGBTQ advocacy groups, the National Mpox Working Group, issued a letter to President Biden on Tuesday, warning of the continued “lack of readiness” the U.S. currently has for the next viral outbreak.

“Mpox was the first national novel infectious disease to test many of the systems put in place during the COVID-19 pandemic, and it offers a roadmap to prepare for the next outbreak,” said the groups.