U.S. declares end to mpox emergency

On Tuesday, the U.S. government quietly declared that the mpox emergency is over.

The official mpox public health emergency was declared in August 2022 and renewed once in November. The first cases of the disease were reported in May of last year.

“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.

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“Given the low number of cases today, HHS did not renew the emergency declaration.”

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The latest data from the Centers for Disease Control and Prevention (CDC) shows the seven-day average for mpox is three cases, a dramatic drop from the August peak of 400 cases per day. More than 30,000 infections and 26 deaths were reported in the U.S. over the course of the outbreak.

The response and outcome was a victory for public health agencies, LGBTQ+ advocacy groups and the public at large.

“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,” said Sean Cahill, director of health policy research at the LGBTQ+ health advocacy organization the Fenway Institute.

“We also commend health care providers and public health officials at the local, state and federal level who worked hard to end this outbreak.”

The understated end to the government’s emergency response was in stark contrast to the early days of the mpox outbreak.

The first cases detected outside endemic African countries were reported in Europe in May. By June, mpox had reached North America, with cases reported in both the U.S. and Canada. Controversy surrounding the means of transmission and the populations most at-risk were soon making headlines.

“Lessons from the AIDS response show that stigma and blame directed at certain groups of people can rapidly undermine outbreak response,” UNAIDS said at the time.

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Throughout the summer, far-right groups used mpox as a cudgel in their continuing assault on the LGBTQ+ community, with calls for quarantines and assaults targeting gay men believed to be harboring mpox.

The reinstalled Taliban government in Afghanistan used mpox as an excuse to persecute the LGBTQ+ community, while anti-LGBTQ+ U.S. Rep. Marjorie Taylor Greene (R-GA) simultaneously called mpox just “another scam” like Covid-19 and blamed gay men for spreading the disease to children.

The U.S. government and public health agencies came under fire, as well, for a stumbling response to the outbreak. While an effective vaccine related to the smallpox virus was already stockpiled, information on where and when to get vaccinated was hard to come by. Poor distribution protocols forced gay men in the U.S. to travel to Canada for mpox protection.

At the beginning of August, the Biden administration announced a course correction, with a new task force including FEMA logistics expert Robert Fenton, and the director of the CDC’s Division of HIV and AIDS Research, Dr. Demetre Daskalakis, an out gay man who became the face of the White House response.

In an interview with LGBTQ Nation, Dasklakis described the new strategy to combat mpox, “a three-part trick that always works in addressing outbreaks and epidemics: community engagement, science and political will.”

By October, the results were clear: since a peak in August, the number of reported daily cases of the monkeypox virus had declined 85%.

“The strategy worked,” Daskalakis told LGBTQ Nation at the time. “I think that the really frank, direct information that we generated through governmental public health, and then saw the community alter, magnify, and contextualize, got out,” he said. “Seeing people who reduced their behaviors that could potentially expose them to monkeypox was definitely a part of this.”

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Looking ahead, public health officials are keeping several key findings in mind as they continue to monitor mpox.

Almost 40% of cases in the U.S. were diagnosed in people who also carried HIV, so the CDC is advocating to make mpox vaccination a regular part of HIV and STI care and at clinics that offer PrEP.

Officials are also keeping an eye on the weather. The CDC found men who have sex with men (MSM) reduced their partners at the height of the outbreak in August by half, contributing to the virus’s decline to the small numbers seen today. Officials are waiting to see if warmer weather and more contact among the MSM community alters that trajectory.

Finally, officials are keeping an eye on asymptomatic transmission. Researchers at a clinic in Belgium re-screened hundreds of STI tests from May and discovered positive mpox cases that went undiagnosed. Three patients showed no symptoms of the disease, indicating mpox could be carried and transmitted by individuals without ever knowing they had it.

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