The Bittersweet Defeat of Mpox

For a few weeks this summer, the world worried that monkeypox might become the next global pandemic. At the peak in early August the US was recording 600 cases a day, and the health authorities’ fumbling response echoed the early days of Covid-19. Vaccines were slow to arrive and in short supply for most of the fall. Testing was bottlenecked. Antiviral drugs, though they existed, were almost unobtainable because they hadn’t been federally authorized for the disease. While most cases were among gay and bisexual men, there were fears that the rarely fatal but often extremely painful infection, which can can take weeks to subside, might spread to the broader population. 

Things today look very different, at least for now. By mid-December, mpox, as the World Health Organization has now renamed it, had appeared in 110 countries, but the spread had dramatically slowed. The US, which had recorded 29,740 cases as of December 21—more than a third of the global total—was registering barely a handful each day. 

While one reason is that access to vaccines and testing improved, and another is that mpox is inherently much harder to transmit than Covid, the biggest, most agree, is that the people most at risk took their protection into their own hands in those crucial early weeks when the authorities were flailing. “The success was the community mobilization,” says Joseph Osmundson, a queer activist, molecular microbiologist, and clinical assistant professor at New York University.

Osmundson helped broker what might be taken as a symbol of the response to mpox: a fleet of tall, white-painted vans with windows masked for privacy. Inside, each van was a mobile vaccine clinic, operated by the New York City health department. Between Labor Day and Thanksgiving, these vans parked late at night outside bars and clubs that cater to gay and bisexual men, including some that host sex parties. (Many of those parties also shut down voluntarily for a period.) The queer community told the city where people would be most at risk, and the venue owners agreed that protecting their patrons was worth the possible stigma of having the vans parked outside. The van vaccination program administered more than 3,000 doses.

The program showed a health department being smart about where to find people who needed help, but just as much, it represented a community that wasn’t willing to wait for the health bureaucracy to find them. From the beginning of the mpox epidemic, gay and bi men as well as others in the queer community had reached out, badgered, and agitated. Some who had caught the disease posted online videos or gave press interviews describing their symptoms in intimate detail, defying the risk of social shaming (“He caught monkeypox, guess what he’s been up to”) to warn others about the risks. People posted information to social media and WhatsApp groups about which clinics still had vaccine supplies or how to get diagnosed when most physicians had never seen a case of mpox before. Those lucky enough to get antiviral treatments before they were made generally available circulated advice for people to pass on to their doctors on navigating the mind-numbing bureaucracy for an individual authorization.

Pretty much everyone agrees that queer men, particularly those with a lot of sexual partners, get the credit for that ski-slope decline in cases. As research by the US Centers for Disease Control and Prevention demonstrated in the fall, men who felt at risk voluntarily abstained from sex, kept to one or a small number of partners, signed out of hook-up apps, or skipped the kind of parties where group sex happens.