Mpox

Addressing Disproportionality in Communities Most Impacted by Mpox

Despite mpox’s vast spread, the impact of this disease has proven far more devastating for people of color and communities with fewer health affirming resources. The disparate numbers of mpox infections are due to several factors, including but not limited to the spread of mpox within social and sexual networks; limited access to medical care; stigma, fear, and mistrust associated with accessing care and getting vaccinated; and increased risk of infection with severe outcomes due to underlying medical conditions (e.g., HIV infection). While individual behavior plays a role in a person’s level of risk, barriers to accessing protective social determinants of health, including a living wage, health insurance, quality housing, healthy and affordable food, transportation, and safe spaces to gain social support have widened the gaps.

Disparities in mpox outcomes are an important reminder that the conditions that people live, work, and socialize in can place them at much higher risk for both exposure and negative outcomes. These deep disparities mirror the trends seen in other health outcomes. They did not happen by chance and reflect decades of social marginalization, community disinvestment, and the legacy of racism. These inequities create and maintain a persistent and challenging problem that requires collaborative, multi-sector approaches to repair and prevent in the future.

These challenges have informed the strategies used to serve communities disproportionately burdened by mpox, including Black/African American, Latino/x, and other communities across LA County. Public Health is working directly with community providers and community-based organizations that serve highly impacted residents to inform the development and implementation of strategies to improve mpox-related outcomes in highly impacted groups of residents. Efforts to date include:

• Facilitating access to vaccination for overburdened groups, including:
  • Racial/ethnic and other communities with fewer health affirming resources that are faced with higher case rates and lower vaccination rates
  • Persons currently experiencing homelessness or intermittent homelessness who frequent shelter services
  • People living in congregate settings (e.g., correctional settings, substance use treatment centers, congregate housing, or dormitories)
• Ensuring widespread, ready access to testing, care, and treatment to facilitate early identification of cases, limit spread, improve recovery, and prevent severe disease and complications through a complement of activities including:
  • Coordinating and educating providers on who to test and how to collect specimens
  • Ensuring testing capacity at the Public Health Lab including sequencing and resistance mutation testing
  • 35 treatment hubs and more than 400 satellite sites including community-based clinics serving the most vulnerable patients
  • Public clinics for any patient regardless of insurance status including testing and evaluation and supportive services such as transportation
  • Nurse, public health investigators and community worker active follow-up of patients and linkage to other services including HIV care
• Coordinating a network of Public Health sites and community-based vaccine clinics throughout the County to provide mpox vaccinations and answer any questions about the vaccine. At the time of writing, this includes:
  • 64 community-based clinic sites serving populations at risk for mpox
  • 26 public vaccinating sites supported by mobile vaccine teams and pharmacy partners
  • 18 healthcare providers connected with health systems
  • 17 public health sites, including health centers and points of dispensing (POD)
• Assessing the need for wrap around services and facilitating access to supportive resources including basic hygiene items, medication, and mental health services for patients and transportation, housing support, and food and water for patients unable to isolate safely
• Providing public data on cases, vaccination, and treatment by race/ethnicity, gender identity, sexual orientation, age, and geography for transparency, monitoring, and evaluating progress on eliminating disproportionality
• Co-hosting mpox informational events, ranging from regular meetings with community stakeholders and health care providers to in-person community events and virtual townhalls that promote positive sexual health and address community concerns and misinformation
• Co-developing clear messaging delivered by trusted messengers on what mpox is, what behaviors might lead to infection, and how to protect against the disease
• Expanding the use of highly used media strategies, including utilizing recognizable messengers and geographically targeted advertisements and billboards to increase awareness and information
• Advocating for community-elevated equitable policies and investments during conversations with elected officials, sector-specific partners, and other decision makers, including:
  • Swift allocation of resources (e.g., vaccines, treatment) and funding for highly impacted groups already burdened by stigmatization and a history of government inaction
  • Clear reimbursement pathways for testing, vaccination, and education conducted by community-based entities (e.g., FQHCs, community clinics)
  • Competitive pricing (e.g., 340B pricing) of vaccines that help prevent diseases that can spread through close intimate contact (e.g., mpox, meningitis, HPV) for entities that primarily serve highly impacted groups including FQHCs, Ryan White Program (RWP, 318 STD providers)
  • A comprehensive approach to health to best serve marginalized communities (e.g., gay men, transgender individuals, transitional age youth, persons experiencing homelessness), including promoting linkage to primary care and vaccination against HPV, meningitis, mpox, COVID-19, and flu
  • Robust data collection infrastructure, requirements, and enforcement that facilitates timely and transparent public health surveillance and reporting
  • Continuous investments in public health infrastructure, particularly, community and faith-based entities that serve as ambassadors during public health emergencies