A public health success story: How the mpox crisis was controlled within 6 months

The rapid deployment of vaccines and treatments controlled the virus's spread.

February 2, 2023, 3:11 PM

When the highly infectious mpox virus, formerly called monkeypox, was declared a public health emergency in August of last year, more than 450 people were testing positive every day. With more than 30,000 cases and 28 deaths, many feared mpox could become the next pandemic.

The virus -- characterized by a painful rash and deep lesion -- was primarily spreading via skin-to-skin contact among sexual networks.

Now, roughly six months later, the emergency is over, with the nation averaging fewer than three cases per day. According to doctors and public health experts interviewed by ABC News, the virus didn't disappear on its own. Instead, the virus was controlled through an aggressive, highly coordinated public health response.

"Mpox is a success story of conquering an outbreak," said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco.

The successful control of mpox was due largely to the rapid deployment of vaccines and treatments paired with an aggressive public awareness campaign that leveraged trusted voices in the LGBTQ community, which was hit first by the outbreak.

"Of course there have been criticisms," said Dr. Vincent Hsu, an infectious disease specialist and AdventHealth's infection control officer. "But the fact remains that in a relatively short period of time, we have been able to get the number of cases down to where there's just very few."

PHOTO: Daily Mpox Cases
Daily Mpox Cases

Key to that success was public outreach and education.

"Health departments and community advocates got the message out about mpox -- how the disease presented, how it was spread, how it could be treated and how it could be prevented, including vaccination," said Dr. Roy M. Gulick, chief of the Infectious Diseases Division at Weill Medical College of Cornell University. "The sharp decrease in cases directly resulted from these efforts."

Public health experts credited a strong, unified response from leaders in the LGBTQ community. In fact, the rapid response in the LGBTQ community did not allow the virus to spread even further, Hsu said.

"The LGBTQ community has a strong record of community advocacy and successful interactions with the public health system from the time of the HIV epidemic," said Gulick. "Education led to behavior changes in the community, including limiting the number of sexual partners, as well as the enthusiastic uptake of the vaccine."

"Some of the secret sauce came around communication," added Chin-Hong, including "using trusted messengers from the community" to deliver the message. Chin-Hong pointed to Reggie Aqui, an ABC anchor in San Francisco and an openly gay man, as an example. Aqui was nominated for a GLAAD award for his work and community discussions about mpox.

PHOTO: FILE - A man speaks to a public health worker before receiving the monkeypox vaccine at the Balboa Sports Center in the Encino neighborhood of Los Angeles, July 27, 2022.
A man speaks to a public health worker before receiving the monkeypox vaccine at the Balboa Sports Center in the Encino neighborhood of Los Angeles, July 27, 2022.
Robyn Beck/AFP via Getty Images, FILE

Another smart move was appointing Dr. Robert Fenton and Dr. Demetre Daskalakis to head the federal government's mpox response, Chin-Hong said. Fenton and Daskalakis deployed evidence-based guidelines which helped doctors like him feel comfortable trusting their advice, he said.

Beyond education, an equally crucial factor in controlling the outbreak was the rapid deployment of existing vaccines and treatments that had been stockpiled for smallpox, a closely related virus.

"The prior availability of therapeutics meant we weren’t flying the plane as we were building it," said John Brownstein, an ABC News contributor and chief innovation officer at Boston's Children's Hospital.

In August -- with limited supplies of the only FDA-approved mpox vaccine -- government public health officials made a controversial choice to break up a single vaccine into multiple doses, tweaking the route of administration to maximize the body’s immune response.

Thankfully, this new vaccine strategy worked -- as did existing treatments, according to doctors and public health experts.

Still, experts warn the virus hasn’t been fully eradicated and could return. Although "the emergency is largely over," Hsu said, "we need to continue to be vigilant."

"The mpox response is now a model by which to prepare for future infectious disease threats," Brownstein said.

Added Chin-Hong, "I think mpox generally provides a great playbook of how to deal with an outbreak: the alignment of science and politics needed, a national a local strategy that was implemented and having strong and unified consistent messaging that is empathic and specific."

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