How CDPH is Addressing Mpox Health Inequities

Health equity is a public health priority in California and is central to the state’s health improvement plan. The importance of health equity has been further elevated by recent outbreaks of infectious diseases. Socioeconomic components such as environment, employment, and access to healthcare are now more widely recognized as elements influencing one’s health. As with the COVID-19 pandemic, inequities (including structural racism within communities) have played an important role in the mpox outbreak. Throughout the mpox response, the California Department of Public Health (CDPH) has recognized the existence of unequal access to and utilization of health care resources by under-resourced communities.  

Mpox Case and State Population Comparison

Mpox is disproportionately affecting persons who identify as Latino, and as Black/African American. People who identify as Latino are 39.4% of the California population, but 45.0% of the people diagnosed with mpox. Similarly, people who identify as Black/African American make up 5.7% of the California population, but account for 13.0% of the people diagnosed with mpox.  

Mpox Case and Vaccine Recipient Comparison

The comparison of proportion of cases and proportion of vaccinations among racial and ethnic groups reveals a call to action to engage communities to close these gaps in care. Although 45.0% of people who have been diagnosed with mpox identify as Latino, only 26.7% of vaccine recipients identify as Latino. Similarly, 13.0% of people who have been diagnosed with mpox identify as Black or African American, but only 7.3% of people vaccinated in California identify as Black or African American. CDPH is working to ensure that all people at risk for mpox have access to vaccine, regardless of race or ethnicity.  

CDPH is identifying communities most impacted by mpox and securing resources to address mpox health inequities. CDPH will continue to use a community-based approach, by supporting and assisting local health departments and community organizations, in this process. Although much more work is required to tackle these disparities, our focus on equity has been fundamental to building a Healthy California for All.

CDPH has taken action to make sure accurate information, vaccines, and supportive resources are available to California's most vulnerable communities. Some examples of these efforts include:

Working to Reduce Stigma:

The Centers for Disease Control (CDC) defines stigma as: discrimination against an identifiable group of people, a place, or a nation. Stigma is associated with a lack of knowledge about how a disease spreads, a need to blame someone, fears about disease and death, and gossip that spreads rumors and myths.

CDPH is committed to reducing stigma in communities most impacted by mpox. Some examples of this work include:

• Outreach to disproportionately affected communities with non-alarmist, fact-based messaging about mpox. Providing communities with tools for protecting themselves and others.
• Communicating the message that 'anyone can get mpox'. Messages that communicate 'only gay or bisexual men or men having sex with men are at increased risk of acquiring mpox' only stigmatizes LGBTQ individuals, an already marginalized group. Naming specific communities may harm public health efforts. It could cause providers to miss mpox in other communities or discourage some individuals from seeking testing and treatment.
• Focused messaging about prevention strategies, symptom recognition, and the treatable nature of mpox. This helps reduce fear and elevate personal agency.
• Focused messages via channels that directly reach gay, bisexual, men who have sex with men, trans women and non-binary communities, such as specific websites, dating apps, or media programs.
• Using inclusive language, such as 'us' and 'we' pronouns.
• Using "mpox" when referring to monkeypox.
• Recognizing that stigma affects a community's overall well-being, and that some people may need additional support beyond medical care.

Hosting Community Webinars and Listening Sessions:

CDPH hosts community webinars and listening sessions in English and Spanish. These meetings are held for local health departments, community-based organizations that work with the LGBTQ community, and other community members.

• The purpose of these meetings is to provide updates about the status of mpox, share what CDPH is doing to curtail infection rates, inform participants on prevention actions they can take, and provide an opportunity for questions and feedback. These meetings are ongoing.
• The information from these sessions provides CDPH the opportunity to hear about and evaluate the urgent needs in local communities and to implement new strategies and develop more impactful policies.

Participating in Local Meetings:

CDPH regularly participates in local meetings at the invitation of local health departments and communities. Through these meetings, CDPH aims to listen to the current needs in our local communities and use this crucial information to launch actionable prevention strategies, including policy development.

Improving Data Collection to Inform Equitable Public Health Efforts:

• As part of mpox surveillance, CDPH is collecting more comprehensive gender identity and sexual orientation data to allow for more detailed and inclusive information on factors linked to health inequities among persons affected by mpox.
• ·CDPH is conducting focused analysis of a range of factors, including race, Latino origin, census tract, occupation, and more, to identify inequities and inform disease control efforts.

Increasing Access to the Mpox Vaccine:

• CDPH has provided mpox vaccine to local health departments and encourages the use of strategic planning to increase access for communities that have lower vaccination levels. Examples of recommended activities include outreach to affected populations through trusted community-based organizations and redistribution of vaccine to safety net clinics. To learn more about these efforts in your local health jurisdiction, please refer to your Local Health Services/Offices.
• CDPH is working with federal partners to provide vaccines for events that attract populations at risk for mpox. Specifically, CDPH has also worked with the U.S. Health and Human Services Agency to implement a pilot program to provide additional vaccine allocations at large events (those with more than 50,000 attendees) that attracted gay, bisexual, and other men who have sex with men. Through this CDPH pilot, vaccines were provided for September events in Alameda County (Oakland Pride and Oakland Pridefest) and in San Francisco County (Folsom Street Fair and Castro Street Fair)

Efforts to Increase Access to Mpox Treatment:

• Antiviral drugs developed to protect against smallpox may be used to treat mpox effectively, because the viruses that cause mpox and smallpox are similar. The antiviral drug tecovirimat (TPOXX) is one of those drugs that can be used to treat mpox in people with severe disease or those at high risk of developing severe disease.
• To help ensure equitable access to this treatment, CDPH has worked with local health departments throughout California to increase treatment capacity and availability including:
• Conducting outreach to encourage healthcare providers to become TPOXX providers.
• Outreach to clinics serving populations that are vulnerable and at-risk for mpox, including Federally Qualified Health Centers (FQHCs), Ryan White Centers, and Sexually transmitted disease (STD) clinics.
• As of October 2022:
• Over 4,000 oral treatment courses of TPOXX have been distributed in 39 counties.
• There are over 200 TPOXX providers statewide.
• 75% of those providers accept Medi-Cal.
• CDPH is continuing to analyze data and gather information regarding barriers to treatment. This information is used to develop strategies that ensure availability of, and equitable access to, treatment.
• For treatment information, please refer to your Local Health Services/Offices.

State public health leaders cannot address mpox health inequities alone. A Healthy California for All  requires partnership with the private sector, local governments, and community partners at all levels. We continue working with our trusted partners to spread prevention and action messaging in historically underserved communities, to reduce stigma, and to expand vaccine outreach to all. For more information on how to get the mpox vaccine visit CDPH Vaccine page and the CDPH Guidance page for treatment.