In 2022, Europe, the US, and Canada experienced widespread community transmission of mpox, constituting a health emergency. Previously, mpox had been endemic to Central and Western Africa. In the UK, a wide response involving multiple stakeholders was developed. In this article, Dr Maurice Nagington, Dr Jeremy Williams, and Dr Jaime Garcia-Iglesias discuss the findings of their research into the response to mpox, and suggest how policy actors and public health officials can co-produce best-practice to respond to future outbreaks of infectious diseases.

• Effective messaging and communication strategies were essential in responding to the mpox outbreak.
• Infrastructure is needed to support rapid co-production of messages with communities, and to establish mechanisms for responsible information dissemination.
• Social media is a crucial tool for disseminating health information, but it may be inaccessible for some communities.
• Marginalised communities require dedicated and comprehensive, social, and biomedical support.

In the early summer of 2022, the UK experienced a significant outbreak of mpox which, by August 2022, meant that as many as 78 new cases were being reported per day. Unlike previous outbreaks, the primary reported transmission route was sexual and predominantly amongst gay, bisexual and other men who have sex with men, leading to academics exploring whether to treat it as an STI. While for most people mpox infection is a self-limiting (albeit painful) disease, there is evidence that groups who already experience poorer health can be disproportionately represented in hospital admissions and deaths from mpox. Based on this evidence, the UK Government targeted messaging and vaccination events for Bangladeshi and Black communities.

It is in this context of an ongoing public health crisis that we began this research in October 2022 to understand what lessons could – and should – be learned. The resulting report highlights the need for changes in healthcare delivery and organisation, and for interventions that address the unique needs of various communities and contexts. There were shortcomings in national leadership, stark local and regional inequalities in relation to vaccine access, and inadequate communication infrastructures. These findings were informed by interviews and focus groups with various stakeholders engaging with affected communities, and those who sought to treat them.

The report also highlights the critical role of sexual health services, which were essential in responding to the mpox outbreak, but which have long faced resource limitations that hampers their capacity and effectiveness. Professional bodies and various third sector organisations played a crucial role in responding to the mpox outbreak, helping to rapidly develop and share information as well as advocating for increased resources. Finally, social media is an important tool in public health messaging, but building and investing in relationships to get messaging out is a key part of pandemic preparedness, and as such capacity and skills in this area should be further developed.

Recommendations for public health policy and practice

In order to be prepared for – and minimise the impact of – future similar outbreaks, the following key areas need to be addressed:

1. Targeted support for marginalized communities:

The mpox outbreak disproportionately affected marginalized communities. In particular, people from BAME backgrounds appeared to have lower levels of accessing the vaccine, while those from lower-income populations faced additional barriers to engaging with health and care services. As one activist interviewed for the report said:

“It privileged people that were part of communities, who were the ones that got the information they needed […] I think the groups that fared better within the community were ones that were already pretty connected to sexual health services.”

Some individuals also faced challenges in self-isolation such as financial or emotional difficulties. Public health teams need to be empowered to give additional support (such as financial) where necessary so people can self-isolate.

2. Strengthening sexual health services:

Sexual health services played a pivotal role in responding to the mpox outbreak. However, in the UK, these services have become chronically underfunded, hindering their ability to effectively manage the rapidly unfolding and complex situation. Policymakers and legislators should secure adequate funding and support for sexual health services to enhance their capacity to address the demands of outbreaks. By recognizing the crucial role these services play, policymakers and legislators can also ensure they have the necessary resources, infrastructure, and personnel to continue delivering comprehensive sexual health care, including testing, prevention services, and contraception, alongside responding to novel outbreaks such as mpox.

3. Harnessing effective communication strategies:

We note social media emerged as a powerful tool in the response to the mpox outbreak, facilitating rapid dissemination of information, promoting awareness, and helping collaboration of a wide range of actors involved in the mpox response.

However, the reliance on social media also poses challenges, particularly in terms of equitable access to information. Outdated and/or misleading information on social media can also complicate the pandemic response.

Policymakers and public health officials should recognize the strengths and limitations of social media and put in place mechanisms to ensure that responsible and accurate information is disseminated through social media channels. Additional forms of communication that can reach individuals who are marginalised should also be simultaneously developed during outbreaks. Community organisations play an important role in developing and distributing information that is suitable and impactful.

Effective messaging during outbreaks requires the rapid co-production of messages, involving diverse stakeholders and experts. Public health bodies should invest in and support co-production process, considering the financial, social, and emotional burdens associated with developing and sharing messages.

4. Coordinating, planning, and engaging for equity:

Across all recommendations, senior Government agencies – primarily the Department for Health and Social Care – should produce guidance for local public health teams to follow, along with additional funding in the event of an outbreak to support the activities we outline above. Governments should provide Ministerial level co-ordination of the above to ensure all relevant professionals, policymakers and community representatives work together to proactively address any emerging inequalities in the immediate outbreak and plan for future outbreaks. Public health teams should also prioritise ongoing building of relationships with various communities and activists, on both a local and national level, to ensure that rapid engagement can occur when necessary.

Conclusion

The mpox outbreak demanded immediate and strategic action from policymakers, activists, government, and healthcare professionals. While those in the frontlines often worked hard to address communities’ needs during the outbreak, the UK response to mpox demonstrated limitations in the current systems in place to respond to pandemics.

By implementing the above recommendations, policymakers, legislators, regulatory bodies, and communities can strengthen responses to future outbreaks. Key to this will be learning from the lessons of mpox to maintain what worked and change what needs improving.

Acknowledgements

Researchers from universities of Manchester, Edinburgh, Bristol, UCL, Queen’s University Belfast, and UKHSA contributed to the report this article is based on.

We are also very grateful to the anonymous participants who were interviewed for this research.