There are many factors contributing to the US response to the current outbreak, notably a failure to build a strategy based on health equity. This is crucial to pandemic response as disparities create unfair economic and social circumstances for individuals, communities and societies—causing fragility in health and social systems.

In our report, we identified four vital areas for US health equity. Progress in each will result in more effective access and care for all during the monkeypox outbreak—and beyond: 

1. Acute reactive care that incentivises the status quo

The US initially took a “wait-and-see” approach to the monkeypox outbreak. Despite rolling out an effective vaccine and treatment, information gaps persist. The number of vaccinated or treated individuals is unknown, and we are unable to determine how many people should be vaccinated to control the outbreak. Without a full picture of the problem, the US was slow to offer resources where they were most needed. Basic data at the national level that are disaggregated by age, gender, race/ethnicity and risk profile are crucial to establishing an equitable, proactive action plan to tackle monkeypox.

2. Disparities lead to resource-intensive care and wasted investment

Much like the early days of securing a covid-19 vaccination, obtaining a monkeypox vaccination requires health literacy, technological savvy and the time and awareness to book scarce appointment slots. This favours young, affluent individuals and has led to inequitable access to vaccinations. Issues accessing the vaccine were compounded by the vaccine being rolled out exclusively through government health agencies. Instead, vaccines should be made available through qualified health centres and primary care providers who operate within vulnerable communities and have a history of establishing trust. A more equitable approach to reducing the spread of the virus could be promoted by expanding distribution sites and reducing the burden of obtaining an appointment.

3. Siloes among stakeholders

Perhaps the most long-standing issue with the US monkeypox response is the country’s patchwork public health system. States and various agencies of the federal government have great difficulty working together, and there is no requirement for states to report data to federal entities. Early in the outbreak only labs from the The Centers for Disease Control and Prevention (the national public health agency) could test for the virus. The agency was quickly flooded with tests beyond their capacity, which led to a limited understanding of the outbreak. Tests are more widely available, but turnaround times are still long and data is incomplete. Without a cohesive, multi-stakeholder plan of action, implementing an effective and equitable solution is impossible.

4. An innovation gap

Reminiscent of the early days of the AIDS epidemic, social stigma is a major factor with the monkeypox outbreak. The associated shame can prevent individuals from seeking urgent care due to fear of judgement from health professionals and employers. Tactics such as anonymous testing appointments, developing effective at-home testing and reducing the burden of prescribing treatment are not ground-breaking innovations, but they could reduce the impacts of social stigma. However, a gap still exists in discussing these innovative approaches and seeing them in practise.

The term “equity” is ubiquitous in the world of health with much of the conversation emphasising the need for progress. The US system is effectively making demands of the people who rely on health services; but it is not the responsibility of affected individuals to fix the problems of a system that should exist to serve them. Without properly addressing the drivers behind these disparities evident in the monkeypox outbreak, the US is doomed to repeat its mistakes for future health threats.

Learn more about the factors exacerbating health disparities from Economist Impact's report: Achieving health equity: a roadmap to eliminating disparities.