From COVID-19 to Monkeypox: Unlearned Lessons for Black, Latino, and Other Men With HIV Who Have Sex With Men

Carlos E. Rodriguez-Diaz, PhD, MPH; Jeffrey S. Crowley, MPH; Yaiomy Santiago-Rivera, BS; Gregorio A. Millett, MPH


Am J Public Health. 2022;112(11):1567-1571. 

In This Article

Abstract and Introduction


The past few years have demonstrated that infectious diseases remain a challenge for public health. Unfortunately, the United States is still unprepared to respond to public health emergencies. Monkeypox (MPX) is a viral zoonosis (an infection transmitted to humans from animals) with symptoms like those seen in people with smallpox, a phylogenetically related virus. However, it is clinically less severe.[1] In April 2022, MPX was identified in the United Kingdom and has been found throughout Europe and other parts of the world. The current MPX strain behaves differently from those historically found in Central and Western Africa.[2] The first case in the United States was confirmed in May 2022, and diagnoses have grown exponentially since that time. On July 23, 2022, after more than 23 000 cases were confirmed cases globally—including eight deaths—the World Health Organization director general declared the current MPX outbreak a public health emergency of international concern.[3] During the first week of August, the United States declared MPX a public health emergency, and by then, there were more than 26 000 cases worldwide, one in four of which was diagnosed in the United States.

In the United States, most confirmed cases of MPX have been among gay, bisexual, queer, and other men who have sex with men (MSM), with New York State reporting the most, followed by California, Florida, Georgia, and Texas. Washington, DC, has the highest case rate by population, and these diagnoses potentially underestimate the actual number of cases. If the COVID-19 pandemic in the United States can serve as a guide, MPX infections could take hold first in the coastal states and then move to the interior of the United States.

Several lessons from COVID-19 have not been heeded in the current outbreak. These lessons include the need for timely and disaggregated surveillance data, free or affordable access to testing and vaccines, greater prioritization of populations at greatest risk, and tackling multiple, overlapping structural barriers.