What Was It Like Responding to Mpox on the Frontline? Clinicians Share their Insights at Second Roundtable of the ESRC IPPO Project

Knowing and Evidencing Mpox: A Rapid Policy-Focused Study of Community Organising, Communication, and Vaccine Engagements is an ESRC-funded project investigating the recent Mpox outbreak.  The project sees the International Public Policy Observatory at UCL collaborating with colleagues from the Universities of Edinburgh, Bristol, and Manchester, and the UK Health Security Agency to fill previously-identified social science research gaps related to the outbreak.

Jeremy Williams

The project is currently in its primary data collection phase which includes hosting professionally-facilitated “deliverative fora” roundtable discussions with key players and those affected by the outbreak, together with associated 1-2-1 interviews.  After a first workshop focused on the experiences of activists and the third sector, the second roundtable was held in December 2022 for clinicians and those working in sexual health services involved in treating the outbreak, as well as the vaccination campaign.  Here are some of the key insights from the discussion:

Mpox was initially challenging for many sexual health clinics – but they rose to the occasion

As the first point of contact for many of those affected, sexual health clinics were the frontline service responding to the Mpox outbreak.  While some attendees expressed concern over a perceived lack of interest from other areas of the healthcare system leaving clinics being left to deal with Mpox alone, clinicians praised the support they were given from their existing informal networks.  Mobilising these networks enabled practical solutions to be put into place at speed, and they were justifiably proud of their work despite the very challenging context during the initial stages of the outbreak. Nevertheless, as many clinics often employed small numbers of staff, there was a feeling that delivery of their core non-Mpox work was affected.  This was particularly the case as limited resources were felt to be stretched even before the outbreak began.

MSM communities rallied – and advocacy was praised

There was a feeling among those present that despite the challenging situation in the clinics, many MSM communities rallied to participate in the response.  This ranged from individuals proactively reaching out to anonymous contacts using hook-up apps like Grindr, through to organic information-sharing on social media.  The accumulated knowledge and experience of clinicians in engaging with these communities was also vital for a multi-faceted response.

Clinicians also praised the advocacy activities being undertaken, with, in the UK, the leadership role of organisations such as BASHH (the British Association of Sexual Health and HIV) being heralded for “banging on the door of government”.

Despite a shortage of supplies, the vaccine rollout was a success

While the distribution and production problems of the vaccine have been well-documented, largely stemming from production being concentrated solely in the Bavarian Nordic plant in Denmark, clinicians and those working in sexual health clinics were able to roll out the vaccine quickly and effectively.  As both the outbreak and supply chain issues subsided, so further outreach was able to take place to encourage vaccine engagements, with the relatively low number of current cases testament to the success of the prgramme.

Questions remain about how effective engagement was with disadvantaged groups

However, the initial lack of available vaccine led to questions as to how and whether this was being administered to the most vulnerable groups.  One potential paradox of the information-sharing and mobilisation in MSM communities was that those who perhaps would benefit most from being engaged with were those without access to the networks through which much self-organising took place.  Opinions varied as to the extent to which the ‘lessons’ of Covid had been learned on communicating with these hard-to-reach groups, although some – but not all – present believed that expertise and know-how gained during the pandemic was successfully deployed in this context.

Nevertheless, existing informal networks, as well as personal initiative played a role in conducting outreach through hook-up apps and sex-on-premises venues, and this outreach was more organic than formally structured.  Clinic websites were often venues where people who don’t normally engage with sexual health clinics could access information.  There were differing experiences in the extent to which these individuals engaged with clinics, with only some clinicians reporting seeing a more diverse cohort of attendees during the outbreak than during ‘normal’ times.

Clear communication was sometimes lacking – but clinicians often took the initiative

A lack of clear communication from governments was felt to be an issue by some participants.  Attendees also noted that given the newness of the outbreak, it took time for a consensus to emerge on the kind of precautions and advice that should be provided to patients and the community as a whole.  In this context and in the absence of clear advice early on, some clinics took the initiative to set up their own clinical pathways to ensure that potential cases were handled in as best and safe a way as possible.

Get involved

If you have been affected by Mpox and/or are involved in the response to the outbreak and would like to have your voice heard by participating in a roundtable, please e-mail Jeremy Williams at [email protected].  Further roundtables and interviews will take place in January 2023, with attendees given the option of their contributions being anonymised in any public-facing material.

The ESRC IPPO Mpox Project is led by Principal Investigator Jo Chataway and Jeremy Williams of IPPO (UCL), with Co-Investigators Jaime Garcia Iglesias and Martyn Pickersgill (Edinburgh), Tom May and Jeremy Horwood (Bristol), Maurice Nagington (Manchester), and Richard Amlôt (UK Health Security Agency).