The United States is facing growing and increasingly unsustainable health inequities, and the number of voices calling for substantive health system reforms is growing. A new paper published yesterday in Nature Medicine examines why the recent U.S. response to the Mpox epidemic achieved successes and how these lessons can inform equity-focused improvements in the broader healthcare complex.

The paper, entitled “Community-engaged Mpox vaccination provides lessons for equitable health care in the United States,” points out that the U.S. is often the first to introduce advanced preventive and therapeutic interventions, yet the dominant models of healthcare delivery are frequently ill-equipped to deploy them in communities experiencing harmful SDOH and health inequities.

The recent response to the Mpox epidemic provides valuable insights into future directions for addressing this persisting challenge. After the first round of Mpox vaccinations showed patterns that were similarly inequitable as past rollouts of important prevention modalities (e.g., HIV pre-exposure prophylaxis [PrEP]), the CDC quickly changed its approach to meaningfully engage grass-roots community leaders in the design and implement of local vaccination campaigns. The resulting approach focused on deployment of decentralized, community-based, and culturally and contextually aligned service delivery models that better served those most affected by Mpox.

“We must re-think the way health care is delivered in this country, especially when, where, and how care is delivered to groups persistently burdened by harmful social determinants of health that perpetuate health inequities,” said Vincent Guilamo-Ramos, Dean of the Duke School of Nursing and lead author on the paper. “The financial and human costs of these inequities are already in the danger zone and cannot be sustained for much longer.”

The paper also highlights the need to design health care interventions that more comprehensively address harmful social determinants of health, drawing from an innovative framework developed by the Center for Latino and Family Health at Duke University, accessible at www.DUSONtrailblazer.com.

In addition to Guilamo-Ramos, the paper’s authors include Marco Thimm-Kaiser, MPH and Adam Benzekri, MPH, MS.