Progress Toward Equitable Mpox Vaccination Coverage: A Shortfall Analysis - United States, May 2022-April 2023

Abstract

More than 30,000 monkeypox (mpox) cases were reported in the United States during the 2022 multinational outbreak; cases disproportionately affected gay, bisexual, and other men who have sex with men (MSM). Substantial racial and ethnic disparities in incidence were also reported (1). The national mpox vaccination strategy* emphasizes that efforts to administer the JYNNEOS mpox vaccine should be focused among the populations at elevated risk for exposure to mpox (2). During May 2022-April 2023, a total of 748,329 first JYNNEOS vaccine doses (of the two recommended) were administered in the United States.^† During the initial months of the outbreak, lower vaccination coverage rates among racial and ethnic minority groups were reported (1,3); however, after implementation of initiatives developed to expand access to mpox vaccination,^§ coverage among racial and ethnic minority groups increased (1,4). A shortfall analysis was conducted to examine whether the increase in mpox vaccination coverage was equitable across all racial and ethnic groups (5). Shortfall was defined as the percentage of the vaccine-eligible population that did not receive the vaccine (i.e., 100% minus the percentage of the eligible population that did receive a first dose). Monthly mpox vaccination shortfalls were calculated and were stratified by race and ethnicity; monthly percent reductions in shortfall were also calculated compared with the preceding month's shortfall (6). The mpox vaccination shortfall decreased among all racial and ethnic groups during May 2022-April 2023; however, based on analysis of vaccine administration data with race and ethnicity reported, 66.0% of vaccine-eligible persons remained unvaccinated at the end of this period. The shortfall was largest among non-Hispanic Black or African American (Black) (77.9%) and non-Hispanic American Indian or Alaska Native (AI/AN) (74.5%) persons, followed by non-Hispanic White (White) (66.6%) and Hispanic or Latino (Hispanic) (63.0%) persons, and was lowest among non-Hispanic Asian (Asian) (38.5%) and non-Hispanic Native Hawaiian and other Pacific Islander (NH/OPI) (43.7%) persons. The largest percentage decreases in the shortfall were achieved during August (17.7%) and September (8.5%). However, during these months, smaller percentage decreases were achieved among Black persons (12.2% and 4.9%, respectively), highlighting the need for a focus on equity for the entirety of a public health response. Achieving equitable progress in JYNNEOS vaccination coverage will require substantial decreases in shortfalls among Black and AI/AN persons.

FIGURE

Shortfalls and percent decreases in shortfalls in first dose JYNNEOS vaccination, by race and ethnicity — United States, May 2022–April 2023 Abbreviations: AA = African American; AI/AN = American Indian or Alaska Native; NH/OPI = Native Hawaiian or other Pacific Islander. * Calculated as the difference between 100% vaccination coverage and the reported vaccination coverage. ^† Monthly reductions in shortfall were calculated as percent decrease in shortfall compared with the preceding month. Because no vaccines were administered before May, the percent decreases in shortfall for May–June were set to zero. ^§ Persons who indicated Hispanic or Latino (Hispanic) ethnicity, regardless of race, were categorized as Hispanic. AI/AN, Asian, Black or African American, NH/OPI, White, and Multiple races (more than one race category selected) or other persons were categorized as non-Hispanic. Persons with missing data on ethnicity or race were categorized as missing or unknown and were not included in this analysis. ^¶ Data from Vermont were not included in the analysis because vaccination data stratified by race and ethnicity were not reported.