Urgent action is needed to prevent monkeypox from becoming endemic in the UK and we need to supercharge the targeted vaccine programme for gay and bisexual men. Over 1,500 cases have already been reported and modelling of the current outbreak warns that cases are doubling every 15 days.

That’s the view of sexual health experts in a joint statement today calling for a speedy step change to avert disaster. 

The statement is being sent to Steve Barclay, Secretary of State for Health and Social Care, Amanda Pritchard, CEO at NHS England, Jenny Harries OBE, CEO of the UK Health Security Agency. You can read or download the full statement below.

Sexual health services are at the frontline of the country’s monkeypox response, with the additional responsibility for testing, diagnosis and vaccinations coming at a time when demand for these services is already outstripping availability. The monkeypox response – including infection control – is unsustainable and currently being delivered without additional funding or staffing. 

Many sexual health services are already reporting reductions in other services because of the additional burden of monkeypox, with some seeing a 90% reduction in access to the HIV prevention pill PrEP and long-acting reversible contraception (LARC). 

The organisations calling for action are British Association for Sexual Health and HIV (BASHH), Association of Directors of Public Health, Terrence Higgins Trust, National AIDS Trust, British HIV Association, LGBT Foundation, PrEPster, i-base and UK Community Advisory Board.

The latest data from the UK Health Security Agency shows gay and bisexual men make up the vast majority of monkeypox cases, but inaction risks transmission to wider groups including those more vulnerable to the infection. For example young children, older people and those who are pregnant. 

The organisations are calling for £51 million from the Department of Health and Social Care to control the outbreak, optimise monkeypox care, protect the wider service delivery of sexual health services and to support people who are required to isolate because of monkeypox. Also needed is the appropriate resourcing for the targeted vaccine programme for gay and bisexual men to be delivered, with BASHH estimating a cost of £62.63 to deliver two vaccine doses. 

The current vaccination roll out is too slow, with far too few being vaccinated. This is compounded by a lack of coordination between those who are responsible for its delivery, as well as insufficient quantities of the vaccine. 

The statement calls for detail on vaccine quantity, a clear procurement timeline and ensuring all who are eligible receive the recommended two doses 28 days apart. The experts estimate that 250,000 doses must be procured and given to 125,000 people. 

There is also urgent support needed for those who are diagnosed with monkeypox and required to isolate – often for a significant period and currently without financial or practical support. This can result in stigma, ill-health, loss of work and other hardship. For those in vulnerable circumstances, such as shared housing or who have unsupportive employers, this can be devastating. 

This action is necessary to prevent serious risk to public health as the pressure from monkeypox grows daily. As the statement says, this includes the risks caused by the destabilisation of wider sexual health services, including services for testing and treating sexually transmitted infections (STIs) with delays increasing the risk of antibiotic resistance.
 
The disruption in access to HIV prevention and testing also risks seriously jeopardising the Government’s target of ending new HIV cases in the UK by 2030 – with a sharp increase in testing and wider access to PrEP vitally needed. 

Dr Claire Dewsnap, President of British Association for Sexual Health and HIV, said: 'Monkeypox cases are currently doubling every 15 days and we have now reached a critical point in our ability to control its spread. Already-stretched sexual health services are buckling under the additional pressures that the outbreak is placing upon them, and an increasing volume of core sexual health care is being displaced as a result. This has left us on the precipice of a fresh public health crisis, one which can only be averted with urgent, additional support.'

Jim McManus, President of the Association of Directors of Public Health, said: 'We must eliminate this outbreak. If it becomes endemic in any part of our population because it will cost hundreds of times more in pain, misery, harm and avoidable cost than eliminating it. Our shared call provides a plan to do that. We want to work with all partners, from NHS England to GBMSM organisations to do this. Together, and only together, we can do this.'

Richard Angell, our Campaigns Director, said: 'There is a clear choice in front of us: urgently do what is needed to tackle the spread of monkeypox or continue the lacklustre response to date which will mean the virus becomes endemic in the UK with more and more people impacted. More vaccines are vital to this.

'Monkeypox is overwhelming our world class sexual health services. Healthcare staff are doing a brilliant job on the frontline of the country’s monkeypox response – but they’re at breaking point, having to make painful choice between treating monkeypox and issuing PrEP or long acting contraception and desperately in need of additional funding to urgently turn the tide.'

We are united in calling for urgent action to prevent Monkeypox (MPX) becoming endemic in the UK.

Since May 2022, the UK MPX outbreak has become a crisis; with case numbers rising steeply, clinics are overwhelmed. MPX can be highly infectious through close contact, requiring people to isolate. Although the outbreak was unexpected, public health strategies have failed.

We need urgent action, now, to eliminate MPX in the UK. Allowing MPX to become endemic risks harming the health of our population and exacerbating the health inequalities experienced by gay and bisexual men and other men who have sex with men.

We need urgent action:

• System-wide coordination with clear lines of accountability.
• Funding to achieve outbreak control, optimise MPX care, protect existing sexual health services and support people required to isolate.
• An appropriately resourced vaccine programme with a clear delivery plan.

Rationale

Serious risk to health

• Pressures from MPX are growing daily. 1,5521 cases have been diagnosed in the UK in just two months.
• Delays in MPX diagnosis risks further transmission and harm to individuals.
• MPX has destabilised services for sexually transmitted infections (STIs), HIV pre-exposure prophylaxis (PrEP) and long-acting reversible contraception (LARC) with many services reporting significant reductions in non-MPX activity and some describing 90% reduction in PrEP and LARC access.
• Delayed access to STI treatments increases transmission and the risk of antibiotic resistance.
• Reduced access to PrEP and HIV testing risks the UK not meeting HIV Action Plan targets.
• MPX risks moving from level 2 (transmission within a defined sub-population with high number of close contacts) to level 3 (transmission within multiple sub-populations or larger sub-populations). While, so far, all of those affected in the current outbreak have recovered, the risk of severe illness of death is higher in young children and pregnant women – wider population transmission will yield avoidable harm.

Lack of resources

• Demand on sexual health services was already high. Managing MPX adds significant burden with additional time required for assessing patients and applying infection control.
• MPX management is being delivered by local sexual health systems without additional funding or staffing.
• Individuals diagnosed with MPX are required to self-isolate, sometimes for long periods, with no financial or practical support. This can result in stigma, mental ill-health, loss of work, and other hardship. For people in vulnerable circumstances (shared housing, sex work), or with unsupportive employers, this can be devastating.

Inadequate vaccine access

• The current vaccination roll-out is too slow; vaccine access is hampered by lack of co-ordination between the agencies responsible for different parts of the system.
• There are insufficient numbers of vaccines, too few men have been vaccinated, and communication about vaccine to affected communities has been poor.
• We have seen no plans for how, or when, suboptimal access to vaccines will be resolved.

Lack of coordination and accountability

• No-one is currently responsible for whether MPX is controlled. No-one is accountable for setting and meeting targets to reduce infections.
• At present there are multiple parallel and overlapping meetings. Some of these have no clear terms of reference. They have unclear powers and no clear accountability.
• Not all key stakeholders are involved in developing response strategy and planning.
• There is lack of detailed information about case severity and risk factors. This limits our ability to provide clear and accurate information to people at risk.
• Pathways are unclear which can lead to poor experiences for patients.

MPX disproportionately impacting already marginalised communities

• Gay, bisexual and men who have sex with men (GBMSM) continue to be disproportionately impacted by MPX.
• The current MPX response risks exacerbating health existing inequalities.
• There have been multiple examples of stigmatising language.

Bold action is needed

Vaccine programme

The Department of Health and Social Care (DHSC), in collaboration with expert and community stakeholders, must produce and publish a Vaccine Procurement and Delivery Plan, including:

• Detail on vaccine quantities, and a procurement timeline, ensuring all eligible people receive the recommended two doses, 28 days apart. We estimate that 250,000 doses of vaccine must be procured for 125,000 people.
• A plan and funding to deliver the programme through community and sexual health services, based on BASHH estimates: £62.63 to deliver two vaccine doses, including health promotion.
• Clear eligibility criteria developed with sexual health experts, which prioritise those at highest risk of MPX exposure.
• A resolution of licensing issues to reduce prescribing and administering bureaucracy.
• A clear communications strategy for those at risk of and affected by MPX including a process for contacting eligible individuals, and centralised management of questions from the public.

Funding

DHSC must fund:

• Sexual health services to provide MPX assessment, treatment, care and vaccination. We estimate this requires an urgent investment of £51m5 to contain and eliminate MPX. Wider MPX transmission may necessitate a more costly national vaccination programme and the costs of hospitalising even just 10% of people with MPX will be far higher than this.
• A clear package of support, using COVID-19 as a benchmark, for people advised to self-isolate.

Coordination and accountability

• Clear accountability, with a named Minister responsible for the MPX response, supported by a National MPX Response Lead with the ability to direct national agencies.
• A national multi-agency group, led by the National MPX response lead, including relevant stakeholders such as commissioners, community organisations and Directors of Public Health. This group should oversee: all MPX responses, including vaccination; a national plan for testing, assessment, treatment and prevention; a joint communications strategy for clear, non-stigmatising messaging; the formation of regional co-ordinating groups to implement MPX responses.
• Coordinated national, regional, and local responses with the needs and welfare of affected people at their core.
• Open access to appropriately anonymised, regularly updated data, to inform public health messaging and service planning.

Commitment to work together

We are a coalition of organisations working in sexual health, from commissioning or providing services, to policy and advocacy.

These recommendations will enable our health systems to respond to this latest public health emergency. Early action is vital.

We need to prevent MPX becoming endemic. We have the tools to stop this crisis and to prevent future outbreaks.

We are fully committed to working together with each other, and with national agencies, to achieve the best possible response. This must start now.

Signatories

• Simon Collins, Senior Editor and Treatment Advocate, i-Base
• Dr Claire Dewnsap, President, British Association for Sexual Health and HIV
• Deborah Gold, Chief Executive, National AIDS Trust
• Ian Green, Chief Executive, Terrence Higgins Trust
• Craig Langton, Sexual Health Coordinator – Testing, LGBT Foundation
• Prof Jim McManus, President, Association of Directors of Public Health
• Dr Will Nutland, Co-director, The Love Tank CIC/PrEPster
• Alex Sparrowhawk, Chair, UK Community Advisory Board
• Dr Laura Waters, Chair, British HIV Association