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Is This the End of Monkeypox?

The news on monkeypox over the past month has been very positive: Numbers of new diagnoses have dropped significantly, vaccines ae easily available (at least in Metro Atlanta), and Tpoxx (the treatment for sever monkeypox) has become much more widely available. Taken together, there is definitely room for optimism, but we aren’t done yet. Now is not the time to back off our efforts; instead, it’s time to press forward even harder in an effort to actually eliminate monkeypox from the United States.

Numbers of monkeypox diagnoses are indeed declining both locally and nationally, but not to zero — in fact, they have mostly leveled off. Coupled with a reduced demand for vaccine, this low-level persistence of the disease means that reaching a state of elimination will mean more work, not less. However, by continuing to accelerate the response instead of slowing it down, we can push the case rate even lower to the point where the epidemic cannot sustain itself.

Vaccination remains the single most powerful tool we have to prevent new cases. Of course, as the number of cases decreases, demand for vaccine decreases as well, so the challenge becomes generating new demand. Doing so requires bringing the vaccine to the people instead the other way around. Pop-up vaccination sites at venues serving communities most likely to encounter monkeypox are one of the best ways to reach people, but these activities require more resources and staff. It is essential that we maintain or increase funding for monkeypox vaccine efforts until the epidemic is ended.

Fortunately, we know that vaccines work. A recent report from the CDC showed a 14-fold reduction in monkeypox incidence among people who had received at least one dose of the vaccine. This is excellent news in that it indicates that the vaccine actually does prevent monkeypox. However, many people reading the report may be under the mistaken impression than a single dose is enough. This is not true — two doses are needed to get full protection, so definitely go back and get your second shot.

That said, some Black and Brown individuals have experienced dark spots (hyperpigmentation) at the site of intradermal vaccination on their forearm, and they may be reluctant to get a second dose for fear of having another spot or making the old one worse. This is definitely a significant problem, but there are ways around it.

First of all, it’s possible to get the vaccine at a site other than the forearm. The upper back or the shoulder are also acceptable locations, and while hyperpigmentation is not less likely at these sites, they are usually covered with clothing. This might make them both less noticeable and also protect them from the sun, which is important to make them eventually resolve. More tips on dealing with this problem can be found on the Fulton County Board of Health’s website at

IF you haven’t received a monkeypox vaccine, please check out the website above to determine if you are among the groups that would benefit from the vaccine. If you are, we encourage you to get vaccinated. The vaccine is safe, effective, and free, and we can work with you to find the best administration site for you. They are available at your local health department; contact them directly or go to to set up an appointment.

We can’t stop now. Although the end is in sight, we must increase our efforts until we get to zero.

David Holland is an Associate Professor at the Department of Medicine, Division of Infectious Diseases at Emory University and the Chief Clinical Officer for the Fulton County Board of Health.