£51m needed to stop monkeypox becoming endemic in the UK

12 July 2022: 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.’

Download Consensus statement on response to the UK monkeypox outbreak