Association between state LGBTQ+ equality and mpox vaccination rates during the 2022-2023 epidemic in the United States.

In 2022-2023, the United States (US) experienced an mpox epidemic that primarily affected men who have sex with men. As part of the emergency response, the JYNNEOS vaccine was offered to those at increased risk, such as the LGBTQ+ community. Despite the vaccine being free, many people at risk remained unvaccinated. We conducted an ecological study to investigate the association between high state LGBTQ+ equality legislation and mpox vaccination rates during the epidemic. We found that states with higher LGBTQ+ equality experienced higher vaccination rates (β=33.62, p = 0.066). The association was stronger earlier in the epidemic (June-August 2022: β=129.7, p = 0.190; September-November 2022 β=76.9, p = 0.096; December 2022-February 2023 β=6.0, p = 0.005; March-May 2023 β=2.8, p = 0.003). We need to learn from this and other past epidemics that have affected marginalized groups and find ways to improve uptake of preventive healthcare, like vaccines, so we can better protect both these communities and the general population.