LGBTQ-friendly states led US in mpox vaccination uptake, study shows
September 18, 2025
A new study highlights how policy environments directly shape health outcomes. During the 2022–2023 mpox epidemic, U.S. states with strong LGBTQ+ equality laws had vaccination rates four times higher than states with weaker protections. Because vaccines were free nationwide, financial access was not the main barrier. Instead, stigma and mistrust of healthcare in less inclusive states likely suppressed uptake. Researchers emphasize that equitable laws can foster trust and improve public health responses. Strengthening LGBTQ+ protections is not only a matter of civil rights but also a vital strategy for ensuring faster, broader uptake of lifesaving interventions during epidemics.
The response to the 2022–2023 mpox epidemic revealed stark differences in vaccination rates across the United States, and a new study shows that state-level LGBTQ+ equality laws were a decisive factor. Researchers at CUNY SPH found that states with stronger legal protections for LGBTQ+ communities achieved vaccination rates up to four times higher than those with weaker protections.
Analyzing over 1.2 million vaccine doses administered nationwide, the study showed that the disparity was most pronounced during the earliest months of the outbreak, when vaccine supply was scarce, but the pattern persisted even after access broadened. Because the vaccine was free across the country, the gap cannot be explained by cost. Instead, the findings suggest that structural stigma, discriminatory policies, and deep mistrust of health systems in less inclusive states played a significant role in reducing uptake.
Lead researcher Claudia Jimenez Castro and Associate Professor Elizabeth Kelvin argue that legal environments that support equity are critical for effective epidemic response. Inclusive policies help create trust, encouraging communities that are disproportionately affected by mpox—particularly gay, bisexual, and transgender individuals—to seek vaccination and care without fear of discrimination.
The implications reach beyond mpox. As future outbreaks emerge, the presence or absence of LGBTQ+ protections could shape who is protected and who remains vulnerable. Public health strategies cannot succeed in isolation from broader social policy. Offering free vaccines is not enough if stigma undermines trust.
This study provides a clear call to action for lawmakers: strengthening LGBTQ+ rights is not only about advancing equality but also about improving national resilience against epidemics. In moments of crisis, equitable laws help ensure that lifesaving tools reach those who need them most, reducing disparities and protecting public health for all.