Patients With Mpox Face Racial Inequities and Delays in Tecovirimat Initiation
November 4, 2025
A new study published in Clinical Infectious Diseases exposes troubling racial inequities and treatment delays among mpox patients who received tecovirimat during New York City’s 2022 outbreak. Black patients were significantly more likely to experience delayed access to treatment and hospitalization, even after accounting for HIV status and insurance. Although most patients improved with tecovirimat, systemic barriers in access and care persist. These findings underscore that public health responses must extend beyond antiviral distribution to address structural inequities in healthcare delivery. Ensuring equitable access to diagnostics, timely treatment, and follow-up care is essential for achieving true outbreak preparedness.
A new retrospective study published in Clinical Infectious Diseases sheds light on significant inequities in mpox care during the 2022 New York City outbreak. Researchers analyzed 708 patients treated with tecovirimat, an antiviral originally approved for smallpox and widely prescribed under emergency use despite limited efficacy data. While most patients experienced symptom improvement within days, the study revealed striking disparities in treatment timing and outcomes by race.
The median time from symptom onset to tecovirimat initiation was eight days, but nearly half of patients received treatment after this period. Non-Hispanic Black patients were 1.3 times more likely to experience delays than Hispanic patients and more than twice as likely to be hospitalized. These disparities persisted even after adjusting for insurance and HIV status. Hospitalizations, which occurred in 14% of all patients, were most commonly due to pain management, bacterial superinfection, and severe skin lesions. The median hospital stay was four days, and most hospitalized patients were also living with HIV.
Despite overall improvement in 86% of patients treated with tecovirimat, the findings highlight critical shortcomings in equitable access to care. The study emphasizes that racial disparities extended beyond treatment delays, affecting hospitalization rates and clinical outcomes. Investigators called for “concerted efforts” to mitigate systemic barriers in care-seeking, laboratory testing, provider prescribing, and treatment access, particularly during public health emergencies.
These results serve as a stark reminder that medical countermeasures alone cannot address the deeper inequities shaping health outcomes. In future outbreaks, timely, equitable access to diagnostics, therapeutics, and vaccines must be built into response strategies from the outset. Structural reforms in healthcare delivery and proactive community engagement are vital to ensure that lifesaving interventions reach all populations, not only those with better healthcare access or social privilege.