Item - 2024.HL16.8

The Board of Health:

1. Requested the Ministry of Health and Health Canada to explore opportunities to increase access and reduce barriers to health care providers providing the mpox vaccine to their patients.

Since 2022, mpox has been circulating in Toronto and globally. It is spread person to person through direct or indirect contact with infected lesions or blisters or with bodily fluids, or respiratory secretions.  In Toronto, it is mostly transmitted between people who have had close, intimate, or sexual contact, and it has been disproportionately impacting men who have sex with men. The strain circulating in Toronto,  known as clade II mpox, is rarely associated with serious illness.

TPH has a comprehensive mpox response that focuses on collaboration across the organization and in the community. This response includes:

- monitoring trends and data to identify and report changes in risk and local epidemiology,

- investigating transmission pathways through case and contact management to quickly
identify cases to reduce transmission and helping people who have been exposed obtain post-exposure vaccination,

- working with community partners and through our own communications channels to reduce stigma and increase awareness of the risks of mpox, the importance of getting two vaccine doses among priority populations, and channels for accessing vaccines, and 

- supporting our health care partners by training health care providers to administer and report mpox vaccinations as required, coordinating and distributing orders of vaccine for healthcare providers, and supplementing their efforts by providing mpox vaccine in TPH clinics.

On August 14, the World Health Organization declared a public health emergency of international concern (PHEIC) due to a clade I outbreak in Africa. Clade I mpox may cause more severe illness and death than clade II. There have been no cases of clade I mpox in Toronto and the risk remains low.

Despite the risk remaining low for clade I, and remaining the same for the ongoing clade II outbreak, since the World Health Organization declaration of a PHEIC, Toronto is experiencing increased demand for the mpox vaccine. In response to this increased demand for vaccination TPH has:

- increased mpox vaccination appointments at TPH clinics,

- ramped up outreach to healthcare providers to increase accessibility in the healthcare system, which is the primary channel for vaccine access in Toronto, and

- onboarded 5 new healthcare providers, with more expected to be onboarded soon.

Given increased demand for the vaccine, and because mpox vaccination is a multi-level governmental effort, I recommend that the Ministry of Health and Health Canada review current processes for accessing the vaccine and look for opportunities to increase access for eligible people, similar to other publicly-funded vaccines.