11 Conclusion
The MPX NYC study began as an act of necessity. When institutions failed to respond quickly enough, queer and trans communities in New York City built the infrastructure to respond themselves. What followed was both a data project and a collective exercise in power—an effort to see the epidemic clearly, to describe how we were connected, and to show that rigorous, community-led research can operate at the scale of a city.
11.1 Findings in context
Across the results chapters, several patterns stand out.
The participants section showed that our sample captured a broad cross-section of the LGBTQ+ population most likely to be affected by mpox—diverse in age, race, borough, and embedded in networks of sexual and social connection.
The gatherings and movement analyses illustrated how urban space shaped exposure: small clusters of venues and neighborhoods linked groups that might otherwise appear separate.
The mixing chapter revealed that the same venues and social circles that sustain queer life also create routes of transmission—networks that can be leveraged for targeted prevention.
Finally, the results from the outbreak-control modeling showed that geographically focused vaccination strategies could reach substantial portions of at-risk populations by working through a handful of community districts.
Taken together, these findings show that epidemics move through an interconnected system of people and places, not just individuals. The architecture of social and spatial networks matters as much as biology. Understanding how people gather, move, and connect is essential to any public health strategy that aims to be both effective and equitable.
11.2 Scientific lessons
To make sense of these dynamics, we developed the SSNAC framework—an approach to causal inference that treats networks as the foundation of analysis rather than a complication to be averaged away. SSNAC extends the logic of NPSEM-IE and FFRCISTG models to populations where interference is the norm. It formalizes how one person’s exposure can affect another’s outcome, and how local structures—places, clusters, community districts—shape those dependencies.
By treating social and spatial connections as observable, manipulable components of a causal system, SSNAC reframes what counts as an intervention. It becomes possible to reason about policies that work through networks: targeted vaccination, venue-based outreach, neighborhood-level investment.
This approach is not limited to mpox. It points toward a broader science of connected populations—one where inference and action are designed together.
11.3 Organizing for the future
The study’s success depended on how it was organized. Through the RESPND-MI LGBTQ+ Community Forum, dozens of partners—activists, health workers, researchers—created a space where decisions were shared and expertise distributed. That process produced more than data; it produced legitimacy. Participants trusted the study because they could see themselves in it.
RESPND-MI’s organizing model shows that democracy and efficiency are not opposites. When communities have a say in how research is done, the work becomes faster, fairer, and more durable.
This alignment—rigor paired with participation—is what we mean by a People’s Department of Health: a structure capable of generating knowledge, coordinating action, and maintaining trust at the same time.
11.4 Where to from here
The systems we need already exist in fragments—in community clinics, nightlife networks, mutual-aid groups, and research collectives. The task ahead is to connect them, resource them, and treat them as the backbone of public health rather than its margin.
A People’s Department of Health is not a metaphor. It is a practical proposal: a way to build health systems that are fast, accountable, and ours.