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 do it 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 demonstrate 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 reflected a broad cross-section of the LGBTQ+ population most affected by mpox—diverse in age, race, and borough, and concentrated in networks of sexual and social connection.
The gatherings and movement analyses illustrated how urban space shaped exposure: small clusters of venues and neighborhoods connected otherwise separate groups.
The mixing chapter revealed that the same venues and social circles that sustained queer life also created routes of transmission—networks that could be leveraged for targeted prevention.
Finally, the outbreak control simulations demonstrated that geographically focused vaccination strategies could reach large portions of at-risk populations by focusing on a handful of community districts.
Taken together, these findings suggest that epidemics move through relationships, not just individuals. The architecture of social and spatial networks matters as much as biology. Understanding these structures—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—a new approach to causal inference that treats networks as the foundation of analysis, not a complication to be averaged away. SSNAC extends the logic of NPSEM-IE and FFRCISTG models to populations where interference is the rule rather than the exception. It formalizes how one person’s exposure can affect another’s outcome and how local structures—places, clusters, or 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 allows us to reason about policies that work through networks: targeted vaccination, venue-based outreach, and neighborhood-level investment.
This approach is not limited to mpox. It points toward a more general science of connected populations, where inference and action are designed together.
11.3 Organizing for the future
The study’s success depended on the way it was organized. Through the RESPND-MI LGBTQ+ Community Forum, dozens of partners—activists, health workers, and researchers—created a space where decisions were shared and expertise distributed. That structure produced more than data; it built legitimacy. Participants trusted the process because they could see themselves in it.
RESPND-MI’s organizing model demonstrates that democracy and efficiency are not opposites. When communities have a say in how research is done, the result is faster, fairer, and more durable.
This principle—the alignment of rigor and 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.
What this work makes possible
- For researchers: Use SSNAC to study connected populations without erasing interdependence.
- For practitioners: Design interventions that follow networks of contact and place.
- For organizers: Build forums where affected communities direct the questions being asked.
- For funders and institutions: Invest in distributed infrastructure that can activate quickly in a crisis.
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 challenge 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.