A more severe strain of mpox, formerly known as monkeypox, has quietly appeared in California, and for the first time, the infections weren’t brought here by travelers. For the nation’s LGBTQ+ communities, the news is unsettling not only because of what it says about the virus, but also because of what it reveals about a public health system in crisis. The strain began to spread in the spring of 2024 in people who had traveled outside the United States.

In an interview with The Advocate, Dr. Demetre Daskalakis, former director of the CDC’s National Center for Immunization and Respiratory Diseases and the Bidenadministration’s White House deputy coordinator for the national mpox response and now principal at Dr. Demetre Consulting, said the development marks an inflection point. 

He explained that this is the first time in the U.S. that Clade I has been identified in three people without a travel nexus. “That means somewhere there’s been local transmission of a virus that we know can transmit and has a pretty good profile for being contagious,” Daskalakis said. 

All three patients, two in Los Angeles and one in Long Beach, were hospitalized. None were vaccinated. The cases appear unrelated, though their viral samples are genetically linked. “It’s a signal that somewhere, this virus is moving among us,” Daskalakis said.

What is the new mpox strain?

Clade I, the version of mpox now circulating in Southern California, is not new to science. It’s been responsible for severe outbreaks in Central and Eastern Africa and has a higher rate of complications than the Clade II strain that spread globally in 2022.

“It’s not necessarily more infectious,” Daskalakis explained, “but it’s more severe. That’s what worries people. The same communities who were most at risk in 2022, men who have sex with men, trans and nonbinary people, people living with HIV, are the ones who need to pay attention again.”

Despite the heightened concern, he emphasized that the Jynneos vaccine still works. “There’s nothing about this virus that’s going to make the Jynneos vaccine not work,” he said. “Two doses are enough. You don’t need a booster right now.”

For those who received only one dose during the 2022 outbreak, “it’s never too late,” he added. “You don’t start over, you just catch up.”

‘Watchful waiting,’ not panic

Daskalakis described the current phase as “watchful waiting” with “aggressive investigation,” not cause for panic. “We’re globalized,” he said. “Things move. The key is staying ready: that means public health must still be strong enough to respond.”

But that last part, he said, is no longer a given.

Related: U.S. steps up response to more deadly mpox outbreak

Since President Donald Trump’s return to power, the CDC has been gutted by political interference, mass resignations, and data manipulation. Daskalakis himself resigned in August, stating that he could no longer serve amid what he termed the “weaponization of public health.” Under the leadership of Health and Human Services Secretary Robert F. Kennedy Jr., Daskalakis said that scientists were not consulted about vaccines, and instead, political ideology and conspiracy theories prevailed.

He told The Advocate after stepping down that “the CDC we knew is over. Unless someone takes radical action, there’s nothing there that can be salvaged.”

In Thursday’s interview, he was blunt about the damage. “I scoured the CDC website,” he said. “Their information on mpox is still up to date, but people should cross-check it. Talk to your doctor, or if you don’t have one, your local health department.”

That distrust, he said, isn’t paranoia. “It’s healthy to be skeptical about what the CDC is saying about LGBTQ+ health right now, because they’ve clearly stated their ideology, and that makes me very concerned.” Since the beginning of the Trump administration, the federal government has erased references to transgender and nonbinary people and excluded significant populations from its research and reporting.

Communities filling the vacuum

With trust in federal institutions fractured, community groups have stepped in. Matthew Rose, the Human Rights Campaign’s director of public policy and health equity, said HRC is now tracking changes to CDC guidance and providing alternatives when necessary.

“You see the CDC remove orientation and gender identity, then it comes back, but not all the pages come back — they’re still deleting pages,” Rose said. “Our community has a long history of taking care of itself. We find trusted messengers like Demetre and make sure we can throw them everywhere they’re willing to go.”

Related: CDC warns of new mpox outbreak, urges vaccination

HRC has relaunched its mpox resource page to help people access clear, science-based information on the virus and vaccination. The page emphasizes that mpox is not a “gay disease,” but a viral infection that can spread through close, often skin-to-skin contact, regardless of gender or sexuality. “What we are seeing reflects tight-knit sexual and social networks, not identity,” the organization notes. “Addressing mpox requires centering science, not stigma.”

The HRC Foundation urges equitable public health responses that prioritize those most impacted, including gay, bisexual, and transgender people, people living with HIV, and LGBTQ+ communities of color. Its guidance stresses that the Jynneos vaccine remains protective against Clade I, does not currently require a booster, and should be accessible to anyone at risk.

California’s response to the mpox strain

The California Department of Public Health confirmed the three Clade I cases in Southern California in a statement on October 17, saying the cases were not travel-related and that “this is the first time clade I cases without a history of international travel have been reported in California or the United States. All previous clade I mpox cases in California and the United States reported international travel to countries where clade I mpox was known to be spreading.” 

The department stated that the risk to the general public remains low, but urged individuals at higher risk to complete both doses of the Jynneos vaccine. The CDPH is also monitoring wastewater for signs of viral spread and stated that enhanced surveillance and contact tracing are underway. 

Daskalakis told The Advocate that wastewater surveillance is among the most effective methods for detecting pathogens like mpox because, although many people are not being tested, all individuals use the restroom and take showers, which allows scientists to estimate the amount of virus present in the population of any given region.

What comes next?

Daskalakis said his focus is on three data points: wastewater, case severity, and vaccine uptake. Mpox is detectable in wastewater — and so far, there’s little evidence of widespread viral presence. “That’s reassuring,” he said. But the fact that all three California patients were hospitalized “makes my antennae go up.”

If more severe cases appear or wastewater signals rise, he said, that would demand an immediate, coordinated response. “The question,” he added, “is whether that coordination still exists.”

In response to The Advocate’s inquiry, HHS Press Secretary Emily Hilliard did not respond to questions but said in a written statement that the Trump administration “is committed to reopening the government for the American people.” She said that while “mission-critical activities at CDC will continue” during the ongoing government shutdown, responses to media questions “may be delayed.”

Hilliard added that the department is working to provide information “as soon as we are able” and referred the public to their local health departments and the CDC’s mpox information website for updates. Daskalakis told The Advocate that it was noteworthy that the CDC has updated its mpox page throughout the government shutdown.

Both Daskalakis and Rose framed vaccination not only as a scientific matter but also as a matter of survival. Rose said, “Be up to date on your vaccines. Lifetime immunity is lifetime immunity.”

Daskalakis ended the interview with a reminder drawn from poet Audre Lorde: “caring for oneself is not self-indulgence, it is self-preservation and in times like these, that is an act of political warfare.”