In the race for monkeypox vaccines, experts see a repeat of Covid

LONDON: Steps by wealthy countries to purchase large quantities of monkeypox vaccine, while refusing to share doses with Africa, could leave millions unprotected against a more dangerous version of the disease and risk to continue spreading the virus in humans, warn public health officials.

Critics fear a repeat of the catastrophic inequality problems seen during the coronavirus pandemic. “The mistakes we saw during the Covid-19 pandemic are already repeating themselves,” said Dr. Boghuma Kabisen Titanji, assistant professor of medicine at Emory University.

While wealthy countries have ordered millions of vaccines to stop monkeypox within their borders, none have announced plans to share doses with Africa, where a deadlier form of monkeypox spreads only in the West. To date, more than 21,000 cases of monkeypox have been reported in nearly 80 countries since May, with around 75 suspected deaths in Africa, mainly in Nigeria and Congo. On Friday, Brazil and Spain reported monkeypox-related deaths, the first reported outside Africa. “African countries that have faced monkeypox outbreaks for decades have been relegated to a footnote in conversations about the global response,” Titanji said. Scientists say that unlike campaigns to stop Covid-19, mass vaccination against monkeypox will not be necessary. They believe targeted use of available doses, along with other measures, could stop the expanding outbreak recently designated by the World Health Organization as a global emergency. Yet while monkeypox is much harder to spread than Covid-19, experts warn that if the disease spreads among the general population – currently in Europe and North America, it circulates almost exclusively among gay men and bisexuals – the need for vaccines could intensify, particularly if the virus takes hold in new areas. On Thursday, the Africa Centers for Disease Control and Prevention called for prioritizing the continent for vaccines, saying it was being left behind again. “If we are not safe, the rest of the world is not safe,” said Africa CDC Acting Director Ahmed Ogwell. Although it has been endemic in parts of Africa for decades, monkeypox mainly jumps in people from infected wild animals and has generally not spread very far beyond the continent.

Experts suspect monkeypox outbreaks in North America and Europe may have originated in Africa long before the disease began to spread sexually at two raves in Spain and Belgium. Currently, more than 70% of monkeypox cases worldwide are in Europe and 98% of cases are in men who have sex with men. The WHO is developing a vaccine-sharing mechanism for affected countries, but has released few details on how it might work. The UN health agency made no guarantees that it would prioritize poor countries in Africa, saying only that vaccines would be distributed based on epidemiological need. Some experts fear the mechanism could replicate problems seen with COVAX, created by the WHO and partners in 2020 to try to ensure poorer countries get Covid-19 vaccines. This has missed repeated goals of sharing vaccines with poorer countries and has sometimes relied on donations. “It will not be enough to ask countries to share,” said Sharmila Shetty, vaccine adviser for Doctors Without Borders. “The longer monkeypox circulates, the more likely it is to enter new animal reservoirs or spread to the general human population,” she said. “If that happens, vaccine needs could change significantly.” At the moment there is only one producer. of the most advanced monkeypox vaccine: the Danish company Bavarian Nordic. Its production capacity this year is around 30 million doses, with around 16 million vaccines currently available. In May, Bavarian Nordic asked the United States to release more than 215,000 doses it was to receive, “to meet international requests the company was receiving”, and the United States complied, according to Bill Hall, a spokesperson for the Department of Health and Social Services. The United States will still receive the doses, but at a later date.

The company declined to specify which countries it was assigning doses to. Hall said the United States made no further promises to share vaccines. The United States has ordered the most doses by far, with 13 million reserved, although only around 1.4 million have been delivered. Some African officials have said it would be wise to stockpile some doses on the continent, especially given the difficulties Western countries have had in stopping monkeypox. “I really didn’t think it would spread very far because monkeypox doesn’t spread like Covid,” said Salim Abdool Karim, an infectious disease epidemiologist at the University of KwaZulu-Natal in South Africa. “Africa should get vaccines in case we need them, but we should prioritize diagnosis and surveillance so we know who to target,” he said. “Normally you can get ahead of a disease like monkeypox, but I’m afraid (the number of new cases) hasn’t started to come down yet.” Dr Ingrid Katz, a global health expert at Harvard University, said monkeypox outbreaks were “potentially manageable” if limited vaccines were distributed appropriately. She believed it was still possible to prevent monkeypox from becoming a pandemic, but that “we need to be thoughtful in our prevention strategies and quick in our response.” In Spain, which is experiencing the largest outbreak of monkeypox in Europe, demand for vaccines far exceeds supply. “There is a real gap between the number of vaccines we have now and the people who could benefit from them,” said Pep Coll, medical director of a Barcelona health center which was giving injections this week. Daniel Rofin, 41, was more than happy to be offered a dose recently. He said he decided to get vaccinated for the same reasons he was immunized against Covid-19.

“I’m reassured it’s a way to stop the spread,” he said. “We (gay men) are an at-risk group.”