To Fight Mpox, Release Vaccine Stockpiles [Guest Essay]

Newsletter Edition #227 [The Files In-Depth]

Hi,

The response to the Mpox emergency is following a familiar trajectory.

Parts of the world where the disease is endemic is struggling to address the outbreak with inadequate vaccines or diagnostics. Whatever vaccines are available, have mostly been stockpiled in a few countries in the developed world. Manufacturers of these vaccines are also located in the developed world. There is a monopoly over production, prices are high.

In today’s edition, experts from Third World Network, are calling for a release of vaccine stockpiles to address the emergency. They also describe the current failings that are making it difficult to immediately boost production. The structural deficiencies in our response mechanisms are yet to be fixed, while another crisis is blowing up in our faces. And yes, they also remind us of the international obligations to assist in situations like this.

Watch this space.

Thank you for reading.

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Until later.

Best,

Priti

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Illustration Credit: Amy Clarke, Chembe Collaborative

I. GUEST ESSAY

To Fight Mpox, Release Vaccine Stockpiles [Guest Essay]

By Chetali Rao & K M Gopakumar

The authors are experts affiliated with Third World Network. Write to them at chetali.rao@gmail.com.

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The World Health Organization (WHO) declared Mpox as a Public Health Emergency of International Concern (PHEIC ) under the International Health Regulations (IHR). WHO’s decision comes at a time when Mpox cases continue to ravage the  Democratic Republic of the Congo (DRC) and a growing number of countries in Africa.  Prior to WHO’s announcement, the Africa Centres for Disease Control and Prevention  (Africa CDC) also declared Mpox as a Public Health Emergency of Continental Security (PHECS). However, any qualitative change on the ground from these declarations depends on the access to vaccines.

With the new variant (clade 1b), spreading more easily through routine close contact, and affecting women and children, vaccines will once again be the cornerstone in managing the emergency. However, it appears that the access to vaccines would remain bleak unless there is immediate release from stockpiles. 

Vaccines for Mpox: The Gap in Supply and Demand

Response to Mpox includes both vaccines and therapeutics. A smallpox vaccine, called JYNNEOS or IMVANEX or MVA-BN, has been approved in Canada, the European Union, and the United States for use against Mpox. In addition to its use in adult population, this vaccine has also been granted an Emergency Use Authorization for people younger than 18 years of age and at high risk of infection. While JYNNEOS is the preferred vaccine for mpox, alternative approaches include second-generation small-pox vaccines like LC16 and ACAM2000. WHO’s Strategic Advisory Group of Experts on Immunisation (SAGE) recommends using these vaccines for Mpox.

From a therapeutic viewpoint - a new antiviral drug TECOVIRIMAT – which was in trials in DRC since 2022 has failed to meet its primary endpoint.

Presently, Africa faces a severe shortfall of health products including vaccines and diagnostics. African CDC estimates that at least 10 million doses of vaccines are needed across Africa, as against the 200,000 doses currently available.

To  meet the shortfall, Africa CDC has signed a tripartite agreement with the EU's Health Emergency Preparedness and Response (HERA), and Bavarian Nordic - the manufacturer of JYNNEOS for the procurement and supply of  200,000 doses. However, this is still just 2 per cent of the required doses. According to a report Bavarian Nordic has stated that it has a current stock of 500000 doses. It could produce another 2 million doses in 2024 and 10 million doses by 2025.

This clearly shows a massive shortage of supply and once again highlights the perils of dependency on monopoly production and underlines the need for a decentralised production through diverse manufacturers. In the case of Mpox the situation is exacerbated as Bavarian Nordic is the only supplier of an effective Mpox vaccine and holds patent monopoly rights.

Image Credit: Photo by Landiva Weber, Pexels