Monkeypox: The next global vaccine equity failure?

Monkeypox – the next global vaccine equity failure?

Bavarian Nordic is the sole supplier of the preferred monkeypox vaccine. Credit: Shutterstock

Inequitable access to COVID-19 vaccines has proven to be the catastrophic moral failure the World Health Organization Director-General warned of in early 2021.

International efforts to distribute COVID-19 vaccine doses equitably failed miserably in 2020-2021, when wealthy countries bought up the bulk of the global supply, leaving insufficient doses for countries that could not afford them. to buy vaccines on the private market. This has resulted in hundreds of thousands of unnecessary deaths in low-income countries.

Disturbing (and familiar) trends emerge

Even today, with more than 12.5 billion doses administered worldwide, only around one in five people in low-income countries have ever received a dose of the COVID-19 vaccine. And because the underlying issues of equitable distribution of previous vaccines have not been addressed, inequitable access to monkeypox vaccines is poised to be the next global disgrace.

We are already seeing the same patterns emerge: vaccine nationalism, as rich countries hoard the limited doses available, and exclusive rights to manufacture medical products carefully protected by Western pharmaceutical companies, while poor countries lack access to vaccines. existing ones the supply or the means to manufacture their own.

If we do not reverse these trends, it will be very difficult to bring the global monkeypox epidemic under control, and poor countries will once again bear the brunt of the health and economic effects.

Monkeypox or MPX: A public health emergency that calls for global solidarity

Monkeypox does not pose the same level of threat as COVID-19, but it remains a major public health concern, with more than 44,000 cases reported in at least 99 countries since the start of 2022.

So far, most cases in 2022 have been in men who have sex with men, but anyone can get monkeypox. Certain population groups, including young children, pregnant women, and people with weakened immune systems, are at higher risk of contracting a serious illness.

To reduce the risk of stigma associated with the term monkeypox, the World Health Organization is considering changing its name. A new name has yet to be announced, but many community organizations have started using MPX or similar terms.

The 2022 outbreak is the first time there has been sustained transmission of MPX outside of Africa. The gravity of the situation is reflected in the WHO’s decision to declare it a Public Health Emergency of International Concern (USPPI) on July 23.

The global pattern of MPX cases and deaths

During the 2022 outbreak, the overwhelming majority of MPX cases were reported in the Americas and Europe, accounting for over 62% and nearly 37% of cases, respectively, over the past four weeks. Nearly 89% of cases have been reported in the United States, Spain, Brazil, Germany, United Kingdom, France, Peru, Canada, Netherlands and Portugal. Currently, new infections appear to be declining in Europe, but continue to rise rapidly in the United States.

Human cases of MPX have been reported in West and Central Africa since 1970, but in 2022 only 350 confirmed cases in these regions have been reported to WHO, representing 1% of global cases. However, Africa is overrepresented when it comes to deaths. Six of the 13 deaths reported to WHO in the current outbreak (46%) occurred in West and Central Africa.

During the first two years of the COVID-19 pandemic, thousands of MPX cases and hundreds of deaths occurred in Africa, according to the Africa Centers for Disease Control and Prevention (Africa CDC). But this situation has received little international attention and the continent has had no access to vaccines.

MPX vaccines are rare

Fortunately, there are several smallpox vaccines that can be used to prevent MPX.

The preferred vaccine is Modified Vaccinia Ankara—Bavarian Nordic (MVA-BN), a third-generation vaccine that has fewer side effects than older vaccines and can be safely given to immunocompromised individuals and pregnant women. Two doses are needed to provide sufficient protection.

A company in Denmark, Bavarian Nordic, is the sole supplier of MVA-BN. Its plant has reportedly been closed for months due to a planned expansion and is not expected to be able to produce new doses until 2023.

According to the WHO, there are approximately 16 million doses of MVA-BN. Most of them are in bulk rather than ready to use.

It’s unclear exactly how many doses will be needed to bring the outbreak under control, but 16 million doses might not be enough, especially if they are unevenly distributed rather than available to the most high-risk groups in each country.

Rich countries are piling up existing vaccine stocks

Most of the roughly 16 million vaccine doses are owned or contracted to the United States, which funded some aspects of the vaccine’s development. Millions of doses made from the bulk vaccine will be “filled and finished” at facilities owned by the US government or US-based companies.

Other wealthy countries rushed to get doses of the remaining supply. The European Commission announced that it had obtained approximately 109 million doses of Bavarian Nordic in June 2022 and an additional 54,000 doses in July.

The UK has also secured over 100,000 doses and Canada is also said to have signed a multi-million dollar contract to supply the vaccine.

On August 4, Health Minister Mark Butler announced that Australia had ordered 450,000 doses of Jynneos, 22,000 of which would arrive in the same week and the rest in 2022-2023.

While the WHO has asked countries that have doses to share them, there is no indication that this is happening so far.

It seems that no African country has yet received a single dose. As the Africa CDC tries to negotiate access to the vaccine, reports suggest there are no more doses left to buy from the private sector.

Bavarian Nordic recently announced that it has reached an agreement with the Pan American Health Organization to provide access to the MVA-BN vaccine to Latin America and the Caribbean. The details of this agreement, including the number of doses and the beneficiary countries, are not yet made public.

Proprietary rights prevent more widespread manufacture of vaccines

Currently, Bavarian Nordic essentially controls the global supply of a vaccine that at least 99 countries desperately need. Although it cannot manufacture the vaccine itself at this time due to the redevelopment of its factory, it can still prevent others from manufacturing the vaccine due to the intellectual property rights underpinned by the Aspects Agreement. Trade-Related Intellectual Property Rights (TRIPS) of the World Trade Organization. .

These intellectual property rights include, among others, patent protection and trade secret protection. Patent protection provides at least 20 years of exclusivity, during which no one else can manufacture or sell the product without permission from the patent holder. Although the TRIPS Agreement allows exceptions to patent protection in certain circumstances, trade secret protection presents a formidable barrier to broader vaccine manufacturing.

Attempts to negotiate a temporary waiver of the TRIPS Agreement rules for COVID-19 vaccines did not produce a meaningful result, and a limited COVID-19 waiver would not have helped make the vaccines available for other diseases such as MPX.

As a global community, we need to do better

If the same mistakes are made in the global response to MPX as those made with COVID-19, the outbreak is unlikely to be brought under control quickly. The virus could become established in animal reservoirs and become endemic in many other countries.

The burden of suffering and death will fall most heavily on those countries least able to access the tools to prevent and manage it. We must do everything so that this does not happen.


Monkeypox vaccine maker and WHO sign agreement with Latin America


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Monkeypox: The next global vaccine equity failure?

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