Moves by rich countries to buy large quantities of monkeypox vaccine, while declining to share doses with Africa, could leave millions of people unprotected against a more dangerous version of the disease and risk continued spillovers of the virus into humans, public health officials are warning.
Critics fear a repeat of the catastrophic inequity problems seen during the coronavirus pandemic.
The mistakes we saw during the COVID-19 pandemic are already being repeated, said Dr. Boghuma Kabisen Titanji, an assistant professor of medicine at Emory University.
While rich countries have ordered millions of vaccines to stop monkeypox within their borders, none have announced plans to share doses with Africa, where a more lethal form of monkeypox is spreading than in the West.
To date, there have been more than 21,000 monkeypox cases reported in nearly 80 countries since May, with about 75 suspected deaths in Africa, mostly in Nigeria and Congo. On Friday, Brazil and Spain reported deaths linked to monkeypox, the first reported outside Africa.
The African countries dealing with 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 won't be necessary. They think targeted use of the available doses, along with other measures, could shut down the expanding epidemics recently designated by the World Health Organization as a global emergency.
On Thursday, the Africa Centers for Disease Control and Prevention called for the continent to be prioritized for vaccines, saying it was again being left behind.
If we're not safe, the rest of the world is not safe, said Africa CDC's acting director, Ahmed Ogwell.
Although it has been endemic in parts of Africa for decades, monkeypox mostly jumps into people from infected wild animals and has not typically spread very far beyond the continent.
Some experts worry the mechanism could duplicate the problems seen with COVAX, created by WHO and partners in 2020 to try to ensure poorer countries would get COVID-19 shots. That missed repeated targets to share vaccines with poorer nations and at times relied on donations.
Just asking countries to share is not going to be enough, said Sharmila Shetty, a vaccines adviser for Medecins Sans Frontieres. The longer monkeypox circulates, the greater chances it could get into new animal reservoirs or spread to" the human general population, she said. If that happens, vaccine needs could change substantially.
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 about 30 million doses, with about 16 million vaccines available now.
In May, Bavarian Nordic asked the U.S. to release more than 215,000 doses it was due to receive, to assist with international requests the company was receiving, and the US complied, according to Bill Hall, a spokesman for the department of Health and Human Services. The US will still receive the doses, but at a later date.
The company declined to specify which countries it was allocating doses for.
Hall said the US has not made any other promises to share vaccines. The US has ordered by far the most number of doses, with 13 million reserved, although only about 1.4 million have been delivered.
Some African officials said it would be wise to stockpile some doses on the continent, especially given the difficulties Western countries were having stopping monkeypox.
I really didn't think this would spread very far because monkeypox does not spread like COVID, said Salim Abdool Karim, an infectious diseases epidemiologist at the University of KwaZulu-Natal in South Africa. Africa should procure some vaccines in case we need them, but we should prioritize diagnostics and surveillance so we know who to target, he said. Normally, you're able to get ahead of a disease like monkeypox, but I am concerned (the number of new cases) hasn't started coming down yet.
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