Fraction of US Monkeypox Cases With No Recent MSM Contact Continues to Increase in Silent Spread to Other Communities  
Administering monkeypox doses in the United States after the US signs off on deployment of 1.1 milion doses

The fraction of monkeypox cases with no recent contact with men who have sex with men (MSM) continues to rise in the US – accounting for one-third of cases – suggesting a silent spread of the virus to other communities.

Men with recent MSM contact accounted for 65.78% of cases as of 20 August, according to the US Centers for Disease Control and Prevention (CDC) data, down from 72.44% a week earlier. Currently, men who had no recent MSM contact account for 27.71% of all US cases, while women account for 4.67% and those with other gender identities account for 1.84% of cases. 

Proportion of cases with known data on sexual history and gender reporting recent man-to-man sexual contact (MMSC) by the week in which monkeypox case was reported.

Overall, cases in the Americas continue to rise sharply, accounting for 60% of all cases compared to Europe’s 38% in the past month. The WHO European region is also demonstrating early signs of a declining infection.

However, there is a clear, disproportionate access globally to vaccines against monkeypox. The US holds nearly 80% of the Jynneos vaccine supplies used to fight monkeypox,  but it has only 35% of the global monkeypox cases. Most countries have no access to any doses, according to a Public Citizen analysis on Thursday.

“Once again, vaccines for an outbreak are not available in the vast majority of countries, including in the African states that have fought monkeypox for years,” said Peter Maybarduk, director of Public Citizen’s Access to Medicines Program. 

He called on the US to “put forward a plan to fight global monkeypox and avoid the tragic mistakes of the COVID crisis.”

The analysis compares vaccine access and monkeypox cases in more than a dozen countries. It shows the US and many European countries obtained most of the vaccine, while Africa, where monkeypox is endemic, has not gotten a single dose.

Lack of monkeypox vaccine access mirrors early days of COVID-19 

The World Health Organization has said little about the lack of monkeypox vaccine access and lopsided availability of vaccines overall, despite having been outspoken about the COVID-19 pandemic’s vaccine inequities.

What’s different in this case is there is only one manufacturer of monkeypox vaccines, Bavarian Nordic, and its European plant shut down in the spring for renovations

Officials from the Africa Centers for Disease Control Prevention and WHO African region have decried the continent’s lack of access to monkeypox vaccines.

In July, Africa CDC’s acting director, Ahmed Ogwell Ouma, drew attention to the disparity between WHO’s urgent declaration of monkeypox as a global public health emergency (PHEIC) and the sluggish response to the burgeoning risks in Africa.

Countries such as Democratic Republic of the Congo (DRC), which reported multiple deaths from monkeypox, have not received any doses or gotten any orders secured. 

Monkeypox cases and vaccines across 12 countries. Countries in Africa where the virus is endemic, such as DRC, have not secured a single dose.

In contrast, the US had 1.1 million vaccine doses on hand for 16,602 cases as of late August — 22 times more doses hoarded than in even the European Union and U.K. combined.

The US supply is enough to treat each case with 66 doses, and the country also had placed orders for nearly 7 million more doses.

Though the US is considered a hotspot for monkeypox, with cases rising across other groups with no MSM contact, advocacy groups say the disproportionate access is a disturbing contrast to WHO’s aim to eliminate monkeypox.  

“Alarm bells are ringing,” said Zain Rizvi, research director in Public Citizen’s Access to Medicines program. 

“As we have learned all too painfully throughout the coronavirus pandemic,” said Rizvi, an expert on pharmaceutical innovation and access to medicines, “we can’t solve a global public health emergency through national policies alone. A global plan is needed to curb this global crisis.”

Image Credits: The Hill/Twitter , US CDC , Public Citizen.

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