World Needs 180,000 – 360,000 Monkeypox Vaccine Doses For People Exposed – Up to 10 million for High Risk Groups 
Men receiving doses of monkeypox vaccine.

About 10% of people with Monkeypox require hospitalization and children are at the highest risk of severe disease, says WHO. Meanwhile, there are only about 1 million doses of the EMA and US FDA-approved MVA-BN vaccine readily available today across the globe – but that vaccine is also untested against monkeypox at large scale.

The world would need about 180,000 to 360,000 Monkeypox vaccine doses to immunize people who may have recently been exposed to monkeypox, said WHO officials on Wednesday. That was the first ballpark estimate of vaccine need to be made by the global public health agency, since the public health emergency was declared on Saturday, July 26. 

If, however, countries eventually opted for a strategy of vaccinating all of those people and groups at risk – the demand could swell to some 5-10 million doses of the two-dose vaccine, said WHO’s Tim Nguyen, speaking at a WHO press conference on Wednesday. 

Tim Nguyen, Unit Head
High Impact Events Preparedness

Currently, there are about 1 -1.4 million available doses worldwide of the MVA-BN vaccine, the only one approved by the European Medicines Agency and the US Food and Drug Administration, both WHO and other pharma sources have said. 

That vaccine is manufactured in Europe as Imvanax and JYNNEOS in the United States by the Danish pharma firm, Bavarian Nordic, the sole producer of the vaccine.  

Estimates based on potential number of contacts with 18,000 people infected now 

WHO Emergency Dashboard for Monkeypox as of 27 July 2022

Nguyen said that the estimates were made on the basis that there are right now some 18,000 cases reported globally, and “if you look at a post-exposure strategy and extrapolate the global number of cases, by 10-20 contacts each, you get to 180,000-360,000 vaccine doses. 

“As for pre-exposure prophylaxis, among what countries define as high risk groups, this could account for something between 5-10 million doses of the vaccine. These are preliminary ballpark figures and we are looking at further modeling studies.” 

He added that in terms of pre-exposure strategies, “when it comes to the supply, we know that there is not enough in fill-and-finish form. So the key is what are their [Bavarian Nordic’s] plans for gearing up on fill and finish capacity.” 

He added that WHO has already “received offers” from other manufacturers to help the Danish firm to “scale up the fill and finish” – and passed those onto the manufacturer.  

Said WHO’s Chief Scientist, Soumya Swaminathan, “We are in discussions with the manufacturers to get an idea of availability of doses.. Many of them have already been committed to countries, we would like to explore the possibility of a donation from countries that do have doses, to put them in a stockpile.”

Soumya Swaminathan, WHO Chief Scientist

Reached for comment, a Bavarian Nordic spokesperson did not comment directly on the WHO’s appeals. However, he told Health Policy Watch that “We are scaling up our production of the MVA-BN vaccine based on customer demand.” 

The spokesperson added that the company had already “made agreements with a contract manufacturer for filling of vaccines as per our announcement on July 15.”

Other approved smallpox vaccines are ACAM2000 and LC-16, the latter produced by the Japanese firm KM Biologics- but neither have been authorized for use against monkeypox. 

WHO calls for men who have sex with men to reduce number of partners  

Tedros Adhanom Ghebreyesus, WHO Director General

 In light of the vaccine supply constraints as well as outstanding questions about the vaccine, non-pharmaceutical measures such as contact tracing and self-isolation of infected people remain very important, the WHO officials said. 

In an unusual appeal, WHO’s Director General Dr Tedros Adhanom Ghebreyesus also called upon the LGBTI community, and particularly men who have sex with men, to reduce their number of sexual partners, in order to get the virus under control. 

“This is an outbreak that can be stopped if countries, communities, and individuals themselves take the risk seriously, and take the steps needed to stop transmission and protect vulnerable groups,” he said. 

“The best way to do that is to reduce the risk of exposure. That means making safe choices for yourself. And for men who have sex with men: this includes for the moment, reducing your number of sexual partners. Reconsider sex with new partners and exchange contact details with any new partners to enable follow up if needed,” he stressed. 

Virus can be transmitted via hugging, kissing, and infected surfaces 

The WHO official noted that while 98% of cases are among men who have sex with men, the virus can be transmitted to household members, through hugging and kissing, and contact with infected towels and betting. 

“Anyone can get monkeypox, so we must take action to reduce the risk of transmission to other vulnerable groups, including women, children, and immunocompromised groups,” he said. 

WHO, meanwhile, has called upon countries that have already purchased the vaccine and are beginning to roll out the vaccine to collect information on its efficacy – in light of the dearth of information that exists on the mass deployment of the vaccine in a real life setting. 

Most cases reported in WHO’s European Region 

Currently, some 70 percent of the more than 18,000 Monkeypox cases reported have been in WHO’s European Region, while about 25 percent have been reported in the Americas, mostly North America. Some 365 cases have been confirmed in Africa, where the disease is endemic, but that excludes more than 2,000 suspected cases for which laboratory tests were unavailable, in light of the dearth of capacity. In other WHO regions, reported cases has been negligible although that, too, may be due to lack of test capacity and stigmatization that makes infected people reluctant to seek care at all. 

However, while some countries already are beginning to roll out the vaccine, it’s still unclear how well the vaccine works. 

Symptoms in children are the most acute – can lead to dehydration, encephalitis, potential blindness

Positive monkeypox test.

While there have only been 5 deaths reported, the 10% rate of hospitalization – often for pain management – reflects the seriousness of the disease. And while 98% of cases seen today are among men who have sex with men, those children who have been affected have also been the hardest hit, officials said. 

“There is a preponderance of children, pregnant women and immune-compromised persons amongst those who do develop severe disease,” said Rosamund Lewis, WHO’s monkeypox lead.

Both current and classic forms of monkeypox appear on the neck and lymph nodes and can become significantly enlarged making it difficult to swallow, she said. 

“So, for example if the rash is very extensive, there can be fluid loss. Because these lymph nodes can become significantly enlarged, making it difficult to swallow – which can also contribute to dehydration.  There can be severe pain in the mouth and throat, which contributes to difficulty eating.

“Taking care of the rash is important for children who develop significant rashes,” she added. “And of course monkeypox can also affect the other mucosal surfaces, especially including the eyes.”

Rosamund Lewis, Technical lead for monkeypox

“And certainly in the African setting, we’ve seen a number of people who develop scarring over the cornea become blind due to monkeypox because of the lesions that appear in the eyes and on the cornea. So there are a number of other things that can happen. 

“We are starting to see a few cases of encephalitis which is inflammation of the brain. This has been reported in the past.”

There also could be “consequences” for a woman that becomes infected during  pregnancy, added Lewis concluding: “so these are people that are vulnerable… either because of their age, their immune status, and children are still building their immunity, and others may have their immunity compromised, whether through pregnancy, untreated HIV or chemotherapy or other immuno-suppressive treatments.” 

-Stefan Anderson in Brussels helped contribute to the research of this story.

Image Credits: The Hill/Twitter , WHO , TRT World Now/Twitter .

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