In an effort to prevent the spread of monkeypox, the Pan American Health Organization (PAHO) signed an agreement with Bavarian Nordic to obtain 100,000 vaccine doses for Latin America and the Caribbean.

That will allow PAHO to start delivering the doses to the 12 countries that requested them in September.

The agreement will make the Americas the first and only region to receive monkeypox vaccines through a multilateral effort.

PAHO used its Revolving Fund, which provides access to vaccines at affordable prices, to secure its first agreement with the Danish vaccine company. Attempts to secure vaccines in other regions, such as Africa, where monkeypox is endemic, have been stymied, with little discussion from the World Health Organization (WHO).

WHO is in talks, however, with some vaccine manufacturers and nations to obtain some of their large vaccine reserves and distribute those monkeypox doses more widely and equitably.

A WHO spokesperson told Health Policy Watch it has been “in close contact” with those manufacturers and nations “since the beginning of the outbreak.”

“WHO continues to urge countries with larger stockpiles to share and donate vaccines,” the spokesperson said, “[and] is concerned that the inequitable access to vaccines and treatments seen during the COVID-19 response is repeating itself in this monkeypox multi-country outbreak.”

The spokesperson also noted that PAHO is still consolidating nations’ formal requests for some of the doses and is “working to define the best way forward to guarantee an equitable vaccine distribution.”

Twelve countries in the Americas region have signed up to receive the vaccines from PAHO’s Revolving Fund, with an additional seven countries talking toPAHO about ordering some. PAHO says it expects to receive the first batch of doses from Bavarian Nordic in September, then  a second batch in November and a third batch in December — making for 100,000 doses in all.

PAHO did not disclose how much it is paying for the doses.

The Americas – highest burden of monkeypox worldwide 

More than 30,000 new monkeypox cases have been reported in the Americas as of 6 September, saddling the region with the highest burden anywhere. Most of the cases are concentrated in the United States, Brazil, Peru, and Canada. 

The fraction of monkeypox cases that do not involve any  recent contact with men who have sex with men (MSM) continues to rise in the US, suggesting a silent spread of the virus to other communities. 

Four monkeypox-related deaths have been reported in Brazil, Cuba, and Ecuador. 

Though PAHO was able to secure an agreement with Bavarian Nordic for monkeypox vaccines, PAHO’s Director Carissa Etienne noted these doses remain in limited supply, necessitating the use of other public health measures as well.

Due to the shortage, WHO does not recommend mass vaccinations.  

“Vaccination, when available, can be deployed as a preventative measure,” said Etienne. 

“With vaccines in short supply, and with no effective treatment for monkeypox, countries should intensify efforts to prevent the spread of the virus in our region,” she said. “We need to guarantee equitable allocation, and this requires the prioritizing of vaccine distribution to maximize the health impact.”

Monkeypox response must involve affected communities 

The limited vaccine supply highlights the need to involve affected communities in the public health response to monkeypox. 

Ciro Ugarte, PAHO’s director of health emergencies, said public health authorities “need to be in close contact with the individuals who have higher risk of transmission and involve them in the prevention and early diagnosis efforts, as well as care.”As vaccine shortages limit the potential to stem the outbreak, Ugarte emphasized, there can be no effective response without community involvement.  

“Risk communication is extremely important and effective,” he said. “The vaccine is a tool to help, but it will not be solving the final problem.”

To achieve full community participation, Etienne said, all possible efforts must be made to reduce the harmful impact that stigma can have on people’s ability to get treatment. 

“LGBTQ+ communities face stigma and discrimination that impacts their health and well being, but stigma has no place in public health”, she said. “It prevents those at risk from accessing information, getting tested, or seeking medical attention when they show symptoms.”

Etienne said the continent’s experience with HIV/AIDS should serve as a cautionary tale.

“We must work to break down stigma and discrimination or most at-risk populations will not seek care,” she said.

“The pandemic is not behind us”

Though the region’s renewed focus and cooperation on monkeypox response is a welcome development, PAHO officials said, significant work remains to be done to confront the COVID-19 threat. 

“COVID-19 cases, hospitalizations and deaths have decreased across the Americas,” said Etienne. “Despite this trend, hundreds of people are still dying every day from COVID-19 across our region. Just last week, we had 4,954 reported deaths in the Americas.”

Dr Marcos Espinal, director of PAHO’s department of communicable diseases and health analysis, said public health authorities must keep delivering COVID-19 vaccinations, too. 

“We have many countries in the region where less than 40% are covered,” said Espinal. “We have not left the pandemic behind.”