WHO Recommends Monkeypox Vaccine Stockpile
Sylvie Briand fielding questions about COVID-19 cases in healthcare workers.

GENEVA — The monkeypox outbreak has spread to almost 200 cases reported by more than 20 nations outside of Africa, where the disease is endemic. But the epidemic can be contained through a quick response, World Health Organization (WHO) officials told a public briefing for member nations on Friday.

With few vaccines and drugs available globally to fight monkeypox, a zoonotic disease transmitted from animals, WHO officials proposed creating a stockpile to equitably share existing resources. They said there is no evidence the virus has changed but acknowledged many questions remain about how this epidemic emerged, and what role animal hosts played in tranmission.

Dr Sylvie Briand, WHO’s director of pandemic and epidemic diseases, said “it’s an unusual situation” because the first case was only reported on 7 May, and since then there have been a high number of cases among non-endemic countries. Most of the cases result in symptoms such as body aches, chills, fatigue and fever, but some people may also develop a rash and lesions on their face and hands that can then spread to other parts of the body.

Monkeypox endemic in nine countries

“We know that it’s endemic in a bit more than nine countries in Africa where we have seen outbreaks in the recent years. This virus is an autopox virus. It’s a virus from the same family as smallpox and also other cowpox viruses,” Briand said.

“What is important is just to see that this event is unusual,” she said. “Usually, we have no cases or very sporadic cases that are exported to non-endemic countries. But now we have more and more cases.”

Briand said WHO doesn’t know “if this unusual situation is due to a virus change. It doesn’t seem so, because the first sequencing of the virus shows that the strain is not different from the strains we can find in endemic countries, and it’s probably more due to a change in human behavior.”

“But we are also investigating this and trying to understand the origin of this sudden outbreak of monkeypox in non-endemic countries,” she continued. “There are so many uncertainties about the future and this disease, about the future, because we don’t know if this transmission will stop.”

Briand said WHO believes there is “a good window of opportunity to stop the transmission now” because of existing medical countermeasures, vaccines and therapeutics. “We are afraid that there will be spread in communities, but currently it’s very hard to assess this risk. We think that if we put in place the right measures now, we probably can contain this easily,” she said.

No need for mass monkeypox vaccination

Dr Rosamund Lewis, head of WHO’s smallpox department, said a vaccine for monkeypox has only been approved in the US and Canada, but there is no need for mass vaccinations because the virus is usually only transmitted only through skin-to-skin contact. But she suggested those few nations that have the vaccines could use them for vulnerable populations, such as health workers or families of patients.

“And as far as we know, smallpox countermeasures may be protective against monkeypox. But you can imagine that there’s not been time to do a lot of research, certainly nothing on smallpox in the last 40 years in terms of human studies, clinical trials and field studies,” Lewis said. “What we have been advised so far is that there is no need for mass vaccination, there is no need for large immunization campaigns.”

Dr Mike Ryan, WHO’s emergencies chief, said the global body will work with member nations on creating a stockpile to share the limited number of smallpox vaccines with other nations that lack the resources to purchase them.

“We would like to see a coordinated mechanism whereby countries can access vaccines and therapeutics through a mechanism that’s efficient, that’s fair, that’s equitable, but also recognizes that mass vaccination is not the target here,” he said.

“We’re talking about providing vaccines for a targeted vaccination campaign, for targeted therapeutics. So the volumes don’t necessarily need to be big, but every country may need access to a small amount of vaccine.”

Ryan said such vaccines would be distributed on the basis of need, not the ability to pay, and a number of countries already “have very wisely invested in stockpiles in case of smallpox” and could make available vaccines and therapeutics that are licensed for monkeypox.

“We will and are and will be working with those countries to see if we can make good on many informal arrangements over the years for the sharing of those products,” he said. “And we would very much thank those countries who do have stockpiles, who have engaged with us previously over the years, and are engaging with us right now to try and find solutions for this issue.”

Image Credits: WHO.

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