For the second time in two years, the World Health Organization (WHO) has declared a public health emergency of international concern (PHEIC)—now in response to a surge of mpox cases in Democratic Republic of Congo (DRC) and neighboring countries.
The WHO's decision came on August 14—a day after the Africa Centers for Disease Control and Prevention (Africa CDC) announced its first public health emergency of continental security over the same crisis, which emphasized the inadequate global support the continent received during the global mpox emergency that ran from July 2022 to May 2023.
With mpox cases rising, the Africa CDC has called for 10 million doses by 2025 to respond to the multicountry outbreak, and DRC Minister of Health Samuel-Roger Kamba is reportedly seeking 3.5 million doses for his country alone.
Based on official government statements and media reports, Think Global Health has identified the countries and companies that have pledged vaccine doses to Africa. A database with sources is linked here and will be updated weekly on Tuesday.
As the global health community coordinates its response to the viral disease, it relies on three vaccines originally created to fight smallpox but repurposed during the previous mpox emergency, given that the viruses are related.
According to the U.S. CDC, the "best protection" against the mpox virus is two doses of the Jynneos vaccine, made by the Danish manufacturer Bavarian Nordic, which also goes by the names MVA-BN, Imvamune, and Imvanex. The LC16 single-dose vaccine produced by KM Biologics is yet to be internationally commercialized but has been approved domestically in Japan; in June, it received emergency authorization from DRC.
On August 29, 2024, the U.S. Food and Drug Administration expanded the approval of a third smallpox vaccine, ACAM2000 manufactured by Emergent BioSolutions, to prevent mpox disease. This vaccine has been shown to cause more side effects than the other two. The WHO recommends use of ACAM2000 only when other options are not available.
According to the WHO, as of late August, none of these vaccine options had been tested in randomized controlled trials for mpox, the gold standard of gauging effectiveness—though some observational studies of Jynneos recorded real-world effectiveness during the previous emergency.
Although the WHO is still currently assessing the vaccines for emergency use licenses, the Africa CDC has urgently called for more donations to contain the spread of mpox. In the meantime, the WHO announced that its partners Gavi and UNICEF, the chief buyers of vaccines for low-income countries, can begin the process of procuring doses for distribution to affected countries. The CEO of Bavarian Nordic told the New York Times on August 23 that the company had 350,000 shots available to sell and could produce up to 10 million Jynneos doses by the end of 2025 if it received orders.
On August 27, the WHO reported the first delivery of mpox vaccine donations to Nigeria—10,000 Jynneos doses provided by the U.S. government. A vaccination drive will reportedly begin in the country on October 8, according to the National Primary Health Care Development Agency.
On September 5, an initial batch of 100,000 Jynneos doses arrived in DRC’s capital Kinshasa, roughly half of the 200,000 doses pledged by the European Commission's Health Emergency Preparedness and Response Authority (HERA). The second half arrived the following weekend, authorities told the Associated Press, and the 50,000 Jynneos doses pledged to the DRC by USAID arrived on September 10. The 15,460 doses donated directly by Bavarian Nordic arrived in DRC on the same day, according to GAVI. DRC’s Monkeypox Response Committee stated that adults in the three most affected provinces of Equateur, South Kivu and Sankuru will receive the vaccine first, beginning on October 2.
Ongoing pandemic agreement negotiations have put pressure on countries to donate given the widespread inequities in COVID-19 vaccine distribution. Some countries—including the Netherlands—have chosen to maintain their national stockpiles rather than donate to affected African nations. The Netherlands has a reported stockpile of 100,000 vials, Lithuania has 2,500, and Denmark has 7,000, according to country health ministries confirmed by Politico.
Many more vaccines from high-income countries are likely currently available. Bavarian Nordic declared that it had supplied over 15 million doses globally during the mpox emergency that occurred from 2022 to 2023. In August, the pharmaceutical company announced that it had received a contract from an undisclosed European country to supply 440,000 doses of the Jynneos vaccine. The United States, which has delivered 60,000 vaccines to Africa as of September 10, deployed more than 1 million vials of the Jynneos vaccine nationally between 2022 and 2024. Although Biden administration officials would not confirm the current number of vaccines held in the U.S. stockpile in September, the Administration for Strategic Preparedness and Response stated that the government supply to be at 7 million vials in mid-2023. Canada, which has yet to donate vaccines, has not disclosed its stockpile, however the country entered a 10-year supply contract with Bavarian Nordic for its mpox vaccine valued at $470 million, with the majority set to be delivered in 2023.
The European Commission had requested that member countries communicate their intentions to donate mpox vaccines to Africa by the end of August.
Minors account for 75% of mpox cases in Democratic Republic of Congo
As of now, LC16 is the only vaccine licensed for use in children (in Japan), and minors account for 75% of mpox cases in DRC. Bavarian Nordic is currently awaiting approval in Europe to extend the Jynneos vaccine's use to adolescents, and the company has announced a new clinical trial for later this year to determine the vaccine's safety in children age 2 to 12 years in DRC.
Even though mpox is endemic to DRC and parts of central and west Africa, cases have risen dramatically since January 2023. The virus breaks into two major ancestral groups of collections of strains, known as Clades I and II. Each clade has two subgroups (a and b).
Clade I is the cause of the new global emergency. In particular, Ia strains, which are endemic in DRC, have now spilled into the Central African Republic and Congo. Clade Ia is considered more severe and deadlier, especially among children, relative to what's been observed for Clade II, which sparked the previous emergency in 2022.
Clade Ib surfaced this year in DRC and appears to be spreading more easily between people, though this trait is unclear because of a historic lack of testing for the disease.
Since declaring the PHEIC, cases of Clade Ib have been detected for the first time beyond the African continent, in Sweden and in Thailand, with experts stating that the clade had "almost certainly" spread elsewhere in Europe.
EDITOR'S NOTE: The tracker was updated to reflect the donation of MVA-BN "vials," one of which can correspond to a single dose intended for subcutaneous vaccination or five doses for intradermal vaccination. Spain's donation was corrected to reflect that the country had pledged 100,000 vials. This article was originally published on August 27, 2024.
