Last month, the World Health Organization declared the monkeypox outbreak a Public Health Emergency of International Concern. Cases have surged in the United States, Western Europe, Latin America and Asia. Governments scrambled to buy the vaccine, and small quantities of Jynneos went to a handful of wealthy countries.
One region has not received any Jynneos vaccine: Africa, where monkeypox has long been endemic. No country in Africa has yet purchased a single dose. The acting head of the African Centers for Disease Control and Prevention recently said, “Let’s bring a vaccine to the African continent.”
For many years, monkeypox was considered a disease that affects only people of color Virus. In fact, our interventions against monkeypox were primarily developed for potential smallpox outbreaks. We ignore monkeypox at our own risk. Where would we be if tools like Jynneos had been researched locally, manufactured regionally, and systematically distributed to affected populations in endemic countries prior to this outbreak? Ultimately, the global outbreak we now face. Local officials’ warnings were ignored.
It’s not too late to make a better route.
We can begin by funding the response to believe that the world is equipped to deal with this and the next outbreak. The United States spends hundreds of billions of dollars to strengthen its military defenses, but a small portion goes to strengthening global health defenses. A few weeks ago, a congressional committee voted to add another $37 billion to the president’s $813 billion request for next year’s Pentagon budget. Meanwhile, there is no new funding for monkeypox: The White House has yet to make a request to Congress. Historic funding for programs like the Strategic National Stockpile — which contained a paltry 2,400 doses of Jynneos at the time of the outbreak in the U.S. — was less than $1 billion a year. The United States has provided grants and loans totaling less than a few hundred million dollars to support global vaccine production.
Nor can we allow the private sector to dominate the public health response. A small Danish manufacturer, Bavarian Nordic, is currently responsible for the entire global supply of Jynneos. By the end of 2022, the company expects to send about 2 million doses of the vaccine to the U.S. (under a new dose-saving strategy, that supply could reach more people than expected, although efficacy issues remain), and produce less than 5 million agent for the rest of the world. That’s because the company’s main plant that makes vaccine bulk has been closed for nearly a year for refurbishment. As a result, the world relies heavily on existing bulk supplies, mostly owned by the US – which previously purchased “bulk” vaccines that could “complete” production of up to 15 million doses, which would take several months.
America must step up. It can quickly convert existing bulk into finished doses and share them with the world. It can also help create regional manufacturing hubs through technology transfer, including in Africa, to help the world better prepare. A South African manufacturer has already expressed interest in helping to bottle the vaccine. The World Health Organization wants to have a dialogue with Bavarian Nordics about sharing technology and working with its network of manufacturers.
The COVID-19 pandemic has brought public health preparedness issues to the fore. Monkeypox is the latest reminder. This is unlikely to be the last time.
Last month, the director of the African Centers for Disease Control and Prevention accurately described the risk of monkeypox: “The solution needs to be global,” he said. “If we are not safe, the rest of the world is not safe.” The global community can help contain this outbreak and build a more resilient future, but only if it works together.
Zain Rizvi, JD, is Director of Research in the Public Citizens Access to Medicines Program. Aly Bancroft, MPH, is the event coordinator for the Public Citizens’ Access to Medicines Program.
