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Urgent efforts to roll out vaccines to tackle the Mpox international public health emergency in central and east Africa risk being hobbled by a lack of orders and logistical challenges, a leading vaccine manufacturer has said as Sweden announced the first case outside Africa.
Cases of the outbreak have been detected in 13 African countries, with the majority in the Democratic Republic of Congo, according to the African Centres for Disease Control and Prevention. It said the continent needs 2mn vaccine doses by the end of the year to help control the outbreak.
Bavarian Nordic, which makes one of two Mpox jabs recommended by World Health Organization experts, said it has 300,000 doses of its Jynneos vaccine ready and enough production capacity to meet demand. But it faces challenges, including the jab’s lack of approval in some affected countries and the need for a cold supply chain, chief executive Paul Chaplin told the Financial Times.
“We have the capacity, but we need people to start placing orders pretty fast,” he said. “We need orders by the end of this month if we’re going to meet 2mn by the end of this year.”
The concerns over vaccine supply and distribution come after similar difficulties stymied immunisation rates in many African countries during the Covid-19 pandemic.
The WHO declared a public health emergency for Mpox on Wednesday. The current outbreak is seen as even more serious than a surge in cases that led to a previous declaration in 2022-23 as it is being driven by the more dangerous clade 1b virus type.
On Thursday, the Swedish Public Health Agency reported that one person had been diagnosed with Mpox clade 1b in the first such case outside the African continent. The agency said the person had returned from a trip to Africa.
Mpox, previously known as monkeypox, can cause fever, skin lesions and sometimes death. It can be more severe among patients with uncontrolled HIV and is transmitted through contact with infected people or animals, or contaminated materials.
Vaccines are based on the now eradicated smallpox, part of the same family of pathogens.
Bavarian Nordic received an order of more than 175,000 doses from the European Health Emergency Preparedness and Response Authority (HERA) on Tuesday and has also donated a further 40,000 to HERA. The US said on Wednesday that it would donate 50,000 Jynneos doses to the DRC.
The company is in talks with other governments about placing further orders that would be distributed to Africa, Chaplin said. Gavi, the vaccine alliance, said it is also discussing direct procurement with the company. If enough orders are booked, Bavarian Nordic can supply 10mn doses by the end of 2025, Chaplin said.
Shares in the vaccine maker have climbed almost 20 per cent since Tuesday.
Another shot by Japan’s KM Biologics is also recommended by the WHO’s immunisation advisory group, while the USA’s Emergent BioSolutions also has a vaccine for smallpox. The companies did not immediately respond to requests for comment.
But with vaccine supplies expected to be limited, public health experts said other measures will be key to preventing spread of the virus, such as contact tracing and testing, and better understanding of how the new clade spreads. Clade 1b appears to be more virulent than the previously dominant clade, they added.
Two-fifths of cases in the DRC are in children under the age of five, according to Brian Ferguson, a professor of immunology at the University of Cambridge.
The DRC did not receive vaccines during the previous emergency in 2022, due to a lack of regulatory approvals.
Bavarian Nordic now has approval for emergency use of its vaccine in the DRC and Nigeria, but other countries affected have not yet followed suit.
On Tuesday, Jean Kaseya, Africa CDC director-general, called on countries to “fast-track the emergency authorisation of Mpox vaccines”. There have been 2,863 cases and 517 deaths this year, it said.
WHO last week launched a process to enable the emergency use of vaccines in countries that have not yet issued national approval, which could speed up its availability to countries and enable Gavi and charities such as Unicef to procure vaccines.
Gavi also said on Thursday that it could repurpose available funding to support the vaccine and waive independent reviews of new vaccine campaigns.
Ferguson welcomed the WHO response but said: “All of these steps take time and the frustration in this case is that we’ve seen what happened two years ago. There’s been very little activity to do those things with a preventive nature in mind to stop the next outbreak.”
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