Mpox vaccine access must be dramatically increased

On August 13, the Africa Centers for Disease Control and Prevention (CDC) declared the mpox outbreak a Public Health Emergency of Continental Security. A day later, WHO declared the upsurge of mpox in the Democratic Republic of Congo (DRC) and a growing number of African countries a public health emergency of international concern.

Although all components of an outbreak response are needed, increasing access and use of existing vaccines is key to help prevent further spread of the virus. Africa CDC Director General Dr. Jean Kaseya has estimated that at least 10 million doses of mpox vaccines will be needed to respond to the ongoing epidemic while supply is extremely limited in the affected region.

“The extremely limited availability of mpox vaccines in DRC has already drastically reduced the reach of the national strategic plan for vaccination against mpox,” said Dr. Justin B. Eyong, intersectional epidemiological coordinator for MSF in DRC. “This means that without improved access to vaccines, thousands of people may be left unprotected.” Children under 15 years old are particularly affected, representing 56 percent of all cases and 79 percent of all deaths from the disease in 2024, said Dr. Eyong.

To help increase access to vaccines, countries that are in possession of substantial stockpiles of MVA-BN vaccines—and that are not experiencing any active outbreaks—must donate as many doses as possible to affected countries in Africa. The MVA-BN vaccine is the only mpox vaccine approved by the US Food and Drug Administration and European Medicines Agency.

Additionally, the current price of the MVA-BN vaccine is out of reach for most low- and middle-income countries where mpox is endemic or is currently spreading. Therefore, the company that makes it, Bavarian Nordic, must review its pricing policy, and urgently seek partnership with one of the emerging vaccine manufacturers in Africa for a full and timely tech transfer so a vaccine protecting against a disease that is endemic to Africa can also be produced on the African continent in the future.

All relevant parties must also find a legal arrangement for any compensation that stems from the use of the MVA-BN vaccine in children and adolescents during this outbreak, such as a no-fault compensation fund. The pediatric use of MVA-BN was recommended by the United States CDC during the 2022 mpox outbreak and by the WHO Strategic Advisory Group of Experts on Immunization among children with increased risk of contracting mpox.

“With the mpox outbreak in DRC continuing to evolve rapidly, the situation is urgent,” Dr. Eyong said. “Every necessary step must be taken to get mpox vaccines to the adults and children who need them now.”

MSF is also calling for the WHO to accelerate the Emergency Use Listing (EUL) Procedure of the two mpox vaccines already approved by WHO-listed national regulatory authorities. EUL will encourage manufacturers to increase their production of the mpox vaccines, and allow Gavi, The Vaccine Alliance, and UNICEF to procure these vaccines for distribution.

MSF has been mobilizing emergency teams over the last couple months to respond to the mpox epidemic across DRC. They are on the ground in South Kivu, North Kivu, Equateur, and South Ubangi provinces to support the local health authorities. More than 1,159 patients have been treated since June 17.