Ángela Bernardo
Senior Health and Public Policy Editor - Civio Foundation
The detection of the first cases of monkeypox outside its usual regions in May 2022 did not hint at the magnitude of the looming crisis. For decades, the circulation of this virus, which is related to the virus that once caused human smallpox, had been limited to central and western Africa, with the exception of small outbreaks in countries such as the United States, Singapore and the United Kingdom. This time, however, the situation has turned out to be dramatically different.
In mid-July 2022, the spread of the disease prompted the WHO to declare monkeypox a "public health emergency of international concern". However, cases are still on the rise: from May to early September 2022, more than 23,000 infections had been diagnosed in European countries. Undoubtedly, problems concerning access to vaccines have represented a major barrier when it comes to preventing and stopping uncontrolled transmission of the disease.
On the one hand, only two EU countries (France and the Netherlands) confirm that, prior to the crisis, they were in possession of stocks of the safest and most effective vaccines against the virus, according to research by the Civio Foundation. These are the Imvanex vaccines, developed by the company Bavarian Nordic. This is why other countries, such as Denmark and Spain, which did not have these medicines, initially bought a number of doses from the Netherlands.
On the other hand, the vaccines which other countries had were older, as was the case in Belgium, Slovakia, Spain, Poland and Portugal.
After the eradication of human smallpox, the availability of these more outdated strategic stocks was due to preparedness for a hypothetical bioterrorist attack using this virus, and not monkeypox.
This potential threat also explains why other countries, such as Germany, Italy, Ireland, Luxembourg and Sweden, do not provide information on these vaccines as a matter of national security.
Against this backdrop, at EU level, the bulk of human smallpox vaccine procurement has been handled by the European Health Emergency preparedness and Response Authority (HERA). The strategy is similar to that used for COVID-19: a joint procurement, but this time financed exclusively through European funds. In total, and up to early September 2022, 334,540 vaccines have been purchased and donated gradually and free of charge by the European Union to the Member States that require them.
However, these vaccines are not all available immediately. In fact, about 170,000 doses of the total number of vaccines purchased up to the beginning of September 2022 will be supplied little by little until the end of this year, as recently confirmed by the European Union. According to the Ministry of Health, these access problems are due to the high demand for the vaccines worldwide and to difficulties in production by a single laboratory, the aforementioned pharmaceutical company Bavarian Nordic.
The situation shows that most European countries lacked the sufficient means to deal with this new public health crisis. Although immunisation against human smallpox is believed to offer 85% protection against monkeypox, people under the age of 50 are not vaccinated against these viruses. This is where the majority of monkeypox cases are concentrated: of the 22,603 cases analysed in Europe, 88.78% of are in individuals who are under this age.
The lack of a sufficient number of vaccines has also meant that their administration has been limited to specific groups. For the time being, up to early September 2022, pre-exposure prophylaxis is recommended for high-risk sex workers (mainly, but not only, men who have sex with men) and health care professionals and scientists who may be potentially exposed to the virus. In addition, post-exposure prophylaxis is advised for close contacts of confirmed cases.
Another important issue is the lack of transparency surrounding the joint EU-wide purchase of these medicines.
Neither the European Union nor the countries receiving the vaccines have so far disclosed the unit price of each dose of Imvanex or their financing terms, according to the aforementioned research by the Civio Foundation.
Unfortunately, this is nothing new, as opacity is commonplace in such a sensitive and delicate matter as access to health care.
Last but not least, international attention was drawn to this public health problem at a very late stage and only when the virus hit Western countries. Although several studies had warned about the threat of monkeypox, it has been a neglected disease for decades. This is because its impact has been concentrated almost exclusively in countries such as the Democratic Republic of Congo, Nigeria and Cameroon. It is there that access to vaccines to prevent infection remains even more limited, a major problem when it comes to controlling this kind of neglected virus.
Endnote: This article was completed on the 14th of September 2022, so case and vaccination data, as well as health recommendations, date from that date.