Moves by rich countries to buy large quantities of monkeypox vaccine, while declining to share doses with Africa, could leave millions of people unprotected against a more dangerous version of the disease and risk continued spillovers of the virus into humans, public health officials are warning.
Critics fear a repeat of the catastrophic inequity problems seen during the coronavirus pandemic.
“The mistakes we saw during the COVID-19 pandemic are already being repeated,” said Dr Boghuma Kabisen Titanji, an assistant professor of medicine at Emory University.
While rich countries have ordered millions of vaccines to stop monkeypox within their borders, none have announced plans to share doses with Africa, where a more lethal form of monkeypox is spreading than in the West.
To date, there have been more than 21,000 monkeypox cases reported in nearly 80 countries since May, with about 75 suspected deaths in Africa, mostly in Nigeria and Congo. On Friday, Brazil and Spain reported deaths linked to monkeypox, the first reported outside Africa.
“The African countries dealing with monkeypox outbreaks for decades have been relegated to a footnote in conversations about the global response,” Titanji said.
Scientists say that unlike campaigns to stop COVID-19, mass vaccination against monkeypox won’t be necessary. They think targeted use of the available doses, along with other measures, could shut down the expanding epidemics recently designated by the World Health Organization as a global emergency.
Yet while monkeypox is much harder to spread than COVID-19, experts warn that if the disease spills over into general populations - currently in Europe and North America it is circulating almost exclusively among gay and bisexual men - the need for vaccines could intensify, especially if the virus becomes entrenched in new regions.
On Thursday, the Africa Centers for Disease Control and Prevention called for the continent to be prioritized for vaccines, saying it was again being left behind.
“If we’re not safe, the rest of the world is not safe,” said Africa CDC’s acting director, Ahmed Ogwell.
Although it has been endemic in parts of Africa for decades, monkeypox mostly jumps into people from infected wild animals and has not typically spread very far beyond the continent.
Experts suspect the monkeypox outbreaks in North America and Europe may have originated in Africa long before the disease started spreading via sex at two raves in Spain and Belgium. Currently, more than 70% of the world’s monkeypox cases are in Europe, and 98% of cases are in men who have sex with men.
WHO is developing a vaccine-sharing mechanism for affected countries, but has released few details about how it might work. The UN health agency has made no guarantees about prioritizing poor countries in Africa, saying only that vaccines would be dispensed based on epidemiological need.
Some experts worry the mechanism could duplicate the problems seen with COVAX, created by WHO and partners in 2020 to try to ensure poorer countries would get COVID-19 shots. That missed repeated targets to share vaccines with poorer nations and at times relied on donations.
At the moment, there is only one producer of the most advanced monkeypox vaccine: the Danish company Bavarian Nordic. Its production capacity this year is about 30 million doses, with about 16 million vaccines available now.