“We don’t have access to testing in Africa so we don’t know where cases are, so you can’t use that as a basis for decisions on the use of resources,” said Dr. Boghuma Titanji, an assistant professor of medicine at Emory University who responded to a monkeypox outbreak in 2018 in her native Cameroon.
What to Know About the Monkeypox Virus
What is monkeypox? Monkeypox is a virus similar to smallpox, but symptoms are less severe. It was discovered in 1958, after outbreaks occurred in monkeys kept for research. The virus was primarily found in parts of Central and West Africa, but recently it has spread to dozens of countries and infected tens of thousands of people, overwhelmingly men who have sex with men.
Most people who die from monkeypox are Africans. There are two different strains of the disease, a more lethal one circulating in the Democratic Republic of Congo and neighboring countries, and a less virulent version in West Africa, which is the one now being seen in high-income countries. Though deaths from monkeypox are rare, the risk of a fatal case is greatest in children and pregnant women, and the disease is excruciatingly painful for anyone infected.
The rapid spread of the disease to high-income nations, beginning four months ago, set off a scramble for vaccines. While there is no shot specifically for monkeypox, data from trials with nonhuman primates suggested that vaccines against the closely related smallpox virus might also prevent transmission of this one. The focus became the Jynneos smallpox vaccine made by the Danish firm Bavarian-Nordic, which is the easiest to administer of several smallpox vaccines and has the lowest number of side effects.
Bavarian-Nordic had approximately 16 million doses of the vaccine, most of which were owned by or contracted to the United States, which contributed more than $1 billion to develop the vaccine as a defense strategy after 9/11 when officials feared small pox could be used as a bioweapon. Those U.S. doses were earmarked as a defense stockpile and in the form of bulk drug, not bottled vaccines, which slowed distribution. The roughly 1 million that remained were quickly purchased by Canada, Australia and European countries starting in May.
There are no doses purchased or ordered for African countries to date. A clinical trial of the Jynneos vaccine led by the National Institutes of Health is beginning in Congo but that country has no vaccine supply available for health workers or contacts of people who fall ill.
“The obvious solution for this problem is for the U.S. government to put all of the doses it owns — more than 15 million — into vials, so they can go into arms, in the U.S. and elsewhere,” said James Krellenstein, a founder of PrEP4All, a medicines access advocacy group. “This is the single most important step that anyone can take to help bring this outbreak under control globally.”
