© The Indian Express Pvt Ltd
Tags:
Journalism of Courage
The Democratic Republic of Congo (DRC) — epicentre of the mpox outbreak that has become virulent and spread to other countries — has received its first donation of mpox vaccines.
Since January 1, 2022, mpox cases have been reported from 121 countries, including 20 WHO member-states across Africa. As of September 5, 2024, a total 1,03,048 laboratory-confirmed cases, including 229 deaths, have been reported from across the world since January 1, 2022. On Monday, India confirmed its first mpox case, which was a travel-related infection.
Despite the surge in the number of cases, vaccines have been in short supply in Africa. Apart from DRC, the only other African country to have any mpox vaccine is Nigeria. That is one of the main reasons why mpox spread rapidly, prompting the WHO to declare the infection a global health emergency last month.
Mpox, which was first reported in humans in 1970, has come under the spotlight largely due to the spread of its new clade Ib variant.
Organisms belonging to a clade share common ancestors. When it comes to mpox, there are two different clades: clade I and clade II; the former is the deadlier of the two.
Clade Ib seems to be transmitting more rapidly between people than previous variants, including through sexual activity. Clade Ia mostly comes from animals, according to a report in the journal Nature. The new variant is also affecting more women and children in the impacted African countries.
Scientists are still trying to determine the reasons behind these aspects of the transmission.
Three mpox vaccines are available currently. All are weakened versions of vaccinia, a live virus that also served as the basis for the smallpox vaccine. Virologist Dr Gagandeep Kang told The Indian Express, “Both smallpox and mpox belong to the same family of viruses. Mpox is less severe and has lower case fatality rates but is spreading fast because it has animal reservoirs, which smallpox did not have.”
The most commonly used vaccine is modified vaccinia Ankara (MVA), manufactured by Denmark-based Bavarian Nordic. It has approval for mpox from both the US Food and Drug Administration (FDA) and European Medicines Agency (EMA). The DRC has received this vaccine.
The other vaccine is LC16m8, which is produced by KM Biologics, a company in Japan. Only Japan’s regulatory authority has approved this vaccine for mpox.
The third is ACAM2000, which is made by a US company, Emergent BioSolutions. It was approved for mpox by the FDA last month.
New mpox vaccines are also being developed. A vaccine by BioNTech, a German biotechnology company, is currently in early clinical development, Dr Kang said. Pune-based Serum Institute of India (SII) has announced it is developing an mpox vaccine, and hopes for a positive outcome within a year.
The Indian Council of Medical Research (ICMR) last week called for experienced pharmaceutical companies and research organisations to “collaborate on royalty basis” for developing mpox vaccine and diagnostic kits.
The currently available mpox vaccines are too expensive — $50 to $75 per dose, according to the WHO — for African countries. As a result, they have to usually rely on direct donations by developed countries and vaccine producers, and on purchases by Global Alliance for Vaccines and Immunization (Gavi, the Vaccine Alliance) and UNICEF.
Gavi and UNICEF cannot buy vaccines unless the WHO issues an Emergency Use Listing to products or gives them full approval, according to a report in the journal Science. To get these, companies have to submit efficacy and safety data about their products.
Some experts have said the WHO has been too slow in giving such approvals. However, WHO Director-General Tedros Adhanom Ghebreyesus said last month that the delay was due to the companies’ failure to complete the required paperwork.
“WHO would give its stamps of approval within weeks, he promised, adding that he had given Gavi and UNICEF permission to start the purchasing process in the meantime,” the Science report said.
Dr Raman Gangakhedkar, former head of Epidemiology and Communicable Diseases at ICMR, told The Indian Express, “High-income countries have their own drug regulators and rely on them. Low and middle-income countries are dependent on clearances by the WHO, which is risk-averse.”
Another reason is that during previous mpox outbreaks, the number of cases remained quite low. Many African countries did not ask for mpox vaccines as health officials had to tackle far more serious health problems in the region.
Gangakhedkar, however, said that the WHO and the developed world should have encouraged the sharing of smallpox vaccines earlier to protect people against a more virulent disease. “Preventive strategies and surveillance are just as crucial so that there is no vaccine inequity in places that need it most.”
Getting a vaccine is recommended for a high-risk population, especially during an outbreak. The vaccine can also be administered after a person has been in contact with someone who has mpox. In these cases, the vaccine should be given less than four days after contact with an infected person. The vaccine can be administered for up to 14 days if the person has not developed symptoms.
