WHO director general Tedros Adhanom Ghebreyesus said he was taking the matter into his own hands after a panel of advisers failed to reach a consensus on whether an international emergency was present.  

At a meeting in June, the advisors said that while the outbreak was “a growing threat,” the disease had not moved of the primary risk group, which is gay men.

Tedros, who was blamed in some circles for not acting quickly enough on Covid, told international media: “We have an outbreak that has spread around the world rapidly through new modes of transmission, about which we understand too little, and which meets the criteria for a public health emergency.”

In recent weeks, the disease that has been endemic in Africa for some years has been spreading, especially in Europe and the US. To date, at least 16,000 cases have been reported, in 75 countries. This is roughly five times the number of cases in June, when the panel last reviewed the situation, Ghebreyesus noted.

With an emergency declaration, WHO member countries can invest significantly more to control an outbreak, including budgeting additional funding and mobilizing other resources, including sharing vaccines and treatments.

Unlike the situation at the advent of Covid-19, vaccines and treatments, including one vaccine specifically for monkeypox and others for smallpox, a close relative, are available. Health experts say nevertheless that distribution is often hampered by bureaucracy.

In a live interview with the newspaper Washington Post on Jul. 22, Rochelle Walensky, director of the US Centers for Disease Control (CDC), said the inconsistent and often late-to arrive-data inhibit the agency’s ability to observe trends in race and ethnicity, sexual behavior and vaccination. The CDC, too, was heavily criticized in the US for its perceived slow response to Covid.

The only source of the sole vaccine approved specifically for monkeypox is Danish biotech Bavarian Nordic and supply seen as potentially limited — even in the US, where it received development aid from the Biomedical Advanced Research and Development Authority (BARDA).

Thanks to a long-running contract with the US Department of Health and Human Services (HHS), in any case the US at least will be first served. HHS has ordered 7 million doses of the Jynneos-branded vaccine, some of which will be produced stateside by an unnamed CDMO using bulk vaccine already manufactured and invoiced under previous contracts with BARDA.

The emergency response agency supported the Copenhagen-based company’s development of a freeze-dried version of Jynneos with longer shelf-life and in 2017 awarded it a ten-year contract for supply of freeze-dried doses.

Under this contract, Bavarian Nordic said it has produced bulk vaccine corresponding to roughly 13 million doses for future delivery. While this vaccine has already been invoiced, the final drug production (formulation, filling and freeze-drying) will take place from 2023 onward.

On the US orders, the Danish biotech has revised upward its financial forecast for 2022 to include the additional vaccine sales and remuneration for technology transfer, though it still expects to post an EBITDA loss.

Author: Dede Williams, Freelance Journalist