“This basically is the largest cluster of monkeypox cases happening in multiple countries simultaneously outside of an endemic region,” said Boghuma Kabisen Titanji, a Cameroonian doctor based at Emory University in Atlanta.
Bavarian Nordic, the manufacturer of the monkeypox vaccine Jynneos approved by the Food and Drug Administration, told POLITICO that it has received calls from “many, many countries” wishing to purchase its shot.
“We’re talking to a large number of countries that are putting in procurement requests to us as the problem is just spreading and increasing day by day,” said Rolf Sass Sørensen, the company’s vice president for investor relations and communication.
Bavarian Nordic is confident it can supply the doses needed — if the immediate and acute demand doesn’t skyrocket. “Of course we don’t have stockpiles available for the entire planet, but just in the midterm and long term we will have quite a large capacity to produce vaccines,” he said.
That’s nearly 50 million doses a year, Sørensen said. The vaccines last for at least three years, he said.
Health officials have confirmed more than 250 cases across 16 countries, most of them in Europe. The U.K., Spain and Portugal have reported most cases of infection with the virus, which typically causes fever, rash and swollen lymph nodes. In the U.S., the Centers for Disease Control and Prevention said on Monday it had confirmed one case of monkeypox in Massachusetts and is reviewing four cases from New York, Utah and Florida that it presumes are monkeypox. On Tuesday, California said it was working with the agency to investigate an additional suspected case.
Monkeypox cases outside the endemic region are very rare, typically brought to non-endemic countries by people coming from that area. Last year, for instance, the U.S. had two cases of monkeypox imported by travelers who had been to Nigeria, according to the CDC.
When routine vaccination for smallpox was still happening globally, monkeypox wasn’t seen because the vaccine protected against both diseases. After smallpox was globally eradicated in 1980 and those vaccinations stopped, monkeypox emerged, health officials say.
“We have a strong concern” that the virus is spreading differently, Jennifer McQuiston, deputy director of the CDC’s Division of High Consequence Pathogens and Pathology, told reporters during a briefing on Monday.
U.S. health officials say the country has a “good stock” of vaccines against monkeypox. But the current strategy of containment, which includes vaccinating high-risk, close contacts of infected patients, could quickly strain the current Jynneos supply if cases rise.
“This is one of the rare diseases where you can be vaccinated after exposure and it prevents you from getting sick,” said Eric Toner, a senior scientist at the Johns Hopkins Bloomberg School of Public Health.
The U.S. national strategic stockpile has just over 1,000 Jynneos doses, approved by the FDA in 2019, as well as has some 100 million doses of an older smallpox vaccine that has more side effects, according to the CDC.
“We expect that level to ramp up very quickly in the coming weeks as the company provides more doses to us,” McQuiston said of the Jynneos vaccine. She said the agency has already requested some of those doses from the stockpile for patients’ contacts.
The U.K. has already started vaccinating people, with 1,000 doses of the vaccine, called Imvanex there, already administered. The country has 3,500 doses left. Germany has ordered 40,000 doses, Reuters reported.
Two FDA-approved antivirals for the treatment of smallpox can also be used in monkeypox, Brett Petersen, a medical officer in the CDC’s Division of High Consequence Pathogens and Pathology, told reporters Monday.
One of the drugs, Tecovirimat, is already in the national stockpile, and the CDC is now developing treatment guidance to help public health authorities and clinicians administer it if needed, he said.
Tecovirimat has also been approved in Europe for the treatment of monkeypox. A spokesperson for SIGA, its manufacturer, said the company cannot comment on orders.
The U.S. government is negotiating with the manufacturer of the second drug, Brincidofovir, to buy doses for the stockpile and to secure emergency access to use the drug to treat monkeypox.
The vaccine and drugs are not widely available commercially because they’re relatively new, said Rosamund Lewis, the head of the World Health Organization’s Smallpox Secretariat. The WHO will work with industry “to see what we can do now to enhance availability of these products,” she said in a public information session Monday.
Still, monkeypox is not as transmissible as Covid-19, and it’s not expected to lead to millions of infections and deaths the way Covid did.
“Of all the things in the world today that people need to worry about, this is probably not one of them,” Toner said.
The Biden administration has struggled in recent days to characterize how worried Americans need to be about the outbreak, wanting to raise awareness about a disease most people aren’t familiar with but loathe to cause fresh panic in a pandemic-weary nation.
On Sunday, President Joe Biden said monkeypox was “something everybody should be concerned about,” only to soften his message the next day, saying that it did not pose the same level of risk as Covid-19.
The virus typically transmits to people through direct contact with infected animals, usually in highly forested areas, in 11 African countries — including Cameroon, the Democratic Republic of the Congo and Nigeria. In the last six months, four endemic countries reported approximately 1,300 cases and around 60 deaths.
Among people, the virus also transmits through close contact with skin lesions or recently contaminated objects.
Many of the cases reported outside of endemic countries appear to have spread through sex and other close contact at a few super spreader events in Europe. Many, but not all, are among men who have sex with men.
Andy Seale, a WHO adviser in the sexually transmitted infections program, warned against stigmatizing men who have sex with men in light of the outbreak. “This is not a gay disease, as some people in social media have attempted to label it,” he said. “Anybody can contract monkeypox through close contact.”
In the African countries where the virus has been typically reported in the last 50 years, outbreaks have usually been controlled without vaccines and antivirals, Kabisen Titanji said. This means local health authorities isolated infected people until symptoms resolved and traced their close contacts, she said. Healing can take up to four weeks, and an infected person is infectious as long as the rash persists, she said.
Belgium has already introduced a mandatory 21 days’ quarantine for infected people. Close contacts are not required to self-isolate in Belgium, but the U.K. recommends they do. Biden said Monday that a quarantine wasn’t necessary in the U.S. because the country has sufficient vaccine doses to combat any serious flare-up, the Washington Post reported.
The outbreak in Western countries could potentially be helpful for endemic countries if it increases funding for vaccines and treatments to stop monkeypox outbreaks at the source, said Kabisen Titanji.