On August 14, the World Health Organization declared Mpox an “international health emergency.” Since then, a race against time has begun: helping Africa obtain enough vaccine doses before the epidemic, carried there by a new variant, spreads elsewhere, and while a first case has already been detected in Sweden.
As the main player in this delicate task – stocks and production capacities are currently largely insufficient – the vaccine cooperation alliance “Gavi” has agreed to provide an overview of the intense international negotiations underway. Interview with Aurélia Nguyen, director of programs and former leader of the Covax program, the international initiative that made it possible to redistribute 2 billion doses during Covid-19.
L’Express: How did “Gavi” react to the WHO announcement?
Aurelia Nguyen: This was not a surprise. Our organization is an alliance that brings together different representatives of low-income countries, UNICEF and WHO. We have therefore been closely monitoring the evolution of Mpox in Africa since 2022. With the increase in the number of cases – around 160% this year compared to last year – we had already switched to daily monitoring. But since the WHO raised its alert level, our activity has increased once again. In recent days, we have increased our contacts with vaccine manufacturers and States, in order to obtain guarantees on the vaccine response to be adopted.
The situation is worrying: the new “clade 1b” variant seems to affect a much wider audience than just the homosexual community, the first to be affected so far. In Africa, the main focus of the epidemic with 12 countries affected, an increase in mortality has also been observed. Since the beginning of the year, more than 500 deaths and 17,000 infections have been recorded by the African health agency “Africa CDC”. A first case was detected in mid-August in Sweden. There is therefore an urgent need to vaccinate. And as a priority where the disease is circulating.
The epidemic has been raging for almost a year in Africa. Why has no large-scale vaccination campaign been launched?
Many epidemics in the world are very localized. This is the case for Mpox, Ebola, chikungunya, Lassa fever, or Nipah. In these cases, it is difficult for manufacturers to have a commercial return [NDLR : d’être rentable] on the development and sale of vaccines. Because the populations to be vaccinated are too small or because the countries concerned cannot afford such expenses. This is the whole point of vaccine cooperation: bringing and maintaining on the markets vaccines without yield.
In essence, we understand that production was insufficient and the funds committed were too low to hope that it would increase. Where are the exchanges now that the alert threshold is at its maximum?
They are fed! Our main contact, the German manufacturer Bavarian Nordic, recently agreed to donate 15,000 doses, free of charge. The European Union, France and the United States have also announced that they will donate 200,000, 100,000 and 50,000 doses of this vaccine respectively. At the same time, we are working with the WHO to ensure that its efficacy profile is relevant in the context of an emergency vaccination campaign, mainly in the Democratic Republic of Congo (DRC), against the new clade.
We also regularly exchange with the Japanese manufacturer KM Biologics, which until now produced only for the Japanese market. Donations have been discussed, but nothing has been finalized. This can be seen as good news, but the African demand is considerable: it amounts to 10 million doses, according to the vaccination plans already established by the local authorities. We are therefore open to any new proposal. Time is pressing. It is essential to act as quickly as possible to hope to stem the epidemic.
Laboratories have a special status in the economic landscape. They are private companies, which cannot operate at a loss, but they are also very largely financed by public money. Have they shown themselves to be sufficiently concerned by this new health crisis?
Our relations are quite good, which is not always the case. Bavarian Nordic has said it is ready to restart its production, in order to supply 10 million doses by 2025, including 2 before the end of the year. This is good news. But for the moment, the question of the sale price has not been decided. To buy on a large scale with public funding, as is the case for Gavi, you need sustainable volumes and prices.
In total, how many doses are already available and what production capacity do manufacturers have?
This must be asked of the states and companies concerned.
How many doses do you think will be needed to stem the epidemic?
We are currently developing various estimates, based on health and industrial scenarios, but it is too early to say. The number of doses needed will depend on the virus on the one hand, and on the target audience of the campaign on the other. In short, who should be vaccinated as a priority. To find out, we need to ensure that cases are tracked with sufficient precision, that countries in the grip of the epidemic are able to take enough samples, and to conduct a large number of analyses. One thing is certain: industrial production will have to be stepped up anyway. Especially since, with the WHO alert, many Western countries have expressed their interest.
What is the vaccination strategy being considered at this stage?
Two doses, like in France. But this is only a hypothesis. For the moment, we do not know exactly how effective the vaccines we have are against the new clade. It will also be necessary, and above all, to take into account local realities. Among other things, the capacity of countries to vaccinate and monitor populations. A significant part of Gavi’s financial support, which amounts to around $500 million, notably thanks to support from WHO emergency funds, will go in this direction.
This money will be used to develop local mobilization, to inform about the disease, reassure about the vaccine and help set up the systems. Here again, it is too early to say what solutions will be chosen to get the vaccine to patients. In cities, in the DRC, we can set up fixed posts, next to markets for example, but this model is not generalizable. There are, as in the north of the DRC, places that are difficult to reach, or very sparsely populated. To reach the people who live there, we will have to set up mobile teams.
All these efforts resemble those put in place to guarantee access to Covid-19 vaccines for poor countries. Have we learned nothing from this crisis?
The health crisis has given rise to unprecedented cooperation efforts. Some of the redistribution mechanisms have been perpetuated, such as the WHO emergency fund, which today allows Gavi to negotiate. Progress has been made, but it is not enough. Let us remember that infectious diseases, even those that only seem to circulate in distant countries, mutate, spread, and often end up affecting the entire globe. These issues therefore concern everyone. It is necessary to step up funding for vaccination operations. And more broadly, it is imperative to help the health systems of the countries in the greatest difficulty, to prevent them from hosting outbreaks of contamination, and to prevent these crises from recurring.
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