Challenges in Global Distribution and Equitable Access to Monkeypox Vaccines
Abstract
:1. Introduction
2. Monkeypox Vaccines
3. Challenges in Global Distribution of Monkeypox Vaccines
4. Barriers to Equitable Access to Monkeypox Vaccines
5. Strategies to Improve Global Distribution and Access
6. Recommendations
6.1. Strengthening Global Vaccine Manufacturing Capacity
6.2. Targeting Countries with Elevated Risk Profiles and Limited Access to Resources
6.3. Overcoming Vaccine Nationalism Through Platforms Like COVAX
6.4. Strengthening Health Surveillance Systems
6.5. Addressing Vaccine Hesitancy
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
- Wang, J.; Shahed-AI-Mahmud, M.; Chen, A.; Li, K.; Tan, H.; Joyce, R. An Overview of Antivirals against Monkeypox Virus and Other Orthopoxviruses. J. Med. Chem. 2023, 66, 4468–4490. [Google Scholar] [CrossRef] [PubMed]
- Mpox. Available online: https://www.who.int/news-room/fact-sheets/detail/mpox (accessed on 1 October 2024).
- Mitjà, O.; Alemany, A.; Marks, M.; Mora, J.I.L.; Rodríguez-Aldama, J.C.; Silva, M.S.T.; Herrera, E.A.C.; Crabtree-Ramirez, B.; Blanco, J.L.; Girometti, N.; et al. Mpox in people with advanced HIV infection: A global case series. Lancet 2023, 401, 939–949. [Google Scholar] [CrossRef] [PubMed]
- Monkeypox Outbreak Global Map: Cases. Available online: https://stacks.cdc.gov/view/cdc/123104 (accessed on 4 October 2024).
- Bunge, E.M.; Hoet, B.; Chen, L.; Lienert, F.; Weidenthaler, H.; Baer, L.R.; Steffen, R. The changing epidemiology of human monkeypox—A potential threat? A systematic review. PLoS Neglect. Trop. Dis. 2022, 16, e0010141. [Google Scholar] [CrossRef] [PubMed]
- Alakunle, E.F.; Okeke, M.I. Monkeypox virus: A neglected zoonotic pathogen spreads globally. Nat. Rev. Microbiol. 2022, 20, 507–508. [Google Scholar] [CrossRef]
- Meseko, C.; Adedeji, A.; Shittu, I.; Obishakin, E.; Nanven, M.; Suleiman, L.; Okomah, D.; Tyakaray, V.; Kolade, D.; Yinka-Ogunleye, A.; et al. Orthopoxvirus Infections in Rodents, Nigeria, 2018–2019. Emerg. Infect. Dis. 2023, 29, 433–434. [Google Scholar] [CrossRef]
- Precious, N.D.B.; Agboola, P.B.; Oluwatimilehin, O.B.; Olakunle, O.K.B.; Olaniyi, P.B.; Adiatu, A.I.B.; Olusogo, A.P.B.; Obiwulu, D.J.B.; Adeola, O.A.B.; Ebubechukwu, E.S.B.; et al. Re-emergence of monkeypox virus outbreak in Nigeria: Epidemic preparedness and response (Review-Commentary). Ann. Med. Surg. 2023, 85, 3990–3996. [Google Scholar] [CrossRef]
- Mpox 2022 Outbreak Cases and Data. Available online: https://stacks.cdc.gov/view/cdc/131079 (accessed on 4 October 2024).
- Update: Multistate Outbreak of Monkeypox—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin. 2003. Available online: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5227a5.htm (accessed on 4 October 2024).
- Fleischauer, A.T.; Kile, J.C.; Davidson, M.; Fischer, M.; Karem, K.L.; Teclaw, R.; Messersmith, H.; Pontones, P.; Beard, B.A.; Braden, Z.H.; et al. Evaluation of Human-to-Human Transmission of Monkeypox from Infected Patients to Health Care Workers. Clin. Infect. Dis. 2005, 40, 689–694. [Google Scholar] [CrossRef]
- Kava, C.M.; Rohraff, D.M.; Wallace, B.; Mendoza-Alonzo, J.L.; Currie, D.W.; Munsey, A.E.; Roth, N.M.; Bryant-Genevier, J.; Kennedy, J.L.; Weller, D.L.; et al. Epidemiologic Features of the Monkeypox Outbreak and the Public Health Response—United States, May 17–October 6, 2022. MMWR-Morb. Mortal. Wkly. Rep. 2022, 71, 1449–1456. [Google Scholar] [CrossRef]
- Adler, H.; Gould, S.; Hine, P.; Snell, L.B.; Wong, W.; Houlihan, C.F.; Osborne, J.C.; Rampling, T.; Beadsworth, M.B.; Duncan, C.J.; et al. Clinical features and management of human monkeypox: A retrospective observational study in the UK. Lancet Infect. Dis. 2022, 22, 1153–1162. [Google Scholar] [CrossRef]
- Vaughan, A.; Aarons, E.; Astbury, J.; Brooks, T.; Chand, M.; Flegg, P.; Hardman, A.; Harper, N.; Jarvis, R.; Mawdsley, S.; et al. Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018. Emerg. Infect. Dis. 2020, 26, 782–785. [Google Scholar] [CrossRef]
- WHO Director-General’s Statement at the Press Conference Following IHR Emergency Committee Regarding the Multi-Country Outbreak of Monkeypox—23 July 2022. Available online: https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on-the-press-conference-following-IHR-emergency-committee-regarding-the-multi--country-outbreak-of-monkeypox--23-july-2022 (accessed on 4 October 2024).
- WHO Director-General Declares Mpox Outbreak a Public Health Emergency of International Concern. Available online: https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern (accessed on 4 October 2024).
- Greenwood, B. The contribution of vaccination to global health: Past, present and future. Philos. Trans. R. Soc. B Biol. Sci. 2014, 369, 20130433. [Google Scholar] [CrossRef] [PubMed]
- Watarkar, S.M.; Upadhyay, P.; Ghosh, S.M.; Godbole, A.A.M.; Kishori, S.K.M.; Mohanty, A.; Padhi, B.K.; Sah, R.M. Vaccines for monkeypox disease and challenges in its production and distribution: A lesson from COVID-19 pandemic. Int. J. Surg. 2023, 109, 536–538. [Google Scholar] [CrossRef] [PubMed]
- Hirani, R.; Noruzi, K.; Iqbal, A.; Hussaini, A.S.; Khan, R.A.; Harutyunyan, A.; Etienne, M.; Tiwari, R.K. A Review of the Past, Present, and Future of the Monkeypox Virus: Challenges, Opportunities, and Lessons from COVID-19 for Global Health Security. Microorganisms 2023, 11, 2713. [Google Scholar] [CrossRef] [PubMed]
- Smith, J.; Lipsitch, M.; Almond, J.W. Vaccine production, distribution, access, and uptake. Lancet 2011, 378, 428–438. [Google Scholar] [CrossRef] [PubMed]
- Rimoin, A.W.; Mulembakani, P.M.; Johnston, S.C.; Smith, J.O.L.; Kisalu, N.K.; Kinkela, T.L.; Blumberg, S.; Thomassen, H.A.; Pike, B.L.; Fair, J.N.; et al. Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo. Proc. Natl. Acad. Sci. USA 2010, 107, 16262–16267. [Google Scholar] [CrossRef]
- Nguyen, P.-Y.; Ajisegiri, W.S.; Costantino, V.; Chughtai, A.A.; MacIntyre, C.R. Reemergence of Human Monkeypox and Declining Population Immunity in the Context of Urbanization, Nigeria, 2017–2020. Emerg. Infect. Dis. 2021, 27, 1007–1014. [Google Scholar] [CrossRef]
- Luo, Y.-H.; Zhang, T.; Cao, J.-L.; Hou, W.-S.; Wang, A.-Q.; Jin, C.-H. Monkeypox: An outbreak of a rare viral disease. J. Microbiol. Immunol. Infect. 2023, 57, 1–10. [Google Scholar] [CrossRef]
- Reynolds, M.G.; Damon, I.K. Outbreaks of human monkeypox after cessation of smallpox vaccination. Trends Microbiol. 2012, 20, 80–87. [Google Scholar] [CrossRef]
- Townsend, M.B.; Keckler, M.S.; Patel, N.; Davies, D.H.; Felgner, P.; Damon, I.K.; Karem, K.L. Humoral Immunity to Smallpox Vaccines and Monkeypox Virus Challenge: Proteomic Assessment and Clinical Correlations. J. Virol. 2013, 87, 900–911. [Google Scholar] [CrossRef]
- Manes, N.P.; Estep, R.D.; Mottaz, H.M.; Moore, R.J.; Clauss, T.R.W.; Monroe, M.E.; Du, X.; Adkins, J.N.; Wong, S.W.; Smith, R.D. Comparative Proteomics of Human Monkeypox and Vaccinia Intracellular Mature and Extracellular Enveloped Virions. J. Proteome Res. 2008, 7, 960–968. [Google Scholar] [CrossRef]
- Molero-Abraham, M.; Glutting, J.-P.; Flower, D.R.; Lafuente, E.M.; Reche, P.A. EPIPOX: Immunoinformatic Characterization of the Shared T-Cell Epitome between Variola Virus and Related Pathogenic Orthopoxviruses. J. Immunol. Res. 2015, 2015, 738020. [Google Scholar] [CrossRef] [PubMed]
- Benhnia, M.R.-E.; McCausland, M.M.; Su, H.-P.; Singh, K.; Hoffmann, J.; Davies, D.H.; Felgner, P.L.; Head, S.; Sette, A.; Garboczi, D.N.; et al. Redundancy and Plasticity of Neutralizing Antibody Responses Are Cornerstone Attributes of the Human Immune Response to the Smallpox Vaccine. J. Virol. 2008, 82, 3751–3768. [Google Scholar] [CrossRef] [PubMed]
- Davies, D.H.; Molina, D.M.; Wrammert, J.; Miller, J.; Hirst, S.; Mu, Y.; Pablo, J.; Unal, B.; Nakajima-Sasaki, R.; Liang, X.; et al. Proteome-wide analysis of the serological response to vaccinia and smallpox. Proteomics 2007, 7, 1678–1686. [Google Scholar] [CrossRef] [PubMed]
- Kennedy, R.B.; Ovsyannikova, I.G.; Haralambieva, I.H.; Grill, D.E.; Poland, G.A. Proteomic assessment of humoral immune responses in smallpox vaccine recipients. Vaccine 2022, 40, 789–797. [Google Scholar] [CrossRef] [PubMed]
- Jing, L.; Davies, D.H.; Chong, T.M.; Chun, S.; McClurkan, C.L.; Huang, J.; Story, B.T.; Molina, D.M.; Hirst, S.; Felgner, P.L.; et al. An Extremely Diverse CD4 Response to Vaccinia Virus in Humans Is Revealed by Proteome-Wide T-Cell Profiling. J. Virol. 2008, 82, 7120–7134. [Google Scholar] [CrossRef]
- Terajima, M.; Orphin, L.; Leporati, A.M.; Pazoles, P.; Cruz, J.; Rothman, A.L.; Ennis, F.A. Vaccinia virus-specific CD8+ T-cell responses target a group of epitopes without a strong immunodominance hierarchy in humans. Hum. Immunol. 2008, 69, 815–825. [Google Scholar] [CrossRef]
- Jing, L.; Chong, T.M.; McClurkan, C.L.; Huang, J.; Story, B.T.; Koelle, D.M. Diversity in the Acute CD8 T Cell Response to Vaccinia Virus in Humans. J. Immunol. 2005, 175, 7550–7559. [Google Scholar] [CrossRef]
- Poland, G.A.; Kennedy, R.B.; Tosh, P.K. Prevention of monkeypox with vaccines: A rapid review. Lancet Infect. Dis. 2022, 22, e349–e358. [Google Scholar] [CrossRef]
- Kennedy, R.B.; Ovsyannikova, I.G.; Jacobson, R.M.; Poland, G.A. The immunology of smallpox vaccines. Curr. Opin. Immunol. 2009, 21, 314–320. [Google Scholar] [CrossRef]
- Gruber, M.F. Current status of monkeypox vaccines. Npj Vaccines 2022, 7, 94. [Google Scholar] [CrossRef]
- Parrino, J.; Graham, B. Smallpox vaccines: Past, present, and future. J. Allergy Clin. Immunol. 2006, 118, 1320–1326. [Google Scholar] [CrossRef] [PubMed]
- Jandrasits, D.; Züst, R.; Siegrist, D.; Engler, O.B.; Weber, B.; Schmidt, K.M.; Jonsdottir, H.R. Third-generation smallpox vaccines induce low-level cross-protecting neutralizing antibodies against Monkeypox virus in laboratory workers. Heliyon 2024, 10, e31490. [Google Scholar] [CrossRef] [PubMed]
- Interim Clinical Considerations for Use of Vaccine for Mpox Prevention in the United States|Mpox|CDC. Available online: https://www.cdc.gov/mpox/hcp/vaccine-considerations/vaccination-overview.html?CDC_AAref_Val=https://www.cdc.gov/poxvirus/MPOX/interim-considerations/overview.html (accessed on 7 October 2024).
- Vaccines Licensed for Use in the United States|FDA. Available online: https://www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-states (accessed on 7 October 2024).
- Malone, S.M.; Mitra, A.K.; Onumah, N.A.; Brown, A.; Jones, L.M.; Tresvant, D.; Brown, C.S.; Onyia, A.U.; Iseguede, F.O. Safety and Efficacy of Post-Eradication Smallpox Vaccine as an Mpox Vaccine: A Systematic Review with Meta-Analysis. Int. J. Environ. Res. Public Health 2023, 20, 2963. [Google Scholar] [CrossRef] [PubMed]
- Hazra, A.; Zucker, J.; Bell, E.; Flores, J.; Gordon, L.; Mitjà, O.; Suñer, C.; Lemaignen, A.; Jamard, S.; Nozza, S.; et al. Mpox in people with past infection or a complete vaccination course: A global case series. Lancet Infect. Dis. 2024, 24, 57–64. [Google Scholar] [CrossRef]
- Rasmussen, S.A.; Watson, A.K.; Kennedy, E.D.; Broder, K.R.; Jamieson, D.J. Vaccines and pregnancy: Past, present, and future. Semin. Fetal Neonatal Med. 2013, 19, 161–169. [Google Scholar] [CrossRef]
- Kennedy, R.B.; Ovsyannikova, I.; Poland, G.A. Smallpox vaccines for biodefense. Vaccine 2009, 27 (Suppl. S4), D73–D79. [Google Scholar] [CrossRef]
- Barrett, A.D.T.; Stanberry, L.R. Vaccines for Biodefense and Emerging and Neglected Diseases; Elsevier Inc.: Amsterdam, The Netherlands, 2008; pp. 527–535. [Google Scholar]
- Mpox (Monkeypox) Vaccines|Australian Government Department of Health and Aged Care. Available online: https://www.health.gov.au/diseases/mpox-monkeypox/vaccines (accessed on 7 October 2024).
- Pittman, P.R.; Hahn, M.; Lee, H.S.; Koca, C.; Samy, N.; Schmidt, D.; Hornung, J.; Weidenthaler, H.; Heery, C.R.; Meyer, T.P.; et al. Phase 3 Efficacy Trial of Modified Vaccinia Ankara as a Vaccine against Smallpox. N. Engl. J. Med. 2019, 381, 1897–1908. [Google Scholar] [CrossRef]
- Health Canada Extends Approval of IMVAMUNE to Immunization. Available online: https://www.globenewswire.com/news-release/2020/11/12/2125193/0/en/Health-Canada-Extends-Approval-of-IMVAMUNE-to-Immunization-against-Monkeypox-and-Orthopox-Viruses.html (accessed on 7 October 2024).
- Global Monkeypox Vaccine Race Sparks Fears That Poorer Nations Will Lose Out|Global Development|The Guardian. Available online: https://www.theguardian.com/global-development/2022/aug/01/global-monkeypox-vaccine-race-sparks-fears-that-poorer-nations-will-lose-out (accessed on 7 October 2024).
- Ogunkola, I.O.; Abiodun, O.E.; Bale, B.I.; Elebesunu, E.E.; Ujam, S.B.; Umeh, I.C.; Tom-James, M.; Musa, S.S.; Manirambona, E.; Evardone, S.B.; et al. Monkeypox vaccination in the global south: Fighting a war without a weapon. Clin. Epidemiol. Glob. Health 2023, 22, 101313. [Google Scholar] [CrossRef]
- Race for Monkeypox Vaccines Exposes Global Health Inequality—The Japan Times. Available online: https://www.japantimes.co.jp/news/2022/08/31/world/science-health-world/monkeypox-vaccine-distribution-inequality/ (accessed on 7 October 2024).
- Multi-Country Monkeypox Outbreak Declared a Global Public Health Emergency of International Concern—Africa CDC. Available online: https://africacdc.org/news-item/multi-country-monkeypox-outbreak-declared-a-global-public-health-emergency-of-international-concern-2/ (accessed on 7 October 2024).
- Support for Africa’s Vaccine Production Is Good for the World. Available online: https://www.imf.org/en/Blogs/Articles/2022/01/12/blog011322-support-for-africas-vaccine-production-is-good-for-the-world (accessed on 7 October 2024).
- Is There Any COVID-19 Vaccine Production in Africa?—Carnegie Endowment for International Peace | Carnegie Endowment for International Peace. Available online: https://carnegieendowment.org/posts/2021/09/is-there-any-covid-19-vaccine-production-in-africa?lang=en (accessed on 7 October 2024).
- Schaefer, G.O.; Emanuel, E.J.; Atuire, C.A.; Leland, R.; Persad, G.; Richardson, H.S.; Saenz, C. Equitable global allocation of monkeypox vaccines. Vaccine 2023, 41, 7084–7088. [Google Scholar] [CrossRef]
- Fidler, D.P. Negotiating Equitable Access to Influenza Vaccines: Global Health Diplomacy and the Controversies Surrounding Avian Influenza H5N1 and Pandemic Influenza H1N1. PLoS Med. 2010, 7, e1000247. [Google Scholar] [CrossRef]
- Tovani-Palone, M.R.; Doshi, N.; Pedersini, P. Inequity in the global distribution of monkeypox vaccines. World J. Clin. Cases 2023, 11, 4498–4503. [Google Scholar] [CrossRef] [PubMed]
- Cernuschi, T.; Gilchrist, S.; Hajizada, A.; Malhame, M.; Mariat, S.; Widmyer, G. Price transparency is a step towards sustainable access in middle income countries. BMJ 2020, 368, l5375. [Google Scholar] [CrossRef] [PubMed]
- Rajkhowa, P.; Dsouza, V.S.; Kharel, R.; Cauvery, K.; Mallya, B.R.; Raksha, D.S.; Mrinalini, V.; Sharma, P.; Pattanshetty, S.; Narayanan, P.; et al. Factors Influencing Monkeypox Vaccination: A Cue to Policy Implementation. J. Epidemiol. Glob. Health 2023, 13, 226–238. [Google Scholar] [CrossRef]
- Choudhary, O.P.; Priyanka; Fahrni, M.L.; Saied, A.A.; Chopra, H. Ring vaccination for monkeypox containment: Strategic implementation and challenges. Int. J. Surg. 2022, 105, 106873. [Google Scholar] [CrossRef]
- Mukherjee, S.; Kalra, K.; Phelan, A.L. Expanding global vaccine manufacturing capacity: Strategic prioritization in small countries. PLoS Glob. Public Health 2023, 3, e0002098. [Google Scholar] [CrossRef]
- Emanuel, E.J.; Persad, G.; Kern, A.; Buchanan, A.; Fabre, C.; Halliday, D.; Heath, J.; Herzog, L.; Leland, R.J.; Lemango, E.T.; et al. An ethical framework for global vaccine allocation. Science 2020, 369, 1309–1312. [Google Scholar] [CrossRef]
- COVID-19 Vaccinations Shift to Regular Immunization as COVAX Draws to a Close. Available online: https://www.who.int/news/item/19-12-2023-covid-19-vaccinations-shift-to-regular-immunization-as-covax-draws-to-a-close (accessed on 7 October 2024).
- Khairi, L.N.H.M.; Fahrni, M.L.; Lazzarino, A.I. The Race for Global Equitable Access to COVID-19 Vaccines. Vaccines 2022, 10, 1306. [Google Scholar] [CrossRef]
- Lawrence, A.; Anejo-Okopi, J.; Adeseye, B. The Feasibility of Elimination of Monkeypox Virus in Nigeria: A Systematic Review. Cureus 2024, 16, e61867. [Google Scholar] [CrossRef]
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Danladi, N.P.; Agboola, P.; Olaniyi, P.; Eze, S.; Oladapo, O.; Obiwulu, D.; Akano, O.S.; Adeola, O.A.; Olawale, K.; Adiatu, A.I.; et al. Challenges in Global Distribution and Equitable Access to Monkeypox Vaccines. Viruses 2024, 16, 1815. https://doi.org/10.3390/v16121815
Danladi NP, Agboola P, Olaniyi P, Eze S, Oladapo O, Obiwulu D, Akano OS, Adeola OA, Olawale K, Adiatu AI, et al. Challenges in Global Distribution and Equitable Access to Monkeypox Vaccines. Viruses. 2024; 16(12):1815. https://doi.org/10.3390/v16121815
Chicago/Turabian StyleDanladi, Nengak P., Progress Agboola, Peter Olaniyi, Solomon Eze, Oluwatimilehin Oladapo, Danielle Obiwulu, Olatokun Shamsudeen Akano, Olowoyeye Aishat Adeola, Khaliq Olawale, Azeez Idowu Adiatu, and et al. 2024. "Challenges in Global Distribution and Equitable Access to Monkeypox Vaccines" Viruses 16, no. 12: 1815. https://doi.org/10.3390/v16121815
APA StyleDanladi, N. P., Agboola, P., Olaniyi, P., Eze, S., Oladapo, O., Obiwulu, D., Akano, O. S., Adeola, O. A., Olawale, K., Adiatu, A. I., & Peace, A. (2024). Challenges in Global Distribution and Equitable Access to Monkeypox Vaccines. Viruses, 16(12), 1815. https://doi.org/10.3390/v16121815