Last month, the World Health Organization declared the monkeypox outbreak a public health emergency of international concern. Cases are surging through the U.S., Western Europe, Latin America, and Asia. Governments are scrambling to purchase vaccines, with small amounts of Jynneos doses trickling into a handful of wealthy countries.
One region has not had access to any Jynneos vaccine: Africa, where monkeypox has long been prevalent. No country within Africa has yet to procure a . "Let us get vaccines onto the continent," the acting head of the Africa Centers for Disease Control and Prevention said recently.
For years, monkeypox received little attention when it was thought to be a virus that affected only poor people of color. Indeed, the interventions we have against monkeypox were largely developed for a potential smallpox outbreak. We ignored monkeypox at our peril. Where could we have been if tools like Jynneos had been studied locally, manufactured regionally, and distributed systematically to affected populations in endemic countries before this outbreak?
Instead, local outbreaks swelled into regional outbreaks, and eventually, the global outbreak we now face. Warnings by local officials were .
It is not too late to chart a better course.
We can start by funding the response to make sure the world is equipped with the tools to fight this outbreak and the next. The U.S. spends hundreds of billions to shore up military defenses, but a small fraction to bolster global health defense. A few weeks ago, a Congressional committee voted to further increase the President's $813 billion request for next year's Pentagon budget by . Meanwhile, there is no new funding for monkeypox: the White House has not yet made a request to Congress. Historic funding for initiatives like the Strategic National Stockpile -- which only contained a paltry when the outbreak started in the U.S. -- is less than . The U.S. has provided grants and loans totaling less than to support global vaccine manufacturing.
We also cannot let private corporations lead the public health response. One small manufacturer in Denmark, Bavarian Nordic, is currently responsible for the entire global supply of Jynneos. The company is expected to send about 2 million doses to the U.S. by the end of 2022 (with the new dose sparing strategy this supply may be available to more people than expected, although efficacy questions remain), and to produce less than 5 million for the rest of the world. This is because the company's main factory producing vaccine bulk has for nearly a year for renovation. The world is thus significantly reliant on existing bulk supply, mostly owned by the U.S. -- the U.S. previously had purchased that could be "finished" to produce up to 15 million doses, which will require several more months.
The U.S. has to step up. It can rapidly convert the existing bulk into finished doses and share the shots with the world. It can also help stand up regional manufacturing hubs through technology transfer -- including in Africa -- to help the world be better prepared. Already, one has expressed interest in helping bottle vaccines. The World Health Organization wants to speak with Bavarian Nordic about sharing technology and working with its of manufacturers.
The COVID-19 pandemic brought the issues of public health preparedness to the fore. Monkeypox is the latest reminder. It is unlikely to be the last.
Last month, the director of the Africa CDC described the stakes for monkeypox accurately: "The solutions need to be global in nature," he said. "If we're not safe, the rest of the world is not safe." The global community can help contain this outbreak and build toward a more resilient future, but only if it works together.
is the research director in Public Citizen's Access to Medicines program. is the campaign coordinator in Public Citizen's Access to Medicines program.