The Access and Allocation Mechanism (AAM) for mpox has allocated an initial 899 000 vaccine doses for 9 countries across the African region that are hit hard by the current mpox surge. In collaboration with affected countries and donors, this decision aims to ensure that the limited doses are used effectively and fairly, with the overall objective to control the outbreaks.
The AAM principals from the Africa Centres for Disease Control and Prevention (Africa CDC), the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance (Gavi), UNICEF, and the World Health Organization (WHO) approved the allocation, following the recommendations of an independent Technical Review Committee of the Continental Incident Management Support Team for mpox. The decision was informed by country readiness and epidemiological data.
The 9 countries are the Central African Republic, Cote d’Ivoire, the Democratic Republic of the Congo, Kenya, Liberia, Nigeria, Rwanda, South Africa and Uganda. The largest number of doses – 85% of the allocation – will go to the Democratic Republic of the Congo as the most affected country, reporting four out of every five laboratory-confirmed cases in Africa this year.
These doses come from Canada, Gavi, the Vaccine Alliance, the European Union (Austria, Belgium, Croatia, Cyprus, France, Germany, Luxemburg, Malta, Netherlands, Poland, Portugal and Spain, as well as the European Union Health Emergency Response Authority), and the Unites States of America.
The outbreak of mpox, particularly the surge of the viral strain clade Ib, in the Democratic Republic of the Congo and neighbouring countries was declared a public health emergency of international concern by WHO and a public health emergency of continental security by Africa CDC in mid-August. This year, 19 countries in Africa have reported mpox, many of them newly affected by the viral disease. The epicentre of the outbreak remains the Democratic Republic of the Congo, with over 38 000 suspected cases and over 1000 deaths reported this year.
Vaccination is recommended as a part of a comprehensive mpox response strategy, focusing also on timely testing and diagnosis, effective clinical care, infection prevention, and the engagement of affected communities. Vaccines play an important role and are recommended to reduce transmission and help contain outbreaks.
In recent weeks, limited vaccination has begun in the Democratic Republic of the Congo and Rwanda. This allocation to the 9 countries marks a significant step towards a coordinated and targeted deployment of vaccines to stop the mpox outbreaks.
For most countries, the rollout of mpox vaccines will be a new undertaking. Implementing targeted vaccination requires additional resources. Partners of the mpox AAM, set up last month, are working to scale up the response. Further allocations of vaccines are expected before the end of the year.
Notes to editors
Key points of the vaccination approach under the global and continental strategic preparedness and response plans:
- Vaccine availability: Over 5.85 million vaccine doses are expected to be available to the Mpox Vaccines AAM by the end of 2024, including the nearly 900 000 allocated doses. The supply includes contributions from multiple nations and organizations, including 1.85 million dose donations of MVA-BN from the European Union, United States, and Canada, 500 000 doses of MVA-BN from Gavi utilizing the First Response Fund, 500 000 doses procured through UNICEF, as well as a further 3 million doses of the LC16 vaccine from Japan.
- Phased vaccination strategy:
• Phase 1: Stop outbreaks – Focused on interrupting transmission through targeted vaccination of people at highest risk of infection including contacts of confirmed cases, health-care workers, frontline responders, and key at-risk populations in areas with active human to human transmission.
• Phase 2: Expand protection – To protect more people at risk in affected communities, as additional doses of vaccine are available. It targets individuals at high risk of severe disease – based on local epidemiology – in affected areas, focusing on regions with the highest incidence of mpox. Special attention will be given to vulnerable populations, including those living with HIV, internally displaced persons, and refugees, due to their increased risk of severe outcomes.
• Phase 3: Protect for the future – Aimed at building population immunity to guard against future outbreaks as part of a longer-term mpox control programme.
The first phase targets the vaccination of approximately 1.4 million people at risk of infection by the end of 2024, with an initial 2.8 million doses of the MVA-BN vaccine to be allocated for this effort.
- Maximizing the impact of vaccines through strategic vaccination is crucial: Implementing targeted vaccination approaches can reduce transmission by focusing on those at the highest risk of infection. This vaccination strategy prioritizes individuals at substantially higher risk of exposure, including close contacts – such as household members and sexual partners – of confirmed cases. A combination of prevention and control interventions are recommended to optimize the effectiveness of vaccination efforts.
- Demand planning for Phase 2: Current demand forecasts for Phase 2 estimate the need to vaccinate at least an additional 10 million individuals to protect high-risk groups across Africa. The projection is based on current epidemiological data and emerging information on transmission patterns. These estimates will be updated as more data becomes available, and the outbreak trajectory evolves.
- Regulatory and policy updates: The WHO Strategic Advisory Group of Experts (SAGE) recommends off-label use of vaccines for children and pregnant women in outbreak settings. Urgent action is required to expedite regulatory pathways for vaccine approval across affected countries, ensuring timely access for infants and children. Additionally, delivery support must be strengthened to address in-country vaccine delivery challenges and ensure efficient distribution.
