The Community of Madrid has asked the Ministry of Health to speed up the purchase of vaccines against traditional smallpox to deal with the increase in cases of monkeypox, that this Tuesday has registered 15 new positives in Spain up to a total of 51. Of them, 47 have been diagnosed in the capital.
The possible use of this vaccine has been discussed at the meeting of the Public Health Commission, which has not adopted any decision and has highlighted that all the cases diagnosed in Spain “are mild”. Actually, the issue is pending two decisions. The first is whether or not to immunize close contacts of those infected -in principle only those for whom becoming infected would pose a serious health risk-, something that has already begun to be debated by the vaccine conference, made up of experts who advise to Health.
“Doing it or not will depend on the evolution of the outbreak. If in the coming days or weeks we see that the number of new cases decreases without there being serious patients, it may not be necessary and measures such as isolating those infected and controlling contacts may be sufficient,” health sources explain.
The second measure to assess is whether it is worth acquiring the vaccines to have, in any case and even if they are not going to be used later, a tool that can be useful if the epidemiological situation worsens. This is something that Health can do on its own without the need to agree with the communities. Health sources explain that the efforts “to acquire thousands of doses have been underway since last week”, although Health declines to report its status, although it specifies that it is something that is also being debated within the European Union.
The European Medicines Agency (EMA) does not have any approved vaccine against monkeypox, although it does against traditional smallpox. This has also proven to be effective against the monkey (up to 85% of cases) because they are two similar viruses belonging to the genus Orthopoxvirus. The vaccine is manufactured by the Danish company Bavarian Nordic, which markets it under the brand name Imvanex in Europe and Jynneos in the United States.
France announced on Monday that it has already decided that, if the number of infections in the country increases – for now it only has three confirmed cases – it plans to vaccinate risk contacts of positive cases. Paris has not made public its plans on the purchase of vaccines.
Germany, for its part, has reported that it has ordered the purchase of 40,000 doses, although for now it has not decided whether to use them. The country has confirmed six cases of monkeypox and Health Minister Karl Lauterbach has said he is confident that measures such as isolating those infected for 21 days should be enough to stop the virus from circulating.
The United Kingdom, which has so far confirmed 71 cases – this Tuesday is the country in the world with the most notifications – has been the first to use doses that it had stored for security to vaccinate close risk contacts of positive cases. Last week, the British Government announced that it has placed a new order to expand its stocks.
The United States, a country that has millions of doses strategically stored, has also begun to put thousands of them in the hands of health officials to control the outbreak. The country has so far diagnosed half a dozen cases of monkeypox.
According to information provided by The Wall Street Journal, These days the Bavarian Nordic company is receiving an avalanche of calls and requests from “dozens” of countries asking about the availability of vaccines. The company is preparing to increase its production capacity, although it has stated that at the moment it has enough doses to deal with the current outbreak if it does not suffer an explosion of cases that no expert or government expects.
Africa González, professor of immunology at the Center for Biomedical Research (CINBIO) of the University of Vigo, maintains that the Bavarian Nordic vaccine —called “third generation”, free of the side effects of the previous ones that served to eradicate the disease — is “very safe, with very few risks”.
“The use of any vaccine must take into account the risk-benefit balance and availability. The arguments that health officials are handling probably take these factors more into account than the safety of the vaccine itself. This may be it, but if we see that the cases are still mild and an explosion of cases does not occur, but that with the measures of identifying cases, isolating the sick and controlling their contacts it is enough to contain the outbreak, perhaps its use is not necessary”, argues González.
This expert adds that there are also effective antivirals to deal with cases at risk of developing more serious clinical conditions and that “the population over 40 years of age is protected by the doses received during campaigns to eradicate smallpox, which some studies have shown that they continue to protect up to 75 years after their administration”.
In any case, the European Commission is willing to assume the coordination of the purchase of vaccines and adopt measures to increase dose reserves if shortages or failures in the supply of the medicine are detected. The community body plans to channel this possible intervention through the Health Emergency Preparedness and Response Authority (HERA). HERA, created in response to the covid-19 pandemic, is responsible for preventing potential health threats and developing responses.
Commission sources indicate that, for now, HERA is awaiting the evolution of the outbreak. But they add that this body is ready to fulfill the task of launching the acquisition of possible medicines or vaccines. HERA could also, according to the same sources, help resolve possible difficulties in accessing antiviral treatments.
The smallpox outbreak on the European continent has already been the subject of analysis this Tuesday in the EU Health Security Committee, where, in addition to the European Commission, representatives of the 27 member states sit. The Committee is the forum where national authorities share information on preparedness and capabilities in the face of cross-border health threats.
Coordinated purchases
Although at the moment the threat seems limited, Brussels will try to avoid a stampede for the acquisition of vaccines or treatments, as happened with the purchase of masks and other medical supplies at the beginning of the coronavirus pandemic.
The Commission, according to community sources, is collecting all available data on the outbreak in each of the States and is in close contact with the pharmaceutical industry to verify the availability of treatments and vaccines against a virus that has already caused more than one hundred cases of smallpox in a dozen European countries.
Unlike the coronavirus, which surprised Brussels without experience in an epidemic of such magnitude, the new outbreak, much more limited, comes when the health machinery at the community level is much more rounded and with unknown resources two years ago.
HERA has a financing of 6,000 million euros for the period 2022-2027 and various items of the community budgets add another 24,000 million euros during the same period for preparations for possible health emergencies. If the emergency is declared, which has not happened with smallpox, HERA can activate urgent financing mechanisms and put in place a mechanism for the development, bidding and purchase of the necessary medicines or raw materials that are needed to its manufacture.
Brussels also has the experience of having organized the joint purchase of covid-19 vaccines, an unprecedented operation launched by the president of the European Commission, Ursula von der Leyen. The strategy mobilized 2.7 billion euros from the EU budget to reserve 4.2 billion doses with the pharmaceutical companies that were developing the vaccines against covid, five of which quickly obtained authorization for their use.
The community body has already indicated that this cooperation model will be repeated if new epidemics occur and that HERA would be the department in charge of coordinating joint purchases.
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