Treatments & tests: Monkeypox shots in short supply, or is it?

NEW YORK: For the past month, a couple of patients a day have sat across from Dr. Alberto Mendoza at the H.I.V. clinic where he works in Lima, Peru, to hear him confirm what they had feared: They have monkeypox. The men are tormented by the painful lesions the virus causes.

They’re also afraid, because the visible sores mark them as men who have sex with men, a dangerous identity in Peru, where there is intense discrimination against homosexuality.

But Dr. Mendoza, an infectious disease specialist, has little to offer. “I have no options,” he said in an interview.

Neither the antiviral drug nor the vaccine being used against monkeypox in the United States and Europe is available in Peru.

“We have nothing, even though we are the country with one of the highest numbers of cases by population,” said Dr. Mendoza, who works with the medical charity Partners in Health.

Neighboring Brazil, which, according to the World Health Organization, has close to 10 percent of global monkeypox cases, currently has no vaccine or treatment either.

Nor do the countries in West and Central Africa that have struggled with monkeypox outbreaks for decades.

The scramble for monkeypox vaccines and treatments has been centered in the United States and Europe, where supplies of shots have stretched thin or nearly run out.

But more than 100 countries are now reporting monkeypox cases, and a vast majority of those have had no vaccine or treatments at all.

They have been shut out by the prohibitive cost and by wealthy nations who bought up most of the available doses.

The United States already controlled most of the vaccine, which was originally developed for smallpox, as part of its bioweapons strategy after the terrorist attacks of Sept. 11, 2001.

Some public health groups are also criticizing the W.H.O. for not doing more to ensure swift movement on equitable access to tests, treatments and vaccines, after it declared monkeypox a public health emergency of international concern on July 23.

They say the issues echo those seen with Covid, but without any of the mechanisms that were developed to try to right the balance during the coronavirus pandemic.

Most people who die from monkeypox are Africans. There are two different strains of the disease, a more lethal one circulating in the Democratic Republic of Congo and neighboring countries, and a less virulent version in West Africa, which is the one now being seen in high-income countries.

Though deaths from monkeypox are rare, the risk of a fatal case is greatest in children and pregnant women, and the disease is excruciatingly painful for anyone infected.

Bavarian-Nordic had approximately 16 million doses of the vaccine, most of which were owned by or contracted to the United States, which contributed more than $1 billion to develop the vaccine as a defense strategy after 9/11 when officials feared small pox could be used as a bioweapons.

Those U.S. doses were earmarked as a defense stockpile and in the form of bulk drug, not bottled vaccines, which slowed distribution.

The roughly 1 million that remained were quickly purchased by Canada, Australia and European countries starting in May.

There are no doses purchased or ordered for African countries to date. A clinical trial of the Jynneos vaccine led by the National Institutes of Health is beginning in Congo but that country has no vaccine supply available for health workers or contacts of people who fall ill.

“The obvious solution for this problem is for the U.S. government to put all of the doses it owns — more than 15 million — into vials, so they can go into arms, in the U.S. and elsewhere,” said James Krellenstein, a founder of PrEP4All, a medicines access advocacy group.

An analysis by the advocacy organization Public Citizen estimates that the high-income countries that have snapped up the Jynneos vaccine are paying $110 per dose.