Context

• Less than five years after the COVID-19 pandemic, the world is again confronting a significant global health threat with the outbreak of mpox (formerly known as monkeypox).
• This crisis has already escalated into an international emergency, prompting declarations from both the World Health Organisation (WHO) and the Africa Centres for Disease Control and Prevention (AfricaCDC).
• Therefore, it becomes imperative to explore the implications of the mpox outbreak, emphasizing the importance of an equitable and coordinated global response, and the lessons that must be applied from the COVID-19 pandemic.

The Emergence of Mpox as a Global Health Crisis

• Mpox has rapidly transitioned from a regional concern in the Democratic Republic of the Congo (DRC) to a global health emergency.
• The WHO’s declaration of mpox as a Public Health Emergency of International Concern (PHEIC) is particularly significant, as it follows the recent amendments to the International Health Regulations (IHR), which now include equity as a core principle.
• Although these amendments will not be implemented until 2025, the global response to mpox must prioritise equity from the outset.
• This principle is crucial in ensuring that all nations, particularly those in the Global South, receive the necessary support and resources to combat the outbreak.
• The declaration of a PHEIC is intended to create international cooperation and the rapid mobilisation of resources.
• The global community’s reaction to this declaration will set the tone for how future public health emergencies are managed, especially considering the lessons learned from the COVID-19 pandemic.

Lessons from the COVID-19 Pandemic on Vaccine Equity and Manufacturing

• The Inequities of COVID-19 Vaccine Distribution
  • During the COVID-19 pandemic, high-income countries swiftly moved to secure large quantities of vaccine doses, often through advance purchase agreements with pharmaceutical companies.
  • This approach, while ensuring rapid access for their populations, resulted in vaccine hoarding and limited availability for lower-income countries.
  • Despite global initiatives like COVAX, which aimed to provide equitable access to COVID-19 vaccines, the distribution remained heavily skewed in favour of wealthier nations.
  • By mid-2021, many high-income countries had vaccinated a significant portion of their populations, while many low-income countries had barely begun their vaccination campaigns.
  • This inequity was exacerbated by the lack of local vaccine manufacturing capabilities in the Global South.
  • Countries without the infrastructure or expertise to produce vaccines were entirely dependent on external supplies, which were often delayed or insufficient.
  • This dependency highlighted the vulnerability of these nations during global health crises and the need for a more resilient and self-sufficient approach to vaccine production.
• Lessons on Technology Transfer in Addressing Inequities
  • A critical lesson from the COVID-19 pandemic is the importance of technology transfer in ensuring equitable vaccine distribution.
  • Technology transfer involves sharing the knowledge, expertise, and patents necessary for the local production of vaccines.
  • This process is crucial for empowering lower-income countries to produce vaccines independently, reducing their reliance on external sources, and enhancing their ability to respond to public health emergencies.
  • However, during the COVID-19 pandemic, technology transfer was limited, with many pharmaceutical companies and high-income countries reluctant to share intellectual property and manufacturing know-how.
  • This reluctance stemmed from concerns about protecting commercial interests and maintaining control over production quality.
  • The result was a significant delay in the ability of lower-income countries to produce vaccines locally, contributing to prolonged inequities in vaccine access.

The Case of Oxford/AstraZeneca and India’s Role

• The case of the Oxford/AstraZeneca vaccine, marketed as Covishield in India, provides a notable exception.
• The Serum Institute of India (SII), the world’s largest vaccine manufacturer, was granted the rights to produce Covishield under a licensing agreement.
• This allowed for the mass production and distribution of the vaccine, not only within India but also to many other low- and middle-income countries.
• This partnership demonstrated the potential of technology transfer to bridge the gap in vaccine access, albeit within the constraints of the existing global intellectual property regime.

Mpox and the Opportunity for a Different Approach

• Opportunity for a Different Approach
  • As the world grapples with the mpox outbreak, the availability of an existing vaccine, MVA-BN (Jynneos), presents an opportunity to apply the lessons learned from COVID-19.
  • Unlike the COVID-19 situation, where vaccines had to be developed from scratch, the MVA-BN vaccine is already approved and in production.
  • This gives the global community a HeadStart in combating the outbreak, provided that the mistakes of the past are not repeated.
• Challenges and Possible Solutions
  • The challenge now is to ensure that the MVA-BN vaccine is not only produced in sufficient quantities but also distributed equitably.
  • To achieve this, it is crucial to prioritise technology transfer to countries that have the capacity to produce vaccines but lack the necessary expertise or resources.
  • India, with its robust pharmaceutical industry and experience in vaccine production, is a key player in this effort.
  • Indian manufacturers, such as SII, Bharat Biotech, and Zydus Cadila, have the infrastructure and expertise to scale up production of the MVA-BN vaccine, provided they receive the necessary technological support.

Way Forward

• Expansion of Vaccine Manufacturing in the Global South
  • One of the most significant steps that can be taken to address vaccine inequities is the expansion of manufacturing capabilities in the Global South.
  • The COVID-19 pandemic revealed that reliance on a few manufacturers in high-income countries creates bottlenecks and delays in vaccine distribution, particularly when global demand surges.
  • By diversifying manufacturing across multiple regions, the global community can ensure a more resilient supply chain that can better withstand the pressures of a public health emergency.
• Investment in Infrastructure and Capacity Building
  • For the mpox vaccine, investing in the infrastructure and capacity of manufacturers in lower- and middle-income countries (LMICs) is very important.
  • These investments should not only focus on the physical infrastructure but also on training and capacity-building initiatives to ensure that local manufacturers can meet international standards.
  • By empowering LMICs to produce vaccines, the global community can create a more equitable and self-sufficient health system, reducing the disparities that have characterized previous pandemic responses.
• A Better Understanding of Both; The Economic and Ethical Imperatives of Vaccine Equity
  • Beyond the practical benefits, there is a strong ethical imperative to ensure vaccine equity.
  • The COVID-19 pandemic showed that vaccine inequity is not just a moral failure but also a strategic mistake.
  • Ensuring equitable access to the mpox vaccine is therefore not just a matter of fairness but also a crucial component of global health security. 

Conclusion

• The COVID-19 pandemic provided a harsh lesson in the consequences of vaccine inequity and the limitations of a global health system that prioritises the interests of high-income countries.
• As the world faces the mpox outbreak, there is an urgent need to apply these lessons and take a different approach.
• The mpox outbreak presents an opportunity to correct the mistakes of the past and create a model for future public health responses that is grounded in equity and solidarity.