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Here’s why most people don’t need a vaccination against monkeypox just yet, according to experts


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Here’s why most people don’t need a vaccination against monkeypox just yet, according to experts

The World Health Organization may have declared the monkeypox outbreak a public health emergency, but experts say the general population doesn’t have to worry about getting vaccinated amid global supply issues.

Vaccination campaigns currently underway in Canada and elsewhere that are limited to men who have sex with multiple male partners makes sense, infectious diseases physicians told the Star, given that it is the group almost exclusively affected by the outbreak, and such campaigns can help ensure there isn’t wider transmission to other segments of the population.

“If you get that done very effectively and efficiently with the vaccine you have available, that is a way to curtail the current expansion of the disease,” said Dr. Gerald Evans, chair of the division of infectious diseases at Queen’s University.

It will be important to continue monitoring the epidemiology should another at-risk group be identified, said Dr. Zain Chagla, professor of medicine at McMaster University, adding he could envision a limited rollout to health-care and lab workers dealing directly with monkeypox.

“But at the same time, we still understand there is a fairly high at-risk population, and the men who have sex with men population should be the priority,” he said, “recognizing that that’s going to have the effect of protecting that population, and also have an impact on the wider population if (the men who have sex with men) population is better protected.”

Symptoms of monkeypox can include fever, swollen lymph nodes and painful lesions. Most people recover within a few weeks without treatment, but infections can lead to hospitalization.

Countries have a limited supply of monkeypox vaccines, which are mostly found in national emergency stockpiles to be used against the virus’s far deadlier cousin smallpox, should that now eradicated disease ever make a reappearance.

The Public Health Agency of Canada has so far distributed 70,000 vaccine doses to the provinces, of which more than 27,000 have been administered. The agency says it has more doses available should the provinces need them, but refuses to provide a number, citing “security implications and requirements.”

Known in Canada as Imvamune, the vaccine is approved as a two-dose series to be given 28 days apart. Its manufacturer, Danish company Bavarian Nordic, is now fielding requests from countries for more doses, including the United States, although those orders are not expected to be fulfilled imminently.

The doctors who spoke to the Star said Canada moved far quicker in dealing with the outbreak than the U.S., where there have been major bottlenecks in rolling out the vaccine.

Bavarian Nordic announced in June that Canada had purchased US$56 million worth of doses as part of a five-year contract that will see deliveries begin next year. The Public Health Agency declined to say how many doses were purchased, and Bavarian Nordic did not return a request for comment.

“Nobody thought that we were going to need hundreds and thousands and maybe a million doses of this stuff, so the company is having to rev up production lines,” Evans said.

Monkeypox is spread through close contact, and cases this year have been found almost entirely among men who have sex with men, particularly those with multiple sexual partners, which has prompted public health officials to advise limiting the number of partners.

The virus is endemic in parts of Africa, and outbreaks outside of the continent have been rare. This year’s outbreak, beginning with cases identified in Europe in May, is the first instance of widespread community transmission of the virus outside of Africa in multiple countries.

The World Health Organization’s director general declared the outbreak a “public health emergency of international concern” last week, which the UN agency describes as “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a co-ordinated international response.”

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As developed countries clamour for vaccines, access for African countries that have grappled with the virus for years — like the Democratic Republic of Congo — must be prioritized, said Dr. Sameer Elsayed, professor at the Schulich School of Medicine and Dentistry at Western University.

Elsayed pointed out that Congo has also had to contend with a far deadlier strain of the virus than the one currently fuelling the global outbreak, adding the “burden of illness is much higher in Africa” given the number of cases and deaths.

“We will never get rid of these emerging infectious diseases, or at least not manage them very well, unless you go to perhaps what you want to call the ‘source,’” he said.

“I would honestly say that the countries that need monkeypox vaccines the most are the ones in Africa. I’m not saying people in developed countries shouldn’t get it, but the African countries should have very high priority.”

There have been 21,000 cases reported in 78 countries. Cases continue to rise in Canada, chief public health officer Dr. Theresa Tam said this week, with 745 cases confirmed to date.

There were 367 cases of monkeypox reported in Ontario as of July 28, all but two of them found in males. There have been 11 hospitalizations, including two people in the intensive care unit, and no deaths.

More than 14,000 doses of Imvamune have been administered in Ontario — more than 11,000 of which were administered in Toronto, which has seen the bulk of the province’s cases.

Like other jurisdictions, Ontario is only providing one dose of the vaccine for now due to limited supply, with the Ministry of Health saying it has “sufficient supply for those who require it,” although refusing to say how many doses it has left.

The ministry said second doses will “soon be available” to those who meet the eligibility criteria and are “moderately to severely immunocompromised.”

Experts said the one-dose strategy for men who have sex with men is reasonable given the limited supply in order to ensure protection for the affected population and slow transmission.

Bavarian Nordic’s CEO has also said a single shot offers sufficient protection, telling the journal Science that a second dose offered up to two years later can be just as effective as 28 days after the first dose.

It remains to be seen when — and whether — a second dose will be needed to provide longer-term protection. Tam said health officials are looking at that issue and gathering data on infection rates after a first dose. She said to “stay prepared for the potential to need that second dose.”

The trajectory of the outbreak will be a major factor, said Dr. Kevin Woodward, professor of medicine at McMaster University.

“If we’re able to give first doses effectively to a large segment of the population at risk — and let’s say three to four months from now we see there are no new cases happening — then it’s a question of, do we need to do second doses for anyone? Are we still at risk? Is monkeypox still circulating?” Woodward said.

“So I think the jury is still out on whether or not those second doses will be totally necessary for everyone long term.”

Jacques Gallant is a Toronto-based reporter covering politics for the Star. Follow him on Twitter: @JacquesGallant

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