Vaccine doses allocated to the 9 African countries worst affected by the mpox wave

The Access and Allocation Mechanism (AAM) for mpox has allocated an initial 899,000 doses of the vaccine to 9 countries across the African region that have been hit hard by the current measles outbreak. In cooperation with affected countries and donors, this decision aims to ensure that limited doses are used efficiently and equitably, with the overall goal of controlling outbreaks.

AAM leaders from the African Centers for Disease Control and Prevention (Africa CDC), the Coalition for Epidemic Preparedness Innovation (CEPI), Gavi, the Vaccine Alliance (Gavi), UNICEF and the World Health Organization (WHO) approved the award funds, following the recommendations of the independent Technical Review Board of the Continental Incident Management Support Team for mpox. The decision was made based on the readiness of the country and epidemiological data.

Those 9 countries are Central African Republic, Ivory Coast, Democratic Republic of Congo, Kenya, Liberia, Nigeria, Rwanda, South Africa and Uganda. The largest number of doses – 85% of the allocation – will go to the hardest-hit country, the Democratic Republic of Congo, which has reported 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, Luxembourg, Malta, the Netherlands, Poland, Portugal and Spain), as well as the European Union Health Emergency Response Agency ), and the United States of America.

The mpox outbreak, especially the rise of the clade Ib virus strain, in the Democratic Republic of Congo and neighboring countries was declared a public health emergency of international concern by the WHO in mid-August, and by the African CDC in mid-August. This year, 19 African countries have reported measles, many of which are newly infected with the viral disease. The epicenter of the outbreak remains the Democratic Republic of Congo, with over 38,000 suspected cases and over 1,000 deaths reported this year.

Vaccination is recommended as part of a comprehensive mpox response strategy, which also focuses on timely testing and diagnosis, effective clinical care, infection prevention and engagement of affected communities. Vaccines play an important role and are recommended to reduce transmission and control epidemics.

In recent weeks, limited vaccinations have begun in the Democratic Republic of Congo and Rwanda. This allocation to 9 countries marks a significant step towards coordinated and targeted distribution of vaccines to stop smallpox outbreaks.

For most countries, the introduction of the measles vaccine will be a new undertaking. Implementation of targeted vaccination requires additional resources. The mpox AAM partners, set up last month, are working to increase responses. Further allocations of vaccines are expected before the end of the year.

Notes to editors

Key points of access to vaccination according to global and continental strategic preparedness and response plans:

1. Availability of vaccines: More than 5.85 million vaccine doses are expected to be available to Mpox Vaccines AAM by the end of 2024, including nearly 900,000 allocated doses. The supply includes contributions from several countries and organizations, including donations of 1.85 million doses of MVA-BN from the European Union, the United States and Canada, 500,000 doses of MVA-BN from Gavi using the First Response Fund, 500,000 doses procured through UNICEF, as well as an additional 3 million doses of the LC16 vaccine from Japan.
2. Vaccination strategy in stages:

• Phase 1: Stop outbreaks – Aimed at interrupting transmission through targeted vaccination of people at highest risk of infection, including contacts of confirmed cases, healthcare workers, frontline responders and key at-risk populations in areas with active human-to-human transmission.

• Phase 2: Extend protection – 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 smallpox. Special attention will be paid 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 protect against future outbreaks as part of a longer-term measles control program.

The first phase aims to vaccinate 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.

3. Maximizing vaccine effectiveness through strategic vaccination is key: Implementation of targeted vaccination approaches can reduce transmission by targeting those at highest risk of infection. This vaccination strategy prioritizes people at significantly higher risk of exposure, including close contacts – such as household members and sexual partners – of confirmed cases. A combination of prevention and control interventions is recommended to optimize the effectiveness of vaccination efforts.
4. 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 new information on transmission patterns. These estimates will be updated as more data become available and as the trajectory of the epidemic evolves.
5. Updates to regulations and rules: The WHO Strategic Advisory Group of Experts (SAGE) recommends unspecified use of vaccines for children and pregnant women in outbreak settings. Urgent action is needed to expedite regulatory pathways for vaccine approval in affected countries, ensuring timely access to infants and children. Additionally, delivery support must be strengthened to address the challenges of in-country vaccine delivery and ensure effective distribution.