Will Australia get the Monkeypox Vaccine?

Over the past week, the 24th International AIDS Conference (AIDS 2022) has been held in Montreal, Canada. During the biannual summit of clinicians, researchers, advocates, activists, and community organisations involved in the global response to HIV and AIDS – there has been a growing concern about the global response to the recent outbreak of Monkeypox (MPX). Since May of this year, a global outbreak has seen more than 22,000 cases spread across more than 78 countries worldwide.

The host country Canada has seemed somewhat more prepared than many countries to handle the outbreak, having approved the Imvamune (aka Jynneos or Imvanex) vaccine back in 2020 for MPX following the growing number of cases in Central and West Africa back in 2017. Montreal has been vigilant in vaccinated at-risk populations, in particular gay, bisexual, and other men who have sex with men.

Marina Klein is the Director of Chronic Viral Illness Service Research Program at McGill University Health centre. This week she provided a snapshot of the local MPX epidemic. She noted that Montreal was the epicentre of MPX in North America with their first suspected case 12 May 2022. Since Canada had more than 800 cases, with more than 350 in Quebec – mostly in Montreal.

Montreal Public Health (Sante Montreal) progressively expanded vaccine criteria from contacts of confirmed cases in late May 2022 to now - where any man (cis or trans) who has or plans to have sex with another man in Montreal. This includes men who are visiting Montreal, such as AIDS 2022 delegates or visitors for the upcoming Montreal Pride Festival.

At this stage, Canada has been focused on giving one shot of the Imvamune vaccine to as many at-risk people as possible. The vaccine has been approved by global health bodies (such as the FDA) as a two-shot vaccine with first and second doses given a minimum of 28 days apart. That being said, at risk people living with HIV (PLHIV) have been prioritised for their second dose due to research that indicates the immune response rate after the first shot is lower in PLHIV [www.i-base.info/monkeypox]

What does this mean for the rest of the world?

This week has seen at-risk communities take action with a number of activists storming the stage during the AIDS 2022 Monkeypox Symposium just before Demetre Daskalakis of the Center for Disease Control (CDC) spoke.

Chiefly among their demands, the group is asking for “aggressive leadership from the World Health Organisation (WHO) and the United Nations (UN) on global Monkeypox vaccine and treatment access and efforts to scale up production as technologically possible. We need a plan – and don’t have one.”

The manufacturer of the MPX vaccine, Bavarian Nordic, is a relatively small operation and their capacity to meet the demand of the growing lists of countries requesting vaccines raises concerns.

Meg Doherty of the World Health Organisation (WHO) confirmed this week that 16.4 million doses of the Imvamune vaccine are currently in bulk and 35 member states of the WHO are requesting access. There are alternative vaccine options. One is currently only available in Japan. The other is the ACAM2000, a vaccine that’s been stockpiled for smallpox. There are currently 100 million doses. but as Meg Doherty noted, “that’s probably the least likely vaccine that most countries want to be using at this point and time due to potential side effects.”

Where does Australia fit into all of this?

At this stage, Australia has had 44 confirmed cases of MPX with the majority of those among return travellers. While contact tracing and isolation of known cases has kept further outbreak at bay, Australia’s window to prevent further spread of MPX its borders is closing.

Heath Paynter is the Acting CEO of the Australian Federation of AIDS Organisations (AFAO).

“We need to secure an immediate supply of vaccines and alongside that, or in parallel with that, we need a largescale health promotion program to build demand for the vaccines as well as having our clinical workforce ready to administer the vaccines in a way that meets the demand.”

“As I understand it, our Government has been negotiating with Bavarian Nordic for about six weeks now and I understand they’re well-advanced in their negotiations to secure a supply and we’re very hopeful that Australia will secure a supply.”

Thorne Harbour Health CEO Simon Ruth believes, “We believe there’s an announcement imminent…but the next step is figuring out who’s going to get the vaccine.”

Depending the amount of vaccine, Australia will not only need to figure out who gets the vaccine, but whether they focus on a one-shot or two-shot strategy in the coming months. As Australia comes out of winter and prepares to host international events like WorldPride 2023, time is of the essence.

As the CDC’s Demetre Daskalakis said, “You can never have enough community engagement and you can never have enough speed.”

Following the first cases in Australia in mid-May 2022, Thorne Harbour Health and other community organisations have been distributing MPX health information and had active campaigns online for months; but with vaccination not an option in Australia, the call-to-action for the community has been limited to awareness, some risk reduction, and seeking medical attention in case of potential infection.

With “an announcement imminent”, the availability of MPX vaccines will change all of this.

Caleb Hawk is currently reporting from the AIDS2022 conference in Montreal for WellWellWell – Thorne Harbour Health’s weekly health and wellbeing radio show and podcast on JOY 94.9.

You can hear more on this week’s episode of WellWellWell from 9pm (AEST) on Thursday 4 August.