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Monkeypox shots, treatments and tests are not available in most parts of the world

For the past month, a few patients a day have been sitting across from Dr. Alberto Mendoza at the HIV clinic where he works in Lima, Perulisten to him confirm what they feared: they had monkeypox, Men are tormented by painful sores caused by viruses. They are also afraid, because visible wounds mark them as men having sex with men, a dangerous identity in Peru, where there is intense discrimination against homosexuality.

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But Mendoza, an infectious disease specialist, has little to offer. “I have no choice,” he said in an interview. Neither the antiviral drug nor the vaccine is being used against monkeypox Available in Peru in the United States and Europe.

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

neighborhood Brazil, which, according to the World Health Organization, accounts for about 10% of global monkeypox cases, currently has no vaccine or treatment. Neither do countries in West and Central Africa that have been battling monkeypox outbreaks for decades.

The scramble for vaccines and treatments for monkeypox has centered in the United States and Europe, where the supply of shots has been thin or nearly exhausted. But more than 100 countries are now reporting cases of monkeypox, and most of them have no vaccine or treatment.

They are cost prohibitive and put off by wealthy countries that have bought most of the supplements available. The United States had already controlled most of the vaccine, originally developed for smallpox, as part of its bioweapon strategy after the September 11, 2001, terrorist attacks. Some public health groups are also criticizing the WHO for not doing more to ensure faster. Movement on equal access to testing, treatment and vaccines after monkeypox was declared a Public Health Emergency of International Concern on 23 July. He says the issues resonate with those who are seen COVID-19, but without any mechanisms that were developed to try to correct the balance during coronavirus Epidemic.

monkey pox Monkeypox was declared a Public Health Emergency of International Concern by the WHO on 23 July (Source: WHO.int)

Tracing the number of people with monkeypox in developing countries is also difficult because many people lack the ability to diagnose the disease, which is done with a polymerase chain reaction test. In countries that have had outbreaks over the years, most tests are conducted at the surveillance level, testing only a sample of the population to find out the overall incidence of the disease. Testing to diagnose individual patients, many of whom live in isolated rural areas, is rare or non-existent.

“We don’t have access to testing Africa So we don’t know where the cases are, so you can’t use that as a basis for making decisions on how to use resources,” said Dr. Boghuma Titanji, an assistant professor of medicine at Emory University who led a monkeypox outbreak. had answered. 2018 in his native Cameroon.

Most people who die from monkeypox are African. There are two distinct strains of the disease, a more deadly one spreading to Congo and neighboring countries, and a less virulent version in West Africa, now seen in high-income countries. Although deaths from monkeypox are rare, the risk of a fatal case is highest in children and pregnant women, and this disease is extremely painful for any infected person.

The rapid spread of the disease in high-income countries that began four months ago triggered a scramble for vaccines. While there is no shot specifically for monkeypox, data from trials in nonhuman primates suggested that vaccines against the closely related smallpox virus may also prevent transmission. The focus was on the Genios smallpox vaccine, made by the Danish firm Bavarian-Nordic, which is the easiest of many smallpox vaccines to administer and has the fewest number of side effects.

Bavarian-Nordic had about 16 million doses of the vaccine, most of which were owned or contracted by the United States, which contributed more than $1 billion to develop the vaccine as a post-9/11 defense strategy , when the authorities feared smallpox. as a bio-weapon. Those US doses were kept as a defense stockpile and as bulk medicine, not as bottled vaccines, which slowed distribution. The roughly 1 million that remained were quickly bought up by Canada, Australia and European countries starting in May.

To date no supplements have been purchased or ordered for African countries. A clinical trial of the Jynneos vaccine, led by the National Institutes of Health in Congo, is beginning, but there are no vaccine supplies available in that country for healthcare workers or contacts of people who have fallen ill.

“The obvious solution to this problem is for the US government to put all of its doses – more than 15 million – in vials so they can go into arms in the US and elsewhere,” said founder James Krellenstein. PrEP4All, a Drug Access Advocacy Group. “This is the single most important step anyone can take to help bring this outbreak under control globally.”

Of the 7 million doses sent for bottling, none is designated for global reach.

An analysis by advocacy organization Public Citizen estimates that high-income countries that have disbursed the Genios vaccine are paying $110 per dose. Bavarian-Nordic President Paul Chaplin said in an earnings call last month that the vaccine had a price across all markets, which would only be discounted to high-volume buyers.

“For a country like Peru, it’s too expensive,” said Mendoza in Lima.

The Latin American arm of WHO has received a small dose donation for that region; Brazil’s health ministry confirmed it expected to receive 50,000 of them.

Public health groups say the WHO’s efforts send an unhelpfully mixed message.

“Despite the declaration of a public health emergency, there is a lack of clear guidance from the WHO,” on strategy to get vaccines, treatments and tests to countries that need them, Krelenstein said. “It doesn’t make sense to declare an emergency without saying anything about the equipment to respond.”

Director of the WHO’s Department of Epidemic and Epidemic Preparedness and Prevention, Dr. Sylvie Bryand said the global response to monkeypox was complicated by the fact that most medical interventions lacked human clinical trial data, and did not have regulatory approval.

“People think that because this is an emergency, it will be a matter of days, but for all those things it is a matter of weeks or months,” she said. “We’re trying to reduce the time between each step and make it faster. But it’s not that easy. You have to make sure there’s something safe and effective.”

Tecovirimat, an antiviral drug marketed in the United States as Tpoxx, has been safety tested in humans, and its efficacy against monkeypox has been tested in nonhuman primates. Two human clinical trials are underway to test against monkeypox, the first of which should report data early next year. But the current paucity of human data means the WHO cannot carry out the specific pre-qualification process that helps countries speed up the authorization of a drug.

monkey pox Test tubes labeled “Monkeypox virus positive and negative” are seen in this illustration. (Reuters: Dado Ruvik)

“The basic sin of this whole pandemic is that we could test these things in endemic countries, and then we would have the data,” said Dr. Ranu Dhillon, infectious disease specialist and instructor at Harvard Medical School. But there was little appetite or investment in monkeypox when only countries such as Cameroon and the Central African Republic were affected, he said.

In the absence of vaccines, tecovirimat could potentially help slow the spread of the virus by reducing symptoms and making patients less infectious, Mendoza said. WHO’s Bryand said that while the experience of COVID had created a preoccupation with vaccination, it was generally easier to manufacture, test and deliver diagnosis and treatment than vaccines. These would be a logical focus of the initial response, as well as behavior change interventions such as encouraging men to reduce their number of sexual partners.

But cost can also be an issue. Tecovirimat is made by Siga Technologies, a New York The company produced batches of it for years only to sell to the US government for its national security stockpile for smallpox. The company would not disclose pricing information to The New York Times, but in April, Canada signed a contract to buy the drug at $920 per course.

“We want this drug to have the widest reach,” said Dr. Phil Gomez, CEO of Siga.

Gomez said Siga can produce 500,000 courses per year, and it now has the product available to ship from its warehouses, though he would not say how much. The company would be open to expanding production with more contract manufacturers, he said, “with the help of the US government.”

Dhillon said the development and manufacture of rapid diagnostic tests to be used in clinical settings in low-income countries should now be a top priority. “Early detection is a chance to break the transmission.”

The role of smallpox as a potential bio-weapon threat has complicated the global monkeypox response. There are limits to transparency with data about vaccine and treatment stores, which are considered national security issues, and access to biomedical interventions is handled by defense experts rather than public health.

“It was a biodefense issue,” Bryand said, “and so the command lines and the decision-making process that was set up for this are different from the kind of outbreaks we’re currently seeing. “

Krelenstein said he felt that not everyone in the research world shared the sense of urgency that prompted the WHO director-general, Dr. Tedros Adhanom Ghebreyesus to declare a state of emergency.

“The response seems to be, ‘No one is dying so it’s not a security threat’ – and it’s gay people and trans people and Africans who are sick – so it seems very academic,” said national security decision makers. For those who control access to vaccine stores, he said.

Many public health experts say a sluggish monkeypox response, based on an analysis that few people are dying in this outbreak, ignores the risks posed by a virus that is behaving in ways not seen before.

“Monkeypox really has a huge runway right now for better adaptation,” TitanG said. “Not going on top of another smallpox virus circulating in humans is a bad thing.”

This article originally appeared in The New York Times.

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