How the lessons of COVID-19 ensured a rapid vaccine response to the mpox outbreak

On September 18, 2024, just over 30 days since the World Health Organization (WHO) declared the latest mpox outbreak a public health emergency of international concern, Gavi, the organization I lead, concluded a transaction with the vaccine manufacturer Bavarian Nordic to procure 500,000 doses of mpox vaccines.

This advance purchase agreement, which will see doses delivered by the end of this year, marks an important milestone in the international mpox response. It also serves as tangible evidence that the global health community has acted on what it learned from the COVID-19 pandemic about the importance of rapid access to vaccine financing during the early stages of a health emergency.

Coming three working days after the WHO added Bavarian Nordic’s MVA-BN vaccine to its prequalification list, this week's agreement represents the single largest contribution of vaccines to the response to date. On top of the 265,000 doses that have so far been donated and delivered to the Democratic Republic of the Congo by the European Union, the US and Bavarian Nordic itself, it brings to 765,000 the total number of secured doses.

This new agreement means affected countries, assisted by our global and regional partners, are now able to plan for an effective vaccine rollout with the certainty that doses will be forthcoming. And, when one considers that at least 3.5 million additional doses have been pledged publicly by other donors, including Japan, Team Europe and Canada, the 4 million doses that the WHO estimates are needed for an initial six-month response begins to look more like an achievable target.

I am proud that the funding for this agreement comes from Gavi’s new First Response Fund. This financial instrument, created from savings generated from Gavi’s renegotiation of its COVID-19 vaccine contracts, was set up with the purpose of providing rapid access to financing for vaccines in the event of an emergency, such as mpox. Despite the fact that the Fund was established in June this year, we were able to initiate and conclude the deal using the Fund well within the 50-day timeframe envisaged as a benchmark for rapid response during the Fund’s design phase.

The design and deployment of the First Response Fund solves for mpox one of the fundamental challenges faced in the early days of COVID-19, when there was no ready cash on hand to secure sought-after production slots with vaccine manufacturers. Over the longer term, Gavi’s African Vaccine Manufacturing Accelerator (AVMA), also launched in June this year, will help address another fundamental challenge to equitable vaccine access: the absence of an ecosystem for vaccine manufacturing on the continent of Africa. With over $1.2 billion of funding available to support local vaccine production, AVMA will, over time, help bring down the cost of vaccines against mpox and other infectious threats and provide Africa with the certainty that in times of crisis, local demand will be met by local manufacturers.

The need for financial innovation to address supply challenges in the early stages of an emergency is not the only lesson from the COVID-19 pandemic. Vaccines are only of value if they are turned into vaccinations: something that proved a challenge in many countries during the COVID-19 pandemic, when planning for campaigns was often hamstrung by unpredictable supply chains and limited delivery funding. Learning from those lessons, we acted speedily, making operational funding available as soon as the emergency was declared, initially through other cash windows and now through the First Response Fund. With reasonable levels of cold chain infrastructure in place and a clear line of sight on when vaccines will become available, the ability for countries to plan with certainty the rollout of mpox vaccines is much greater.

Nevertheless, many operational challenges lie ahead before we can bring mpox under control. The response is still in its early stages. It is important to emphasize that vaccines are just one, albeit crucial, pillar of a comprehensive response that must also encompass infection prevention and control, surveillance, rapid diagnosis and clinical care. Effective engagement with affected and at-risk communities will be vital, both to ensure the response is adapted to local contexts and to overcome any barriers to care seeking and vaccine uptake. Choreographing such a multifaceted response requires close coordination between international agencies, national and local partners and civil society: a complex effort that will be led jointly in Africa by Africa CDC and the WHO Regional Office for Africa.

Gavi is supporting this effort and, looking further ahead, is committed to building a stockpile of mpox vaccines for rapid deployment in the event of future outbreaks. Such stockpiles have been vital enablers of rapid responses to other outbreak-prone diseases, including cholera, Ebola, meningococcal vaccine and yellow fever. As with all of Gavi’s vital work, such as the rollout of the new malaria vaccine or expansion of HPV vaccination to beat cervical cancer, strategic vaccine stockpiles can only be built and maintained if Gavi is fully funded for its next strategic period.

Here, we call on our donors and partners in the public and private sectors to support us in our bid to accelerate progress towards a healthy, equitable future for all and an end to outbreaks of diseases, such as mpox. Gavi’s 2026-2030 replenishment is coming, the time is now to ensure we can respond to present and future health threats.