ADVANCING EQUITY, FROM COVID-19 TO MPOX

THE CONTEXT: The recent mpox outbreak has highlighted significant challenges in global health preparedness, echoing the lessons learned from the COVID-19 pandemic. Addressing these challenges requires coordinated international efforts to ensure equitable vaccine access and strengthen health systems worldwide.

About Mpox:

• Mpox, formerly known as monkeypox, is a zoonotic disease caused by the monkeypox virus. The virus belongs to the Orthopoxvirus genus, the same group as smallpox and cowpox viruses.
• The virus was first identified in monkeys in Denmark in 1958, and the first human case was recorded in the Democratic Republic of the Congo in 1970.
• Mpox spreads through contact with infected animals, humans, or contaminated materials, with transmission occurring via skin lesions, bodily fluids, or respiratory droplets.
• To control its spread, avoid contact with infected individuals, isolate those with symptoms, and use personal protective equipment when necessary.
• Vaccination and public health measures such as quarantine and contact tracing play a crucial role in preventing further transmission.

Manufacturing of MVA-BN vaccine:

The process for making the mpox vaccine, specifically the MVA-BN (Modified Vaccinia Ankara – Bavarian Nordic) vaccine, involves several key steps:

• Egg-based production: The vaccine is produced using an egg-based production process that Bavarian Nordic has adapted for commercial-scale manufacturing.
• Cell preparation: The starting material is specific pathogen-free (SPF) embryonated chicken eggs. Chicken embryo fibroblast (CEF) cells are freshly prepared from these eggs. About 5000 eggs are used per batch of vaccine.
• Cell culture: The CEF cells are seeded in a bioreactor, typically a single-use plastic bag attached to a rocking platform called a WAVE Bioreactor Unit. A serum-free medium containing epidermal growth factor and antibiotics incubate the cells.
• Virus inoculation and harvesting: The cells are inoculated with the MVA-BN virus. After incubation, the virus is harvested and purified.
• Formulation and filling: The purified virus (bulk drug substance) is formulated and filled into vials. The vaccine can be produced in liquid-frozen (LF) or freeze-dried (FD) formulation.

THE ISSUES:

• Global spread of mpox: The recent mpox outbreak has rapidly evolved into a worldwide health concern. The World Health Organization (WHO) declared mpox a Public Health Emergency of International Concern (PHEIC), highlighting the severity of the situation. The outbreak originated in the Democratic Republic of Congo. It quickly spread to over a dozen African countries, prompting the Africa Centres for Disease Control and Prevention (AfricaCDC) to declare a Public Health Emergency of Continental Security (PHECS). This marks the first instance where regional and global health emergencies have been declared concurrently for the same disease.
• Spread of virus: The virus has now spread beyond the African continent, with cases identified in Sweden, Pakistan, and the Philippines. This global reach underscores the urgent need for a coordinated international response. As of 2023, 99,176 cases and 208 deaths were reported across 116 countries, illustrating the rapid and widespread nature of the outbreak.
• Vaccine availability and production capacity: The Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine, produced by Danish manufacturer Bavarian Nordic, presents a crucial tool in combating the mpox outbreak. However, current production capacity falls far short of global needs. The Africa CDC estimates that 10 million doses are required to stem the epidemic effectively, yet only about 0.21 million doses are immediately available.
• Cost constraints: Bavarian Nordic has stated its capacity to manufacture 10 million doses by the end of 2025, but this timeline may not be sufficient to address the urgent global demand. The estimated price of an mpox vaccine shot at $100 further complicates access, particularly for low- and middle-income countries. This significant gap between supply and demand highlights the critical need for expanded vaccine production and more affordable pricing strategies.
• Technology transfer and manufacturing in the Global South: The COVID-19 pandemic exposed the glaring lack of vaccine manufacturing capabilities in the Global South. This situation risks being repeated with the mpox outbreak. To address this, comprehensive technology transfer is crucial, encompassing the sharing of biological resources, know-how, and patents. This transfer is essential for rapidly scaling up MVA-BN production in countries with the potential to manufacture vaccines at lower costs.
• India in the global supply chain: India is well-positioned to meet this challenge. Three major Indian vaccine manufacturers – the Serum Institute of India, Bharat Biotech, and Zydus Cadila – already have experience producing vaccines using chick embryo fibroblast (CEF) cells, the same technology used for the MVA-BN vaccine. These manufacturers played pivotal roles in national and global responses to the COVID-19 pandemic, demonstrating their capacity to scale up production rapidly.
• Equity in vaccine access: The recent amendments to the International Health Regulations, including equity as a core principle, underscore the importance of ensuring global vaccine access. While these amendments won’t take effect until 2025, it is crucial that the international response to the mpox outbreak is grounded in this principle from the outset.
• Equity and Justice: Ensuring equitable access means producing enough vaccines and making them available to the populations that need them most at the right time. The lower cost structure of manufacturers in lower-middle-income countries (LMICs) could potentially reduce vaccine prices, thereby increasing accessibility. This approach aligns with the lessons learned from the COVID-19 pandemic, where inequitable vaccine distribution led to prolonged global health and economic impacts.

WAY FORWARD:

• Accelerate technology transfer and local vaccine manufacturing: Facilitate technology transfer and support local vaccine manufacturing in low- and middle-income countries (LMICs) to improve vaccine access. The WHO is launching a project in South Africa to provide technical expertise for vaccine production. Indian manufacturers like Serum Institute of India, Bharat Biotech, and Zydus Cadila have experience producing vaccines using chick embryo fibroblast cells, which is relevant for mpox vaccine production.
• Prioritize equitable global vaccine distribution: Ensure fair allocation of vaccines globally, prioritizing high-risk populations and LMICs. The Africa CDC estimates 10 million vaccine doses are needed to stem the outbreak, but only 0.21 million doses were immediately available. COVAX helped address equity disparities in COVID-19 vaccine distribution, delivering over 1.7 billion doses to 146 countries. Prioritizing sex workers and men who have sex with men for vaccination could help control the spread, as they face a disproportionate infection burden.
• Strengthen global health governance and accountability: Improve international cooperation, resource mobilization, and accountability mechanisms for pandemic preparedness and response. The 2024 amendments to International Health Regulations aim to foster equity in global health responses. Establishing stronger accountability measures and dedicated groups to engage with countries and manufacturers could help balance supply and demand. The WHO’s declaration of mpox as a Public Health Emergency of International Concern triggered international cooperation efforts.
• Invest in health system strengthening in LMICs: Support capacity building in LMICs for vaccine manufacturing, healthcare delivery, and outbreak response. The Developing Countries Vaccine Manufacturers Network (DCVMN) works to strengthen vaccine manufacturers through training and technology transfer initiatives in emerging countries. Investments in cold chain infrastructure and logistics systems are needed in many LMICs to support vaccine distribution. The IRC is scaling up health system support in the DRC and Burundi in response to the mpox outbreak, including training healthcare workers and improving infection control.
• Address vaccine hesitancy and promote community engagement: Implement targeted communication strategies and community engagement to build trust and increase vaccine acceptance. Stigma and discrimination linked to mpox can undermine public health efforts by making people reluctant to seek care and treatment. Community-led responses played a key role in controlling the 2022 global mpox outbreak. Engaging local leaders and addressing cultural contexts helped improve vaccine acceptance during Ebola outbreaks in Africa.

THE CONCLUSION:

Addressing the mpox outbreak requires urgent action to ensure equitable vaccine access and strengthen global health systems. By learning from past pandemics and implementing collaborative solutions, the international community can build a more resilient and just global health framework.

UPSC PAST YEAR QUESTIONS:

Q.1 What is the research in developmental achievements in applied biotechnology? How will these achievements help to uplift the poor sections of society? 2021

Q.2 What do you understand by nanotechnology, and how is it helping in the health sector? 2020

Q.3 The COVID-19 pandemic has caused unprecedented devastation worldwide. However, technological advancements are readily available to win over the crisis. Give an account of how technology was sought to manage the pandemic. 2020

Q.4 Stem cell therapy is gaining popularity in India to treat various medical conditions, including Leukaemia, Thalassemia, damaged cornea, and several burns. Describe briefly what stem cell therapy is and its advantages over other treatments? 2017

MAINS PRACTICE QUESTION:

Q.1 Discuss the challenges and opportunities presented by the recent mpox outbreak regarding global health governance and vaccine distribution.

SOURCE:

https://www.thehindu.com/opinion/lead/advancing-equity-from-covid-19-to-mpox/article68573895.ece