[GENEVA] Concerns are growing about an outbreak of deadly mpox caused by a novel, sexually transmitted strain of the virus in the southeast of the Democratic Republic of Congo (DRC).

The strain triggered an outbreak in September, which has persisted and has now jumped to another province.

There are concerns that it might already have crossed borders and be spreading silently elsewhere, in the same way as the strain of mpox that caused the global epidemic in 2022—yet this time it appears the new strain is significantly more lethal.

To contain it, DRC and its neighbours need to acquire the former smallpox vaccines which have been shown to be effective against mpox. These are available, and DRC last week put regulatory approval in place enabling it to use donated vaccines.

In April, the US development agency USAID offered DRC 50,000 doses of a vaccine from the US stockpile that was developed for smallpox but works against mpox. Yet, that is barely enough for 25,000 people.

While the vaccine approvals mean DRC can now accept and use such donations, it cannot get anywhere like the number of doses it needs through agencies such as GAVI, the vaccine alliance, which help low-income countries buy vaccines.

First the vaccines, which cost US$200 for a course of two injections, according to Rosamund Lewis, emergency manager for the global mpox response at the WHO, need prequalification from the UN health agency for use against mpox, a long process not yet under way.

A WHO Emergency Use Listing would also enable purchases, but to date the WHO has only issued these when a Public Health Emergency of International Concern has been declared for the outbreak.

One was issued in 2022 for the global mpox epidemic, but it was lifted in May 2023 when behavioural change and immunity from vaccination or exposure among the people most affected—men who have sex with men—had reduced case numbers.

One is not in place for mpox now, but as the virus spreads into crowded refugee camps, some form of emergency vaccine authorisation may be needed soon.

GAVI plans to set up a global stockpile of mpox vaccines, while the WHO’s Strategic Framework for mpox calls for a global rapid vaccine deployment mechanism by 2026.

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