Earlier this month, the World Health Organization (WHO) declared the mpox outbreak in Africa a public health emergency of international concern.

The majority of cases have been detected in the Democratic Republic of Congo but the disease has also spread to several countries in central and east Africa. Sweden recently recorded a case of a more dangerous variant of mpox, the first of that kind recorded outside Africa.

The new variant has increased the need for vaccines in the Democratic Republic of Congo and elsewhere. At the time of writing, the country still does not have any doses of an mpox vaccine. The country's health minister said on Monday (August 19) that Japan and the US had pledged to donate vaccines before the end of the month.

The situation has shone a light on the severe global inequity that exists when it comes to vaccines and public health crises, and the extent to which profitability is often the key determining factor as to whether vaccines are produced and procured.

Stuart Blume, emeritus professor of science and technology at the University of Amsterdam, says companies can only make a profit from vaccines if the virus becomes "an issue" in rich countries. "Nobody's going to get rich selling vaccines to Africa," he told DW.

Which companies have produced an mpox vaccine?

There is currently only one vaccine against mpox that has secured widespread regulatory approval from leading authorities around the world.

That's the MVA-BN vaccine produced by the Danish biotech company Bavarian Nordic. The company sells the vaccine under the brand names Jynneos, Imvamune and Imvanex. The US has pledged to send 50,000 doses from its stockpile to DR Congo in the coming days.

Japan's LC16 vaccine, made by KM Biologics, secured domestic Japanese approval during the previous mpox outbreak of 2022-2023. The WHO also recommends its use but it has not yet secured global regulatory approval.

The AFP news agency reports that Japan has pledged to send 3.5 million doses of its LC16 vaccine to DR Congo. Japan has reportedly asked that they be used specifically for children, who are particularly susceptible to serious illness caused by the virus.

Another vaccine of note is one originally designed to combat smallpox called ACAM2000. US biopharmaceutical company Emergent BioSolutions bought the vaccine from French company Sanofi in 2017.

Although it is a smallpox vaccine, experts believe the similarities between the viruses that cause mpox and smallpox are so great that ACAM2000 would produce immunity against mpox.

"At present, WHO recommends the use of MVA-BN or LC16 vaccines, or the ACAM2000 vaccine when the others are not available," the WHO states on its website. 

Another smallpox vaccine designated for possible use against mpox is Russia's state-produced OrthopoxVac, which like Japan's LC16 vaccine, was approved for use against mpox in 2022. However, it has only been approved by Russia.

Can Bavarian Nordic meet potential demand?

Earlier this month, Bavarian Nordic Chief Executive Paul Chaplin said the company had the capacity to produce millions of vaccines before the end of the year but needed to see more demand as soon as possible.

"We have the capacity, but we need people to start placing orders pretty fast," he told the British business daily Financial Times. "We need orders by the end of this month if we're going to meet 2 million (doses) by the end of this year."

The company recently received an order of more than 175,000 doses from the European Health Emergency Preparedness and Response Authority (HERA) and says it is in talks with other governments about potential orders that would be distributed to Africa.

Bavarian Nordic claims it can produce 10 million doses by the end of 2025 if there is sufficient demand, and said that it's working closely with the Africa Centers for Disease Control and Prevention (Africa CDC) "to ensure the equitable access to our mpox vaccine."

Stuart Blume, meanwhile, is calling on rich governments to step up and pay for orders on behalf of many African countries. "African countries don't have the resources to buy them and it's also not at all clear if the developed world is going to come up with the money," he told DW.

However, regulatory approval is also a problem in Africa. DR Congo did not receive vaccines during the 2022/23 outbreak due to a lack of approvals although now it and Nigeria have approved Bavarian Nordic's jab for emergency use.

Other countries currently affected by outbreaks in Africa have not approved any vaccine, complicating vaccine delivery further. 

How key is profitability to determining the amount of vaccines produced?

Bavarian Nordic's share price has surged by around 40% in the week since the mpox crisis was declared a public health emergency, a sign of how much vaccines can move markets.

Blume says profit is now a key determining factor for the production of vaccines in a public health crisis. "In the 1960s and 1970s, public health concerns really dominated the vaccine field. With neoliberalism in the 1980s, it became a matter of profitability and shareholder return."

He argues geopolitical influence has also become a factor in the production of vaccines, and cites the example of Chinese and Russian efforts during the COVID-19 pandemic.

"Their production was not necessarily geared to profit. It was geared equally to creating client relationships with other countries," he said, adding that it's hard to tell what role diplomacy is going to play this time.

With mpox, Blume is concerned that vaccine delivery will continue to be sluggish in Africa.

"It's a bit like with Ebola," he said, citing the example of the deadly Ebola virus which has caused thousands of deaths in Africa over the past few decades. "Ebola was around for years, and it was only when it affected the Global North that anybody got interested in developing a vaccine." 

Edited by: Uwe Hessler