UK orders 150,000 doses of MVA-BN mpox vaccine

16 September 2024. Related: mpox (monkeypox).

Simon Collins, HIV i-Base

On 16 September 2024, the UK Health Security Agency announced that the UK has ordered 150,000 doses of the modified vaccinia ankara virus (MVA) vaccine from Bavaria Nordic, the sole global manufacturer. [1]

Although the press release states that these vaccines will increase protection against the clade 1b mpox, should cases be identified here, the vaccine order is based on recommendations from the Joint Committee on Vaccination and Immunisation (JCVI) in November 2023. [2]

This recommended developing a pre-emptive mpox vaccination programme as part of routine sexual health services across the UK, rather than a reactive strategy that only offered vaccine following a new outbreak.

Details of the vaccine programme have still to be announced, including a timeline, but the press release said it will prioritise those with highest risk of mpox while ensuring equity of access across all populations at similar risk.

Although the press release is about ordering vaccines, Bavaria Nordic recently announced that all orders for the MVA-BN vaccine would be suspended in order to prioritise getting 2 million doses to the Democratic Republic of the Congo by the end of 2024. They also plan a further 10 million doses as part of the international emergency response to the clade 1b outbreak there. [3]

The global reliance on a single global vaccine manufacturer is a terrible model for global health and shows nothing was learnt from COVID.

Both Moderna and BioNTech have announced plans to develop mRNA vaccines against mpox, with early compounds already in phase 1 studies, with the Moderna study running at 12 sites in the UK (all in England). [4, 5, 6]

Recent guidance from the US CDC summarises the evidence showing that protection from two doses of the MVA-BN should be sustained for at least five years and that, unlike in France, a third booster dose is not being recommended. Also, that people who recovered from mpox generate sufficient immune responses to not require subsequent vaccination. [7]

This conclusion however is controversial as decreasing levels of neutralising antibodies have been reported over time and infections have also been reported in people who had two shots of the MVA-BN vaccine.

By contrast to US advice, selective use of a booster dose of the mpox vaccine after two years is being recommended in France, mainly in people without previous immune protections, who received one or two vaccine doses during the 2022 outbreak. [8]

The strategy for the booster dose is to eliminate mpox circulation in France among people at highest risk, rather than just to minimise symptoms.

Given the extremely limited short-term access to mpox vaccines, the greatest population benefit is likely to come from increasing use of first- and second-dose vaccination.

References

1. UKHSA press release. UK secures more vaccines to help boost resilience against mpox. Additional vaccines will help ensure the UK can protect those that may be at high risk from mpox. (16 September 2024).
   https://www.gov.uk/government/news/uk-secures-more-vaccines-to-help-boost-resilience-against-mpox
2. gov.uk. JCVI statement on mpox vaccination as a routine programme. Joint Committee on Vaccination and Immunisation (JCVI). 10 November 2023.
   https://www.gov.uk/government/publications/mpox-vaccination-programme-jcvi-advice-10-november/jcvi-statement-on-mpox-vaccination-as-a-routine-programme
3. Bavarian Nordic press release. Bavarian Nordic provides update on the mpox vaccine supply situation (12 September 2024).
   https://www.bavarian-nordic.com/investor/news/news.aspx?news=6989
4. BioNTech press release. BioNTech and CEPI announce partnership to advance mRNA mpox vaccine development and support CEPI’s 100 days mission. (18 September 2023).
   https://investors.biontech.de/news-releases/news-release-details/biontech-and-cepi-announce-partnership-advance-mrna-mpox-vaccine
5. NIHR press release. New mpox vaccine being tested in the UK. (14 March 2024).
   https://www.nihr.ac.uk/news/new-mpox-vaccine-being-tested-in-the-uk/35622
6. Moderna. A study to investigate the safety tolerability and immune response of a range of doses of mRNA-1769 compared with placebo in healthy participants from ≥18 years of age to <50 years of age.
   https://trials.modernatx.com/study/?id=mRNA-1769-P101
7. US CDC. Mpox vaccines. (Undated)
   https://www.cdc.gov/poxvirus/mpox/interim-considerations/overview.html#anchor_1724429163828
8. ANRS. Avis n° 2024.0058/AC/SESPEV du 29 août 2024 du collège de la Haute
   Autorité de santé relatif à la stratégie de vaccination contre le mpox. Avis n° 2024.0058/AC/SESPEV du 29 août 2024. (29 August 2024).   
   https://has-sante.fr/upload/docs/application/pdf/2024-08/avis_2024.0058.ac.sespev_du_29_aout_2024_du_college_de_la_has_relatif_a_la_strategie_de_vaccination__2024-08-30_16-13-45_323.pdf