美国国家公共电台 NPR--Is there enough monkeypox vaccine to go around? Maybe yes, more likely no

Is there enough monkeypox vaccine¹ to go around? Maybe yes, more likely no

Transcript²

As monkeypox cases continue to mount – topping 31,000 cases globally – governments of wealthy nations have been scrambling³ to buy vaccines⁴. But what's available for the rest of the world?

NPR spoke⁵ with two people in a position to know: Matt Linley is with Airfinity, an independent, London-based analytics company that has been tracking production and deliveries of monkeypox vaccine. Dr. Phiona Atuhebwe coordinates⁶ the introduction of new vaccines in Africa for the World Health Organization. Here are eight takeaways.

1) Vaccine options are limited

In theory there are at least three existing vaccines that could be used to protect people from monkeypox. But one is not recommended for widespread use. It's a vaccine against smallpox⁷ called ACAM2000 that the United States' Food and Drug Administration has now made available for use against monkeypox under what's called an "investigational⁸" protocol⁹; in rare cases it may cause dangerous side effects such as swelling¹⁰ of the heart.

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Another option, developed in Japan, "has had significant production issues," says Airfinity's Linley. "So they've been unable to scale up any significant amount of production to use it outside of Japan."

As a result, in practice, notes Linley, countries are currently turning to only one vaccine: the Imvanex vaccine often referred to as JYNNEOS and approved by the U.S. FDA specifically for monkeypox in addition to smallpox. The catch is that only one company makes it – Denmark-based Bavarian Nordic.

2) Supply is also limited

In an email, a spokesperson for Bavarian Nordic told NPR that the company has the capacity to produce 30 to 40 million doses of JYNNEOS annually¹¹. With the recommended two-dose regimen, this would be enough to cover 15 to 20 million people. (The number of individuals covered could presumably be expanded even further to 100 million people if other countries follow the lead of U.S. officials – who, in an effort to stretch the current U.S. supply, this month approved a plan to cut each dose by a fifth by using a different method for injecting the vaccine.)

But Linley is skeptical¹² that Bavarian Nordic's production capacity is as high as the company claims. "At least from what's known about Bavarian Nordic's deliveries [to date], they are significantly lower than we would expect" if the company really were able to produce 40 million annually, he says. As to what Bavarian Nordic's true capacity is, Linley thinks it might be more like 20 million annually. But he adds "with the initial complications that they've had and the lack of data that we have [from them], it's hard to come up with a proper estimate."

3) There is a best case scenario¹³ where supply meets need

How does this admittedly fuzzy picture of the likely JYNNEOS supply match up against the likely worldwide need?

To get a sense, Linley first considered the population among whom monkeypox is currently spreading in the current outbreak. Right now that is overwhelmingly men who have sex with men, most particularly with multiple partners. There is no known figure of how many people in the world are in this category, says Linley. So to come up with an estimate, Linley turned to statistics that can serve as proxies¹⁴ for it – and that match up with the eligibility¹⁵ criteria¹⁶ that several countries are using to ensure their vaccine is given to those most at risk: Specifically men who are HIV positive and men who are taking PrEP, a medication that can reduce a person's chances of contracting HIV. Linley cautions, however, that this is a very imperfect proxy¹⁷, because many men who are taking PrEP or who are HIV positive are not men who have sex with men or who have sex with multiple partners.

That said, Linley estimates that this target population encompasses¹⁸ 18 million people worldwide. It's possible that just a fraction of them would need to be vaccinated²⁰ in order to halt the outbreak, says Linley. And in that case, at least within a few months, Bavarian Nordic should be able to produce sufficient quantities of JYNNEOS to accomplish that.

4) But many other scenarios²¹ are worrisome

The trouble is that this best case scenario falls apart quickly if other potential developments are factored in. For instance, what if all 18 million people in the initial target population need to be vaccinated rather than just a fraction? Linley estimates that even at Bavarian Nordic's stated capacity it would take until November to produce enough vaccine for just the first dose. And what if the outbreak becomes sufficiently²² large that it becomes necessary to vaccinate¹⁹ all health-care workers? That would bring the total who need the vaccine to more than 62 million, says Linley.

Less likely – but even more dire²³ – is what Linley has dubbed²⁴ the "extreme" scenario in which monkeypox starts spreading among children, who are at higher risk of developing severe complications from the disease. That would bring the number of people requiring vaccination²⁵ to 1.5 billion.

5) Even the U.S. is struggling to get doses

Although Bavarian Nordic has ramped²⁶ up production, at the moment the available supply is so limited even wealthy countries are struggling to obtain doses.

Take the U.S., which with nearly 10,000 cases has world's highest count and which appears to have the largest contract with Bavarian Nordic. The U.S. had virtually no doses at the start of the outbreak in May. Since then, only about 1.1 million doses have actually been delivered. U.S. officials say another 150,000 doses should arrive in September and another roughly 150,000 before the end of the year, bringing the expected U.S. supply to just 1.4 million doses.

The U.S. also has an additional contract with Bavarian Nordic to get 5.5 million more doses this year and next using material that the U.S. had purchased from the company years ago. But it's unclear how soon those doses will reach the U.S., because first the material needs to be put into vials — or "filled."

Asked about the timeline, a spokesman for Bavarian Nordic told NPR that the company is "partnering with a U.S.-based contract manufacturer to expedite filling."

In the meantime, to stretch the current supply, U.S. officials are supplementing the one-fifth dose strategy with yet another plan: They've instructed Bavarian Nordic to test about 1 million expired JYNNEOS doses in the U.S. reserve to see if they are still usable.

6) Other wealthy countries are worse off than the U.S.

It's difficult to know precisely²⁷ how many JYNNEOS doses each country in the world has contracted with Bavarian Nordic to obtain because both pharmaceutical²⁸ companies and nations tend to keep much of this information confidential²⁹. But based on available reports, Linley says that almost all the contracts to date appear to be with wealthy countries. (Bavarian Nordic declined NPR's request to comment on Linley's statistics.) For instance Canada has contracted to get 750,000 doses; Australia as many as 450,000 doses; France 250,000; Germany 240,000; the United Kingdom 154,000; Israel 10,000 doses. There's also an undisclosed European Union country that has a contract for 1.5 million doses, and the European Union as a whole has a contract for an additional 164,000 doses.

But so far, like the U.S., most of these countries have seen only a fraction of these doses delivered – if at all. Germany and the EU have received 50,000 each, the U.K. 54,000 and Israel 5,600. That's a total number of deliveries of under 160,000 doses.

7) The rest of the world is being left out

Last week Brazil – which currently ranks sixth in confirmed monkeypox cases with more 2,000 infections – announced that through the auspices³⁰ of the Pan American Health Organization it too had reached a deal with Bavarian Nordic: More than 20,000 doses will be shipped to Brazil in September and another 30,000 in October.

Beyond that it appears that the vast majority of the dozens of middle-income and low-income countries with current outbreaks have not secured any JYNNEOS vaccine.

8) Per usual Africa is coming in last

The inequity is particularly stark³¹ in Africa, where monkeypox had been endemic in several countries for years before the current outbreak. For now, at least, official case numbers remain relatively³² low in African countries. Still that could always change – or the official counts could be missing cases – notes WHO Africa's Dr. Phiona Atuhebwe. So the lack of availability of monkeypox vaccine is galling³³.

"It's just the same as how we were with COVID," she says. "It is just history repeating itself. Africa always gets [vaccines] last."

Indeed, largely for this reason, adds Atuhebwe, WHO is not stressing vaccination as the main strategy for combating the monkeypox outbreak, focusing instead on surveillance and contact tracing.

"We've learned to deal with reality, " says Atuhebwe with a sigh. "We push for more access to better tools to ensure that the African population is protected. But we've learned to work within reality."

1 vaccine   

n.牛痘苗，疫苗；adj.牛痘的，疫苗的

参考例句：

• The polio vaccine has saved millions of lives.脊髓灰质炎疫苗挽救了数以百万计的生命。
• She takes a vaccine against influenza every fall.她每年秋季接种流感疫苗。

2 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

3 scrambling   

v.快速爬行( scramble的现在分词 )；攀登；争夺；（军事飞机）紧急起飞

参考例句：

• Scrambling up her hair, she darted out of the house. 她匆忙扎起头发，冲出房去。 来自《现代英汉综合大词典》
• She is scrambling eggs. 她正在炒蛋。 来自《简明英汉词典》

4 vaccines   

疫苗，痘苗( vaccine的名词复数 )

参考例句：

• His team are at the forefront of scientific research into vaccines. 他的小组处于疫苗科研的最前沿。
• The vaccines were kept cool in refrigerators. 疫苗放在冰箱中冷藏。

5 spoke   

n.（车轮的）辐条；轮辐；破坏某人的计划；阻挠某人的行动 v.讲，谈（speak的过去式）；说；演说；从某种观点来说

参考例句：

• They sourced the spoke nuts from our company.他们的轮辐螺帽是从我们公司获得的。
• The spokes of a wheel are the bars that connect the outer ring to the centre.辐条是轮子上连接外圈与中心的条棒。

6 coordinates   

n.相配之衣物；坐标( coordinate的名词复数 )；（颜色协调的）配套服装；[复数]女套服；同等重要的人（或物）v.使协调，使调和( coordinate的第三人称单数 )；协调；协同；成为同等

参考例句：

• The town coordinates on this map are 695037. 该镇在这幅地图上的坐标是695037。 来自《简明英汉词典》
• The UN Office for the Coordination of Humanitarian Affairs, headed by the Emergency Relief Coordinator, coordinates all UN emergency relief. 联合国人道主义事务协调厅在紧急救济协调员领导下，负责协调联合国的所有紧急救济工作。 来自《简明英汉词典》

7 smallpox   

n.天花

参考例句：

• In 1742 he suffered a fatal attack of smallpox.1742年，他染上了致命的天花。
• Were you vaccinated against smallpox as a child?你小时候打过天花疫苗吗？

8 investigational   

[医]调查研究的

参考例句：

• Investigational New Drug Application (IND) for the compound. 为化合物的研究中的新药物申请(IND)。
• He said it representsan investigational H.I. 一位博士说：我们已经向成功迈出了重要的一步。

9 protocol   

n.议定书，草约，会谈记录，外交礼节

参考例句：

• We must observe the correct protocol.我们必须遵守应有的礼仪。
• The statesmen signed a protocol.那些政治家签了议定书。

10 swelling   

n.肿胀

参考例句：

• Use ice to reduce the swelling. 用冰敷消肿。
• There is a marked swelling of the lymph nodes. 淋巴结处有明显的肿块。

11 annually   

adv.一年一次，每年

参考例句：

• Many migratory birds visit this lake annually.许多候鸟每年到这个湖上作短期逗留。
• They celebrate their wedding anniversary annually.他们每年庆祝一番结婚纪念日。

12 skeptical   

adj.怀疑的，多疑的

参考例句：

• Others here are more skeptical about the chances for justice being done.这里的其他人更为怀疑正义能否得到伸张。
• Her look was skeptical and resigned.她的表情是将信将疑而又无可奈何。

13 scenario   

n.剧本，脚本；概要

参考例句：

• But the birth scenario is not completely accurate.然而分娩脚本并非完全准确的。
• This is a totally different scenario.这是完全不同的剧本。

14 proxies   

n.代表权( proxy的名词复数 )；（测算用的）代替物；（对代理人的）委托书；（英国国教教区献给主教等的）巡游费

参考例句：

• SOCKS and proxies are unavailable. Try connecting to XX again? socks和代理不可用。尝试重新连接到XX吗？ 来自互联网
• All proxies are still down. Continue with direct connections? 所有的代理仍然有故障。继续直接连接吗？ 来自互联网

15 eligibility   

n.合格，资格

参考例句：

• What are the eligibility requirements? 病人被选参加试验的要求是什么？ 来自英汉非文学 - 生命科学 - 回顾与展望
• Eligibility for HINARI access is based on gross national income (GNI). 进入HINARI获取计划是依据国民总收入来评定的。

16 criteria   

n.标准

参考例句：

• The main criterion is value for money.主要的标准是钱要用得划算。
• There are strict criteria for inclusion in the competition.参赛的标准很严格。

17 proxy   

n.代理权，代表权；（对代理人的）委托书；代理人

参考例句：

• You may appoint a proxy to vote for you.你可以委托他人代你投票。
• We enclose a form of proxy for use at the Annual General Meeting.我们附上委任年度大会代表的表格。

18 encompasses   

v.围绕( encompass的第三人称单数 )；包围；包含；包括

参考例句：

• The job encompasses a wide range of responsibilities. 这项工作涉及的职责范围很广。
• Its conservation law encompasses both its magnitude and its direction. 它的守恒定律包括大小和方向两方面。 来自辞典例句

19 vaccinate   

vt.给…接种疫苗；种牛痘

参考例句：

• Local health officials then can plan the best times to vaccinate people.这样，当地的卫生官员就可以安排最佳时间给人们接种疫苗。
• Doctors vaccinate us so that we do not catch smallpox.医生给我们打预防针使我们不会得天花。

20 vaccinated   

[医]已接种的，种痘的，接种过疫菌的

参考例句：

• I was vaccinated against tetanus. 我接种了破伤风疫苗。
• Were you vaccinated against smallpox as a child? 你小时候打过天花疫苗吗？

21 scenarios   

n.[意]情节；剧本；事态；脚本

参考例句：

• Further, graphite cores may be safer than non-graphite cores under some accident scenarios. 再者，根据一些事故解说，石墨堆芯可比非石墨堆芯更安全一些。 来自英汉非文学 - 环境法 - 环境法
• Again, scenarios should make it clear which modes are acceptable to users in various contexts. 同样，我们可以运用场景剧本来搞清楚在不同情境下哪些模式可被用户接受。 来自About Face 3交互设计精髓

22 sufficiently   

adv.足够地，充分地

参考例句：

• It turned out he had not insured the house sufficiently.原来他没有给房屋投足保险。
• The new policy was sufficiently elastic to accommodate both views.新政策充分灵活地适用两种观点。

23 dire   

adj.可怕的，悲惨的，阴惨的，极端的

参考例句：

• There were dire warnings about the dangers of watching too much TV.曾经有人就看电视太多的危害性提出严重警告。
• We were indeed in dire straits.But we pulled through.那时我们的困难真是大极了，但是我们渡过了困难。

24 dubbed   

v.给…起绰号( dub的过去式和过去分词 )；把…称为；配音；复制

参考例句：

• Mathematics was once dubbed the handmaiden of the sciences. 数学曾一度被视为各门科学的基础。
• Is the movie dubbed or does it have subtitles? 这部电影是配音的还是打字幕的？ 来自《简明英汉词典》

25 vaccination   

n.接种疫苗，种痘

参考例句：

• Vaccination is a preventive against smallpox.种痘是预防天花的方法。
• Doctors suggest getting a tetanus vaccination every ten years.医生建议每十年注射一次破伤风疫苗。

26 ramped   

土堤斜坡( ramp的过去式和过去分词 )； 斜道； 斜路； （装车或上下飞机的）活动梯

参考例句：

• With the arrival of George Lucas, the pace has ramped up. 随着乔治·卢卡斯的到来，速度大大加快。
• They also sold corporate bonds as the global financial crisis ramped up. 在全球金融危机加剧之际，他们还抛售了公司债券。

27 precisely   

adv.恰好，正好，精确地，细致地

参考例句：

• It's precisely that sort of slick sales-talk that I mistrust.我不相信的正是那种油腔滑调的推销宣传。
• The man adjusted very precisely.那个人调得很准。

28 pharmaceutical   

adj.药学的，药物的；药用的，药剂师的

参考例句：

• She has donated money to establish a pharmaceutical laboratory.她捐款成立了一个药剂实验室。
• We are engaged in a legal tussle with a large pharmaceutical company.我们正同一家大制药公司闹法律纠纷。

29 confidential   

adj.秘（机）密的，表示信任的，担任机密工作的

参考例句：

• He refused to allow his secretary to handle confidential letters.他不让秘书处理机密文件。
• We have a confidential exchange of views.我们推心置腹地交换意见。

30 auspices   

n.资助，赞助

参考例句：

• The association is under the auspices of Word Bank.这个组织是在世界银行的赞助下办的。
• The examination was held under the auspices of the government.这次考试是由政府主办的。

31 stark   

adj.荒凉的；严酷的；完全的；adv.完全地

参考例句：

• The young man is faced with a stark choice.这位年轻人面临严峻的抉择。
• He gave a stark denial to the rumor.他对谣言加以完全的否认。

32 relatively   

adv.比较...地，相对地

参考例句：

• The rabbit is a relatively recent introduction in Australia.兔子是相对较新引入澳大利亚的物种。
• The operation was relatively painless.手术相对来说不痛。

33 galling   

adj.难堪的,使烦恼的,使焦躁的

参考例句：

• It was galling to have to apologize to a man she hated. 令人恼火的是得向她憎恶的男人道歉。
• The insolence in the fellow's eye was galling. 这家伙的傲慢目光令人恼怒。 来自英汉文学 - 嘉莉妹妹