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Why the UK’s efforts to vaccinate against monkeypox are faltering

·5 min read
Inside the UK’s faltering efforts to vaccinate against monkeypox
Inside the UK’s faltering efforts to vaccinate against monkeypox

Matt and his boyfriend have spent hours on the train to London from Coventry over the past few weekends – all in the hope of getting a monkeypox vaccine.

“We’d heard about a walk-in clinic at Guy’s Hospital last Saturday so we were up at 7am to get down there,” he says.

But when they arrived an hour before it opened, the vaccine doses had been sent elsewhere: “There were at least 40 of us there all ready to join the queue. But they’d cancelled it at the last-minute.”

Matt is trying again this weekend, with an appointment at another clinic in London. “We don’t know what’s going on, and we are all just trying to be responsible and protect ourselves,” he says, describing the situation as “super frustrating”.

For weeks, social media has been flooded with stories of people eligible for the vaccine – as healthcare workers, or gay and bisexual men at higher risk – but unable to book appointments.

Hard figures on the monkeypox vaccine roll-out have been scant. The UK Health & Security Agency says thousands of doses of the Bavarian Nordic vaccine – initially meant for smallpox, but also effective for monkeypox - have been given, out of the 100,000 doses ordered.

Britain is still battling to get enough jabs to those who need it, around five months since the country’s first monkeypox case was identified.

Charities say the current order numbers are not enough. Around 125,000 people in Britain are eligible for doses, according to the British Association for Sexual Health and HIV (BASHH).

With the vaccine designed as a two-dose regime, “BASHH estimates that 250,000 doses of vaccine must be procured… yet the government has only procured over 100,000 to date”.

Not only does too little appear to be coming, but experts are concerned it is taking too long to arrive. BASHH estimates suggest only 8,300 vaccines remain available in the UK, “making it likely that the remaining number of vaccines will run out in approximately 10 to 20 days, leaving a gap in supply until the next shipment arrives in September”.

For those who haven’t yet been able to get an appointment, this could mean even more delays in getting jabbed.

The troubles in clinics across the country partly stem from wider supply issues. Other countries are also facing shortfalls, with Europeans reportedly travelling across borders to get a jab.

In early 2022, Danish biotech company Bavarian Nordic shuttered its bulk manufacturing facility to build out more capacity to make other vaccines at the site, effectively bringing production to a halt just before demand picked up.

“Three months ago, there was no demand for this vaccine,” explains spokesman Thomas Duschek. “There was no need to produce any bulk, and now we’ve been caught in a situation where everybody wants the vaccine.”

In some countries, the bottleneck is less of a problem. The US, for instance, has a large stockpile of smallpox vaccines held in case the virus is used in a terror attack, and it has ordered another 3m doses in the past few months. In Britain, however, there is a debate over which vaccines should be stockpiled to help improve pandemic preparedness.

Sir John Bell, the UK life sciences champion, says “you could end up with a very long list of what you’d want to stockpile”.

Any decision over this also comes with political scrutiny, adds Matt Hancock MP, the former Health Secretary.

“There's always going to be pressure when there isn't a pandemic on to reduce costs,” he says, adding there is a limit on how much you can stockpile vaccines, given some viruses change over time, but “we must remain pandemic ready and obviously stockpiles of vaccines are important for this”.

These debates are only more likely to come to the fore amid concerns the monkeypox response heralds future mess-ups.

Clive Dix, who chaired the vaccine taskforce, says: “when we gave long term objectives to the Government, those recommendations have not been carried through”. He thinks the current situation shows a real lack of a “structured approach to having everything ready for another pandemic”.

Others point to other opportunities. While Bavarian Nordic points to the specialist nature of producing the monkeypox vaccine as the reason behind the struggle to ramp up production, a new production deal is on the horizon in the US. Some argue a similar deal could have been struck in Britain.

The Vaccine Manufacturing & Innovation Centre, that the UK pumped more than £200m into during the pandemic, was “set up to not just be able to make a vaccine in the event of a pandemic,” notes ex-chief executive Matthew Duchars. “It was also to make sure we had some key indications like smallpox or anthrax, to be able to make those vaccines under licence if they were needed.”

Instead, it was sold to US company Catalent. “It is much harder to coordinate the pandemic preparedness piece than it would be through a centralised body, like VMIC was supposed to be,” adds Duchars.

For now, it appears Britain will simply have to rely on supply from Bavarian Nordic’s facility in Kvistgaard, Denmark.

The situation is spawning much anxiety across the country. Matt says that one closeted gay man he knows has shut himself off completely, for fear catching the virus could inadvertently disclose his sexuality. “There’s a lot of fear among the community,” he adds. “If I’m honest, it feels like there’s just no one in control of it.”