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Monkeypox vaccine
What type of vaccine will work against a viral zoonotic
disease? How is India gearing up to this challenge?

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31/07/2022
Jacob Koshy

The story so far: With the World Health Organization (WHO) declaring monkeypox as a
Public Health Emergency of International Concern (PHEIC) and cases rising globally to
around 19,179 in 78 countries as of July 27, governments around the world are initiating
steps towards developing or even sourcing a vaccine against monkeypox.

Are there vaccines for monkeypox?

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Are there vaccines for monkeypox?

The monkeypox virus belongs to a family of viruses called orthopoxviruses, which is different from
that of the coronaviruses. According to the WHO, it is a viral zoonosis — a virus transmitted to
humans from animals — with symptoms similar, but less severe to smallpox. It is also an
enveloped double-stranded DNA virus, unlike the RNA virus, that makes it far more stable and less
prone to rapid mutations. There are two distinct genetic clades of the monkeypox virus: the central
African (Congo Basin) clade and the West African clade. The Congo Basin clade has historically
caused more severe disease and was thought to be more transmissible.

There is yet no dedicated monkeypox vaccine, but vaccinations against smallpox was found to be
85% effective in preventing smallpox, a disease eradicated in 1980. In 2019, the United States
Food and Drugs Administration (FDA), approved the JYNNEOS vaccine for the prevention of
smallpox, monkeypox and other diseases caused by orthopoxviruses, including vaccinia virus, in
adults 18 years of age and older and categorised as having a “high risk of infection.” These include
contacts of those who have been confirmed to have contracted a monkeypox infection, sexual
partners (with contact within previous two weeks) of those confirmed with an infection and those
whose immune systems are compromised.

How does JYNNEOS work?

JYNNEOS, developed by Danish biotechnology company, Bavarian Nordic, contains a live vaccinia
virus that does not replicate efficiently in human cells. The vaccinia virus is the smallpox virus but
made incapable of replicating within the body. It is administered as two injections 28 days apart.
The immune response takes 14 days after the second dose.
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comparing the immunogenicity of JYNNEOS to a licensed smallpox vaccine (ACAM2000) based
on a laboratory test called the Plaque Reduction Neutralisation Test (PRNT). This test evaluates
what quantity of the vaccine was needed to kill the virus made to replicate in a petri-dish. Because
of structural similarities to the smallpox virus, the effectiveness of the JYNNEOS is estimated
based on comparison to another licensed, smallpox vaccine called ACAM2000. There is no data
yet on JYNNEOS’ effectiveness. This is because smallpox has been eradicated and the
monkeypox outbreak has risen too rapidly for a traditional phase 3 trial to have evaluated the
vaccine’s effectiveness. However, there is evidence that the precursor for ACAM2000 was effective
in eradicating smallpox.

The US-based Centers for Disease Control and Prevention said public health officials are
concerned about the lack of effectiveness data for JYNNEOS. “We do not know if JYNNEOS will
fully protect against monkeypox virus infection,” the CDC said.
Is the vaccine easily available?

As of July 29, doses were available in Brazil, Canada (Toronto, Montreal,) Cyprus, the Democratic
Republic of Congo, Denmark, Europe, France, Germany (Berlin), Israel, Mexico, Nigeria, Portugal
(Lisbon), Scotland, Spain (Madrid) and the U.K. (London) with the company claiming to have
delivered around 3 00 000 doses
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delivered around 3,00,000 doses.

What about India?

Health Ministry officials said discussions were in progress with international and local companies
for a vaccine. The Indian Council of Medical Research and the National Institute of Virology Pune
have isolated the virus strain from samples of people confirmed with the infection in India; there
have been four confirmed cases of monkeypox in India so far. Officials said the genomic sequence
of the Indian strain has a 99.85% match with the West African strain circulating globally. The ICMR
has invited tenders from local companies to develop a vaccine. The Serum Institute of India said it
was in talks with international partners regarding a potential vaccine but that it would take time.
However, despite its infectiousness, monkeypox is largely a contained disease that doesn’t attack
vital organs and is as yet, not airborne. For COVID-19, Indian companies made billions of vaccine
doses — most of which were locally consumed — but were also shipped internationally. Some
experts have expressed reservations on whether approaching it as a COVID vaccine is the right
way forward.

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