Gellin said it’s no longer useful to argue about whether or not it’s too late to control the virus.
“Instead, the starting point is to recognize that what helped this outbreak to expand is that everyone in the world who is under 40—the people who have not had a smallpox vaccine—have no immunity at all,” he said.
Like any vaccination policy, the first step is to determine who in the population is at risk and who could then benefit from vaccination.
Given the current outbreak among MSM, Osterholm and Gellin suggest as a proxy to look at the global population who are recommended to take the HIV oral preexposure prophylaxis (PrEP). By next year, between 2.4 million to 5.3 million people worldwide should receive PrEP, which gives a sense of the number of vaccine doses needed to target monkeypox.
But that’s just a starting point, says Gellin, as modeling studies will be needed to refine these estimates. He added, “Above all, we need to ensure that we don’t replay the vaccine inequity experience of COVID-19 vaccines.”