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Monkeypox Vaccine in US by 2023

Healthy Communities Monkeypox (mpox)

Question

Recently, there have dozens of reported cases of monkeypox outside of areas in sub-Saharan Africa (namely, Nigeria, Central African Republic, Cameroon, and Democratic Republic of Congo) in which it is endemic. As of 12PM EST on 19 May, there are 75 confirmed or suspected monkeypox cases across the UK, Portugal, Spain, Canada, Sweden, Italy, and the US. According to a 19 May report by the the European Centre for Disease Prevention and Control, many of these cases are likely the result of community transmission since many do not appear to be linked to travel:

Given the unusually high frequency of human-to-human transmission observed in this event, and the probable community transmission without history of traveling to endemic areas, the likelihood of further spread of the virus through close contact, for example during sexual activities, is considered to be high. The likelihood of transmission between individuals without close contact is considered to be low.

Monkeypox is closely related to but distinct from smallpox, which was eradicated in 1980. The first case of monkeypox was diagnosed in in 1970 and in recent years the frequency and geographic distribution has increased in Central Africa and West Africa. A recent systematic review finds that monkeypox has a less severe clinical presentation and is less transmissible than smallpox, but also that it has been evolving in recent decades to become of "global relevance." The same article also reports a pooled case fatality rate estimate of 8.7%, with a point estimate of 10.6% for the Central African clade and 3.6% for the West African clade. As of 18 May, all sequenced monkeypox cases seem to be of the West African clade according to WHO. Prior to the ongoing 2022 outbreak, the majority of reported and suspected monkeypox cases were thought to be the result of animal-to-human transmission rather than human-to-human transmission. The secondary attack rate estimates of monkeypox pre-2022 are consistent with this — according to the aforementioned systematic review article:

More than half of the articles (9/16) reported an SAR of 0%, and this spanned the decades from the 1970s through 2010–2019. Similarly, over those same five decades, the SAR ranged from 0.3–10.2% in 6/16 articles . In the remaining article, a median SAR of 50% was reported in an outbreak among 16 households.

However, monkeypox now seems to be spreading as a result of close contact between humans, perhaps in particular during sexual activities.


ACAM200 and JYNNEOSTM (Imvanex) are two currently-authorized vaccines in the United States to prevent smallpox, and JYNNEOS (Imvanex) is also authorized specifically to prevent monkeypox . Effectiveness against monkeypox is thought to be about 85%. The FDA approved JYNNEOS (Imvanex) in 2019 for "the prevention of smallpox and monkeypox disease in adults 18 years of age and older determined to be at high risk for smallpox or monkeypox infection.".

As of 19 May, the UK is offering Imvanex to healthcare workers at high-risk. As of 19 May, the US is not yet expanded the population to which it is offering a smallpox/monkeypox vaccine.

Will the US CDC recommend use of a smallpox/monkeypox vaccine for at least 10% of the US population, before 2023?

This resolves positively if the U.S. CDC recommends that groups constituting at least 10% of Americans receive a vaccine intended for protection against monkeypox.

Note that there are about 22M healthcare workers in the US, which is about 6.7% of the overall US population of 330M. Thus, a CDC recommendation for all healthcare workers would not on its own be sufficient for positive resolution.

Previous resolution criteria

This question will resolve on the basis of whether the U.S. FDA authorizes use of a vaccine against monkeypox before 2023, and the group(s) it authorizes this for constitute at least 10% of the U.S. population.

Note that there are about 22M healthcare workers in the US, which is about 6.7% of the overall US population of 330M. Thus, a FDA authorization for all healthcare workers would not on its own be sufficient for positive resolution.

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