Two weeks ago I queued for more than five hours outside a London hospital to receive a monkeypox vaccination. But I’m one of the lucky ones; thousands of people in at-risk groups haven’t been so fortunate, and it’s about to get worse. Britain, despite being one of the centres of the outbreak, expects to run out of vaccines in the next couple of weeks, with no further deliveries planned until late September.
This matters because it’s a race against time to prevent monkeypox becoming an endemic disease. At that point, we’ll be stuck with it, and it will continue to circulate at low levels indefinitely, with regular danger of outbreaks and possibly new and more dangerous variants. Even in the optimistic scenario that it gets no more severe, lives will be lost. And while LGBTQ+ groups have led the way in demanding a stronger response, we know that the disease is particularly dangerous for several groups, including small children, pregnant women and those with compromised immune systems.
There’s plenty of blame to go around for this dangerous situation, not least years of damaging cuts to sexual health services on the part of the government. But one stands out: a pharmaceutical system that routinely places profits ahead of the protection of human life.
As things stand, the sole supplier of the only approved vaccine for monkeypox is a Danish pharmaceutical company called Bavarian Nordic. In a case of almost unbelievably unlucky timing, the company’s bulk production line has been closed for refurbishment. Even more ironically, the company has millions of doses in the freezer, but getting them into vials and ready to go isn’t a small job. The company is looking for other factories to help with this. But even when it does happen, the overwhelming bulk of the doses have been bought by the US, with a trickle going to other high-income countries.
The vaccine – known as Jynneos, Imvamune or Imvanex – was developed as a safe immunisation for smallpox, and was being kept on hold in case of a biological terrorist attack. It was funded, to the tune of $2bn, by the US government, but like most medicines, it was patented. Bavarian Nordic, which holds the patent, dictates who can make the vaccine, how many doses are made, who gets to buy them, and at what price.
Bavarian Nordic is far from the biggest pharmaceutical company in the world. Its revenues are a drop in the ocean next to the well-known pharma giants. In fact, in early 2021, the company offered to produce Covid vaccines if only one of those bigger players would share their knowhow. The offer was not taken up.
Now the shoe is on the other foot. Bavarian Nordic is reportedly looking into licensing its vaccine to other manufacturers, but details are confidential so far. As we saw with Covid-19, leaving production entirely to the market can be slow, opaque and unequal. It would be tragic to see this repeated with monkeypox. Africa is so far the only continent to suffer more than a couple of deaths from monkeypox to date, yet it hasn’t received a single dose of vaccine so far.
Covid-19 was the final proof for many countries in Asia, Africa and Latin America that they couldn’t rely on the western-dominated pharmaceutical companies to provide them with medicines. Even when it was so clearly in all of our interests to stamp out Covid-19 everywhere, the vaccines were hoarded. Here in Britain, we were getting third and fourth doses while many countries had still barely received any vaccines at all.
In response, several southern governments ramped up their own research, development and manufacturing capacity, preparing for the next time. Some of these factories now have spare capacity and could be helping us – as well as themselves – to deal with monkeypox.
To miss this opportunity to bring the situation under control would be unforgivable. Bavarian Nordic should openly share its knowledge and patents so we can expand vaccine production as quickly as possible worldwide. Bavarian Nordic will make a huge windfall, producing and selling as much as the company can manage. Its shareholders have already seen the price of their stock triple. The company must now share the knowledge, so others can benefit and we can all reap the rewards of more advanced medical science in the future.
This is particularly vital if we are to address the fact that many people in the world simply don’t matter in our profit-driven pharmaceutical model. Monkeypox has been endemic in a handful of African countries for years. Even though we had the medicines to deal with it, we didn’t do anything until an outbreak spread to the west. The monkeypox vaccine – like other medicines which could treat diseases primarily suffered in the poorest countries – isn’t even registered in those countries where the disease is endemic. The medicines, it seems, exist simply to protect us from those diseases. We can now see that that policy is as shortsighted as it is unethical.
How many more times must we approach public health emergencies with both hands tied behind our backs by this pharmaceutical monopoly model?
During the HIV crisis in the late 1980s, a previous generation of LGBT activists had to fight for their rights to decent healthcare in a deeply discriminatory society. As they won their own battle, receiving life-saving antiretroviral drugs, they realised that their own marginalisation was part of a much deeper inequality at a global level.
Today, as gay and bisexual men have to once again fight for our own right to decent healthcare, in a system which seems almost comically set up to fail us, we also need to look further. It’s time to join together with those in countries that experience this injustice on a permanent basis, to challenge pharmaceutical control, just as we did 30 years ago.
Nick Dearden is director of Global Justice Now