Should we all be vaccinated against monkeypox?

On August 4, 111 cases of monkeypox had been confirmed in Sweden.

The rising number infected by the virus apkoppor has caused the Swedish health authorities to increase preparedness.

Now more and more Swedish regions are offering vaccinations to people who have had close contact with infected people, and others in the risk group, i.e. men who have sex with men.

Illustrated Science has therefore asked a professor of global health at Aarhus University, Christian Morberg Wejse, if we are facing a new mass vaccination of the entire population.

READ ALSO: Chief Medical Officer: Therefore, monkeypox may have become more contagious

Economics and mortality are included in the decision whether you should be vaccinated

When researchers and doctors have to assess whether a vaccination should be included in the fixed vaccination program in a country, several circumstances come into play.

Christian Morberg Wejse has participated in the assessment of whether a vaccine against the so-called rotavirus should be included in the fixed vaccination program for children in Denmark.

Christian Morberg Wejse says that researchers would assess the pros and cons of vaccinating against monkeypox based on the same criteria they used when they assessed the so-called rotavirus 29012.

“Although it was economically justifiable to vaccinate against the rotavirus, it still did not end up on the vaccination programme. This was because the virus gives rise to a relatively mild course of disease with very low mortality – and monkeypox has much the same background.”

Monkeypox has a low mortality rate

On July 20, it had been registered five deaths from monkeypox out of more than 14,000 cases globally. This gives a mortality of 0.4 percent.

It can be compared to one of the world’s most dangerous viruses, the Marburg virus, which has a mortality of 50 percent.

In addition to investigating how contagious, deadly and financially costly the disease is, researchers also look at what side effects the vaccine has and how expensive it is to administer.

“It is these circumstances that we take into account for every disease for which there is an effective vaccine. Some work by using the vaccine widely on the entire population – as we did during the coronavirus – and others do not, as we have seen in connection with, among other things, hepatitis and pneumonia in recent years.”

Monkey pox is half as contagious as covid-19

The so-called basal reproduction number (R0) for monkeypox is 1-2, which means that a person with monkeypox will pass the disease on to one or two people.

It can be compared to the delta variant of covid-19 which had a reproduction number of five, while the omicron variant, which then took over the world, has been assessed to be three to four times as infectious as the delta variant.

Despite the relatively low reproduction rate, countries such as Sweden have started vaccinating against monkeypox, which is particularly contagious during sex.

Professor: At the moment we don’t need to vaccinate everyone

Despite the fact that monkeypox causes a rather mild course of the disease, the Swedish authorities have decided to offer the vaccine to everyone who is part of the risk group “men who have sex with men without barrier means (such as a condom)”.

According to Christian Morberg Wejse, this is mainly due to three circumstances.

“Most cases of infection more within that particular group, so it is probably most effective to focus vaccination there.”

“Also, the vaccine has already been used in Nigeria, where some oil workers have been vaccinated against monkeypox. It turned out to be quite effective, around 85 percent, so we know the vaccine works.”

“In addition, we already have a fairly strong prevention program for the group of men who have sex with many men, because the risk of contracting other sexually transmitted diseases, such as HIV, is also high.”

Although the majority of the Swedish population is now offered vaccination, according to Christian Morberg Wejse, we are not yet close to everyone needing to be vaccinated.

“A disease like hepatitis B is slightly higher on the list of diseases to be vaccinated against than monkeypox.”

Monkeypox almost never mutates

The disease’s ability to mutate is another factor that comes into play when health authorities around the world have to decide whether a disease is so dangerous that everyone should be vaccinated.

“However, there is no indication that monkeypox has changed to any significant degree since the first outbreaks in 1970. It may be a couple of small changesbut not something that has drastically changed the virus,” says Christian Morberg Wejse, explaining that the entire current outbreak probably comes from a single traveller, who has been to West Africa.

“The biggest factor for the spread now is that the virus – which is highly transmitted through sex – has been introduced to a new group of people, who are sexually active. Therefore, it is most logical to focus on that group.”

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