The World Health Organization (WHO) has issued a call to the manufacturers of mpox vaccines to combat monkeypox virus to submit Expressions of Interest (EOI) for Emergency Use Listing (EUL), as the situation surrounding the disease intensifies. The announcement, made by WHO Director-General Dr Tedros Adhanom Ghebreyesus last week, follows an outbreak that has extended beyond the Democratic Republic of the Congo (DRC). The outbreak, which originated in the DRC, has now spread internationally, with a new viral strain first identified in September 2023 appearing outside the country. This development highlights the need for immediate preventive measures, leading WHO to expedite the review process for mpox vaccines. The EUL procedure is designed for emergency situations, allowing for the swift review and recommendation of unlicensed medical products based on a risk-benefit assessment. This time-limited recommendation aims to ensure that vaccines are available quickly during public health emergencies, especially in regions affected by the outbreak. WHO’s call for EOIs is particularly relevant for lower-income countries that have not yet issued national regulatory approvals. The EUL process will enable organisations like Gavi and UNICEF to procure and distribute vaccines more efficiently, supporting global efforts against mpox. Mpox, caused by the monkeypox virus, is transmitted through direct contact with infected individuals, contaminated materials, or animals. Given the increasing concerns about its spread, prompt action is necessary to mitigate its impact. Currently, WHO’s Strategic Advisory Group of Experts on Immunisation (SAGE) has recommended two vaccines for mpox i.e. Jynneos (Imvamune/Imvanex) developed by Denmark’s Bavarian Nordic, and ACAM2000 from the U.S. firm Emergent BioSolutions. These vaccines have demonstrated efficacy in controlling the disease, and the EUL process will facilitate their broader distribution in affected areas. Relevance for India The development also holds significance for India as the country has reported around 27 cases of monkeypox since the disease was first detected in the country in mid-2022. Although the number of cases has been relatively low, the emergence of new viral strains and the risk of imported cases highlight the importance of preparedness. Indian health authorities have implemented measures such as surveillance, contact tracing, and public health advisories to manage the situation. Access to mpox vaccines through the EUL process would significantly strengthen India’s efforts to prevent potential outbreaks. According to doctors, new generation smallpox vaccines are effective against monkeypox because the monkeypox virus and the smallpox virus are closely related, both belonging to the Orthopoxvirus genus. As smallpox was eradicated from the India in 1977, the country ceased production of the smallpox vaccine in 1979. “Both smallpox and monkeypox viruses are genetically similar. The existing approved vaccines are new-generation smallpox vaccines recommended for people at high risk, such as close contacts and healthcare workers exposed to cases. The government can procure and use these vaccines as needed. While being prepared is important, the situation is not alarming enough to warrant stockpiling vaccines in India,” said vaccinology expert Dr Naveen Thacker, a member of the Covid-19 expert task force of doctors formulated by the government and President of the International Pediatric Association. “Indian companies have historically produced smallpox vaccines but no longer do so. If there is interest in business opportunities, companies may consider developing new-generation smallpox vaccines. The commercial viability of these vaccines for use in India remains uncertain at this stage, and pharmaceutical companies should evaluate this opportunity,” he said. From 1 January 2022 through 31 May 2024, a cumulative of 97,745 laboratory-confirmed cases of mpox, including 203 deaths, was reported to the WHO from 116 countries in all six WHO Regions. This includes significant outbreaks in various regions, with the highest case numbers in countries like the DRC and recent expansions into other areas due to new viral strains.