SCIENCE science.org 10 JUNE 2022 • VOL 376 ISSUE 6598 1143are the ones that are going to be used
[in the new outbreak] because they have
a much-enhanced safety profile,” says
Marion Gruber, who headed the U.S. Food
and Drug Administration’s vaccine office
until October 2021.
Canada and the United States have
already licensed MVA for use against
monkeypox and Bavarian Nordic is in
talks with the European Medicines Agency
( E M A ). “ I r e a l l y h o p e t h at i n a m att e r o f 1 o r
2 months from now, this can be approved”
in Europe, says EMA’s Marco Cavaleri.
The United Kingdom has been using
MVA “off-label” for a few years to vaccinate
contacts of imported monkeypox cases.
WHO’s Strategic Advisory Group of Experts
on Immunization is set to release guidance
in the next days that will back MVA, but it
will also recommend using earlier vaccines
in certain scenarios. Still,
Cavaleri says, “If [MVA] is
available, clearly that will
be the vaccine to start.”
Exactly how much is
available remains murky.
“Countries have been reluc-
tant over the past couple of
decades to share that infor-
mation in detail with WHO
but WHO is now reaching
out to all of them again,” Lewis says. The
United States, which supported develop-
ment of MVA, likely has the biggest supply.
A federal spokesperson says the Strategic
National Stockpile has 36,000 doses, that an-
other 36,000 doses will be delivered “in the
near future,” and that the company is storing
bulk material for millions more U.S.-reserved
doses. A Bavarian Nordic spokesperson says
many other countries had ordered its MVA
vaccine in the past weeks and the company
was trying to send smaller batches to coun-
tries “so they can start to vaccinate sooner
rather than later.”
How broadly to roll out MVA, or any vac-
cine, remains the key debate. Ring vaccina-
tion among MSM can be challenging given
the stigma faced by that group in many
cultures and the nature of the contacts. A
paper published last week in Eurosurveil-
lance noted that in the United Kingdom,
many of those infected reported sexual
contacts with people whose details they ei-
ther did not know or did not want to share.
The Canadian province of Quebec has
already extended vaccinations from direct
contacts of monkeypox cases to any men
who have had more than two male sexual
partners in the past 14 days. Another way
to tackle the problem, says Yale School
of Public Health epidemiologist Gregg
Gonsalves, “would be to offer it to indi-
viduals who have attended social events in
which close contact with someone infected
was possible, but this would increase the
numbers of those being recruited for vacci-
nation even further.” Germany is also likely
to offer the vaccine more broadly, though it
will not quickly have enough vaccine avail-
able for all MSM, says Leif Erik Sander,
an infectious disease expert at the Charité
University Hospital in Berlin.
Even where contacts of infected
cases were identified, uptake has been
low. The same U.K. study reported that
169 out of 245 health care workers who
had been offered MVA had taken it, but
only 15 out of 107 contacts in other groups.
“It’s very challenging to target high-risk
groups while balancing stigma and en-
couraging uptake of the vaccines,” says
Boghuma Titanji, a virologist at Emory
University. The politicization of vaccines
during COVID-19 has
increased the barriers,
she adds.
How well MVA really
protects humans from
monkeypox is uncertain.
The license for MVA in
Canada and the United
States is based on ani-
mal studies, where it was
shown to protect macaques
and prairie dogs, plus data in humans
showing a strong antibody response. A pair
of DRC studies vaccinated 1600 health care
workers with one of two MVA formulations
and found no monkeypox cases in each
2-year study period. But there were no con-
trol groups, and one vaccinated health care
worker did get monkeypox half a year later.
“The truth is, we don’t know the efficacy of
any of these monkeypox vaccines,” says Ira
Longini, a biostatistician at the University
of Florida who is advising WHO.
That is why WHO has urged countries
that deploy monkeypox vaccine to study
how well it works and how best to use it.
“If we want to contain these outbreaks and
learn something about the efficacy of these
vaccines, it’s going to have to be a con-
certed effort with protocols and organized
properly,” Longini says. One question is
whether a single dose of the vaccine, which
is normally given as two doses 4 weeks
apart, may suffice. That could encourage
more uptake and stretch supplies.
The question of vaccine equity looms
large, too. Titanji notes that the hopes for
MVA are based partly on the DRC data. “It’s
almost a moral obligation to make sure
that, if these vaccines are being utilized
elsewhere now, the people on whom the
data was generated, who have been deal-
ing with monkeypox for 50 years, should
have access to it as well.” jT
he small fishing settlement of Puerto
Edén is nestled on Wellington Island
in southern Chile, among a labyrinth
of islets and fjords at least a day’s
journey from the nearest city. But the
distance and Patagonian cold have
not discouraged generations of scientists
from making the trip. Puerto Edén is home
to some of the Kawésqar, descendants of no-
madic seafarers. Their culture, territory, the
remains of their ancestors, and their dying
language have all drawn academic interest.
But the goals of researchers and the com-
munity have sometimes been at odds, says
Ayelen Tonko Huenucoy, a Kawésqar physi-
cal anthropologist at the Chilean National
Museum of Natural History, who partly
grew up in Puerto Edén. “Several scien-
tists arrived in a totally conquerorlike way
... using us for their [own] goals,” such as
demanding genetic information from the
community, she says.
Now, the Kawésqar and other Indigenous
peoples in Chile hope to see their rights rec-
ognized for the first time in the country’s
new constitution, which Chileans will vote
on in a referendum in September. And other
efforts to balance the relationship between
Indigenous groups and scientists in Chile are
underway, including a collaborative work-
shop last week on ethics and genomics.
“We will no longer be the guinea pigs,”
says Elisa Loncón, a Mapuche linguist at the
University of Santiago and former president
of the constitutional convention. “And we
will not be a hindrance to knowledge either.”
The constitutional process began in 2019,
when massive protests against inequality
called for replacing the constitution enacted
during Augusto Pinochet’s dictatorship in- If approved, the new constitution
would make Chile “plurinational,” with at
least 11 Indigenous groups, representing
Chile’s
Indigenous
groups seek
fairer research
New constitution may help
reset relationship between
scientists and communities
RESEARCH ETHICSBy Emiliano Rodríguez Mega“The truth is, we don’t
know the efficacy
of any of these
monkeypox vaccines.”
Ira Longini,
University of Florida