Publications

Introduction
The number of mpox cases has increased sharply in the WHO African Region in recent years. This upsurge has been fuelled in large part by increases in the Democratic Republic of the Congo (DRC). As of 30 August, the DRC had reported more than 27,000 suspected cases of mpox and over 1,300 mpox deaths since January 2023, linked to the more virulent clade I of the monkeypox virus (MPXV).

In 2023, a new variant of clade I MPXV was identified in the DRC’s South Kivu province, named clade Ib, demonstrating evidence of adaptation to humans due to sustained human-human transmission. In recent months, clade Ib mpox has spread to neighbouring countries, including Burundi, Central African Republic, Republic of the Congo, Kenya, Rwanda, and Uganda. In response, the World Health Organization (WHO) declared the outbreak a Public Health Emergency of International Concern (PHEIC) (1). This declaration obligates the coordinated mobilization of extraordinary resources by the international community for response to control and stop the current outbreak, including for vaccination.

As a component of the overall mpox response, vaccines are an important tool at our disposition to stop mpox transmission and end the current outbreak. Vaccines have not yet been used in the African region in mpox control efforts to date. The expanding outbreak and the ongoing difficulties controlling it using traditional public health measures highlight the clear role of vaccines as part of the comprehensive response. A strong, well-coordinated mpox vaccine rollout, built on the lessons learned from the COVID-19 and Ebola vaccine rollouts, among others, is essential.

Purpose
The Mpox Vaccination Preparation Roadmap is developed to support countries in planning mpox vaccine introduction and implementation. The Roadmap contains a series of recommended actions for countries to ensure mpox vaccines can be used safely, effectively, and efficiently once they are accessed. The Roadmap is designed to further support countries in preparing possible applications for mpox vaccine supply through multilateral mechanisms once they are finalized (e.g., a global stockpile managed by the International Coordinating Group on Vaccine Provision (ICG), the Access & Allocation Mechanism (AAM), etc.)

This Roadmap can be used both by countries with active mpox outbreaks preparing to use mpox vaccines as components of their emergency response and by countries not currently experiencing an outbreak but looking to ensure vaccine preparedness for a possible future one.

While all included recommended actions are important, those listed as ‘Very high priority’ & High priority’ are essential actions to initiate early in the preparation process. Countries are encouraged to review the recommended actions included in the Roadmap in light of their current national situation and identify and prioritize actions needing to be taken, as well as possible support needs.

To facilitate this process, this Roadmap is accompanied by an Mpox Vaccine Readiness Assessment Tool that can further be used by countries 1) to assess programme readiness to introduce mpox vaccines, 2) to identify gaps and areas where they may need support, and 3) to prioritize actions for enhanced readiness. The Tool translates the recommended actions of the Roadmap into both excel- and Kobo Toolbox-based formats.

Plans for updating
WHO will continue to monitor the situation closely for any changes that may affect this vaccination preparation roadmap. WHO will issue necessary updates as evidence becomes available and is reviewed.