Equitable Global Allocation of Monkeypox Vaccines

16 Pages Posted: 15 Mar 2023

See all articles by G.O Schaefer

G.O Schaefer

National University of Singapore (NUS)

Ezekiel J. Emanuel

University of Pennsylvania

Caesar A. Atuire

University of Oxford

RJ Leland

University of Manitoba

Govind Persad

University of Denver Sturm College of Law

Henry Richardson

Georgetown University

Carla Saenz

Pan American Health Organization


With the world grappling with continued spread of monkeypox internationally, vaccines play a crucial role in mitigating the harms from infection and preventing spread. However, countries with the greatest need – particularly historically endemic countries with the highest monkeypox case-fatality rates – are not able to acquire scarce vaccines. This is unjust, and requires rectification through equitable allocation of vaccines globally. We propose applying the Fair Priority Model for such allocation, which emphasizes three key principles: 1) preventing harm; 2) prioritizing the disadvantaged; and 3) treating people with equal moral concern. Post-exposure prophylaxis (PEPV) has the most potential to mitigate harm, and so ensuring countries have sufficient supply for PEPV should be the first priority. And historically endemic countries, which face disadvantages that compound potential harms from monkeypox, should be the first recipients of such vaccines. Once sufficient supply is allocated for countries to apply PEPV, global allocation could move on to pre-exposure prophylaxis (PrEP), again prioritizing historically endemic countries first before distribution to the rest of the global community, based on projected number of cases and vulnerability to harm.

Additional Conflicts of Interest: EE reports personal fees from United Health Group, personal fees from BC/BS Dana Point, CA, personal fees from CBI/Informa, personal fees from Rise Health, personal fees from Galien Foundation, personal fees from WellSky, personal fees from Rightway, personal fees from Signature Healthcare Foundation, personal fees from Healthcare Leaders of New York, personal fees from Medimpact, personal fees from Massachusetts Association of Health Plans, personal fees from Princeton University, personal fees from Philadelphia Committee on Foreign Relations, personal fees from Yale University, personal fees from Hartford Medical Society, personal fees from American Association of Health Colleges (AAHC), personal fees from Hawaii Medical Services Association, personal fees from Advocate Aurora Health, travel fees from Macalester College, travel fees from DPharm conference, travel fees from UCSF Department of Urology, Travel fees from Oak CEO Summit, travel fees from Peterson Foundation, grants from Laura and John Arnold Foundation, grants from Humana, grants from Signify Health , grants from Hawaii Medical Services Association, grants from University of Miami, grants from Freeman Foundation, grants from Patient Centered Outcome Research Institute, other from Biden/Harris Transition COVID-19 Committee, other from WHO COVID-19 Ethics & Governance WG, other from HIEx Health Innovation Exchange Partnership, other from World Health Organization, outside the submitted work; and Dr. Emanuel was an unpaid board member at Village MD (end 2021) and since 2022 serves as an External Advisory Board Member of Village MD. He was an unpaid board member at Oncology Analytics (end 2022), an unpaid board of advisors member at Cellares, a member of the unpaid board of advisors for Notable, a member of the unpaid board of advisors for HIEx Health Innovation Exchange partnership sponsored by UN. He is an advisory board member for Peterson Center on Healthcare and an Advisory Board member of JSL Health Fund. He is a venture partner at Oak HC/FT. He is an Advisor to Clarify Health. He was a partner at Embedded Healthcare (ended 6/2022) and at COVID-19 Recovery LLC (ended 3/2021). All other authors have no declarations.

Funding Information: There is no funding.

Declaration of Interests: GP reports grants from Greenwall Foundation and personal fees from the American Society of Clinical Oncology Post and WHO, outside the submitted work. Please see PDF for additional Conflicts of Interest.

Keywords: Monkeypox vaccines, Monkeypox, fair priority model, Global Health, vaccine allocation, PEPV, PrEP

Suggested Citation

Schaefer, G.O and Emanuel, Ezekiel J. and Atuire, Caesar A. and Leland, RJ and Persad, Govind and Richardson, Henry and Saenz, Carla, Equitable Global Allocation of Monkeypox Vaccines. Available at SSRN: https://ssrn.com/abstract=4370249 or http://dx.doi.org/10.2139/ssrn.4370249

G.O Schaefer

National University of Singapore (NUS) ( email )

1E Kent Ridge Road
NUHS Tower Block Level 7
Singapore, 119228

Ezekiel J. Emanuel (Contact Author)

University of Pennsylvania ( email )

Caesar A. Atuire

University of Oxford ( email )

Mansfield Road
Oxford, OX1 4AU
United Kingdom

RJ Leland

University of Manitoba ( email )

Govind Persad

University of Denver Sturm College of Law ( email )

2255 E. Evans Avenue
Denver, CO 80208
United States

Henry Richardson

Georgetown University ( email )

Carla Saenz

Pan American Health Organization ( email )

Washington, DC
United States

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