Rich countries have several hundred million doses of vaccines that could help fight an mpox outbreak in Africa, where donated shots fall far short of what is needed, according to a Reuters tally of public statements, documents and estimates from non-governmental organizations.

The shots have been stockpiled for years by countries such as Japan, the United States and Canada in case smallpox, an eradicated disease that is the more dangerous cousin of mpox, ever makes a comeback. Some of the vaccines were used outside of Africa in 2022 when mpox spread globally.

A small fraction of those doses could help curb what is now the worst mpox outbreak on record in the Democratic Republic of Congo and neighboring countries, disease experts say.

Less than 4 million doses have been pledged for donation out of an estimated 18 million to 22 million that are needed to vaccinate 10 million people in the next six months, depending on the vaccine, Africa’s Centers for Disease Control and Prevention said in a statement.

“It’s not a technical question, it’s a political one,” Maria Van Kerkhove, acting head of pandemic and epidemic prevention at the World Health Organization, told Reuters. She is lobbying for more donations alongside Africa’s CDC and other health authorities.

“Vaccines are useless on shelves,” Van Kerkhove said. “Why wouldn’t we get them to the people who need them right now?”

The current outbreak began in early 2023 in Congo, which accounts for most of the 37,500 infections and 1,451 deaths. It has spread to 14 African countries, according to Africa’s CDC. A first inoculation campaign using 265,000 donated shots is due to begin in Congo in early October.

“If we’d had more doses earlier, we could have planned a large-scale campaign and reduced transmission,” said Cris Kacita, head of Congo’s mpox response.

Health officials are concerned about a new strain, known as clade Ib, which was first identified in Congo and appears to spread more easily by close contact. Children are particularly vulnerable to mpox, as well as people with immune system conditions like HIV. The risk outside of Africa appears low at this time.

Other factors have held back the mpox response, including slow regulatory procedures at WHO and in Congo, high vaccine prices and competing health crises exacerbated by conflict in the country.

Mpox shots alone are not a magic bullet and affected countries also need access to testing and awareness-raising to tackle outbreaks effectively, disease experts say.

But the stark divide on vaccine access shows governments are still not prepared to stamp out viral threats where they begin and before they spread.

“The disinterest in mpox and other viral threats where they emerge is a significant danger to people the world over,” said Peter Maybarduk, access to medicines director at the US consumer group Public Citizen.

Where are the doses?

Three vaccines recommended by the WHO are held in stockpiles worldwide: Bavarian Nordic’s Jynneos (Imvanex or Imvamune outside the United States); KM Biologics’ LC16; and Emergent BioSolutions’ ACAM2000.

They are all being considered for purchase and donation in Africa, said a spokesperson for Gavi, the Vaccine Alliance, a global group that helps lower-income countries buy vaccines. The group has up to $500 million available for the mpox response.

Many wealthy countries declined to say how much vaccine they have, citing national security reasons.

Japan has around 200 million doses of LC16, according to a WHO document from 2022. Unlike rival shots, LC16 can be used for children, although it is not available outside of Japan and requires special needles to administer.

“Children are the main victims of this epidemic. The first emergency is not really being treated,” Kacita said, adding that Congo is in discussions for up to 3.5 million LC16 doses from Japan.

A Japanese health official and KM Biologics declined to comment.

Canada may have up to 2 million doses from Bavarian Nordic in its stockpile, said Adam Houston, medical policy and advocacy adviser for Medecins Sans Frontieres Canada, based on previous years’ announcements from the company. This shot was used to curb the 2022 mpox outbreak outside of Africa. This week, the Canadian government said it would donate up to 200,000 doses.

US officials declined to disclose how much vaccine is in its stockpile, but two senior Biden administration officials said it is enough to protect its population.

That includes around 100 million doses of Emergent’s vaccine, according to Maybarduk, as well as an unspecified number of Jynneos shots, which experts say have fewer side effects. The US has donated 60,000 Jynneos doses to the current outbreak.

Spain is among the largest confirmed donors, pledging in August 20 percent of its mpox vaccine stockpile, or 500,000 doses. The country has urged all European Union member states do the same.

The European Commission has a joint procurement contract with Bavarian Nordic to buy vaccines for donations, and has sent 215,000 doses to Congo.

“Some of the vaccines could cost around $150 for a person to be fully vaccinated, a price that is unaffordable to most African countries,” a spokesperson for the Africa CDC team in DRC said. “So donated vaccines from countries is all the more important.”