The unusual cases of monkeypox in Western countries are causing déjà vu for many people: Does the population need more vaccination protection, as with Corona?

To this day, the scar on the upper arm of many adults bears witness to this: In 1967, the World Health Organization (WHO) launched a worldwide vaccination campaign against smallpox, during which billions were vaccinated.

It was the beginning of the end of the disease. It had raged for thousands of years before. Smallpox-like rashes have even been found on Egyptian mummies. According to the US disease control agency CDC, three out of ten infected people died. As early as 1980, the WHO declared the eradication of smallpox worldwide.

Since the end of smallpox vaccinations – the obligation to vaccinate for the first time was lifted in Germany in 1976 and in East Germany in 1982 – fewer and fewer people are immune to the variola virus that causes smallpox. With the currently unusual accumulation of cases of monkeypox in western countries due to a related pathogen, the question of renewed vaccinations arises. There are no approved vaccines specifically against monkeypox in Europe. However, experts assume that conventional smallpox vaccines offer some protection.

Especially after the attack on the World Trade Center in the USA, many countries stocked up on smallpox vaccines for fear of bioterrorism. Real human pox viruses capable of replication are stored in the USA and Russia, as the virologist Norbert Nowotny from the Institute of Virology at the University of Veterinary Medicine in Vienna said. “In retrospect, however, it must be said that the fears of bioterrorism after 2001 were irrational. After all, using smallpox as a weapon would be completely uncontrollable.”

Old smallpox vaccine not suitable

The federal government has stored about 100 million doses of smallpox vaccine, according to a report for the Bundestag health committee. However, due to the expected side effects, this vaccine is not suitable for use against monkeypox, said Federal Health Minister Karl Lauterbach. “The older smallpox vaccine has many side effects, and it also contains reproductive viruses that could spread in the body of immunocompromised people,” said Stefan Kaufmann, director emeritus at the Max Planck Institute for Infection Biology in Berlin.

There is also a newer smallpox vaccine that is based on a further development by the microbiologist Anton Mayr in Bavaria in the 1960s. A vaccination virus weakened in the laboratory is used to generate an immune response against smallpox, said the Viennese specialist in vaccination and travel medicine Herwig Kollaritsch. Experts speak briefly of MVA vaccination (MVA: Modified Vaccinia Virus Ankara).

“This vaccine was used for a time in the 1960s, but never on a large scale. It is better tolerated, the virus can no longer reproduce, »said Kollaritsch, who is a member of the Austrian counterpart to the Standing Vaccination Commission (Stiko).

Lauterbach announces order of the vaccine

The MVA vaccine that has been approved in the EU for adults against smallpox since 2013 is called Imvanex and comes from the German-Danish company Bavarian Nordic. It is already approved for monkeypox in the United States. The WHO recently pointed out that it is not universally available. British health authorities recently gave more than 1,000 doses of it to contacts of people infected with monkeypox.

Germany is also making provisions for the event that such so-called ring vaccinations should become necessary in the event of contact with the sick: Lauterbach announced the prophylactic order of up to 40,000 doses of Imvanex. There are no concrete plans to use this as yet. “We could use this vaccine immediately if it became necessary,” said Lauterbach.

Monkeypox is more harmless than smallpox

At best, Kollaritsch sees the newer vaccine as a tool to vaccinate people who are at high risk of being exposed to the pathogen, such as staff in special isolation wards. “For the general public, this vaccination would be nonsense. Monkeypox is much more harmless than smallpox and of much lesser importance in terms of epidemiological infection. We also have to keep in mind that very good therapy is available for infected people.”

The causative agent of monkeypox is a DNA virus, said the virologist Nowotny. That means it is much slower than Sars-CoV-2 and hardly mutates. Variants will therefore not be seen so quickly.

The Robert Koch Institute (RKI) stated that, according to current knowledge, close contact is required for pathogen transmission, “so it can currently be assumed that the outbreak will remain limited”. Isolation or quarantine is recommended for infected people and their close contacts. From an expert perspective, contacts of infected people must be followed up precisely. But that can be challenging: According to the RKI, the incubation period is 5 to 21 days. According to the RKI, people with several sexual partners have a higher risk of infection than others. Especially with them, however, anonymous contacts may also play a role.