What Role Can Routine Vaccination Play in Pandemic Prevention and Preparedness? An Economic Evaluation of Mpox Vaccination

Since 2022, mpox has triggered two public health emergencies of international concern, with sustained transmission across Africa and beyond. We conducted a modelling study to assess the cost-effectiveness of routine mpox vaccination in endemic African provinces as a strategy to reduce disease transmission and strengthen pandemic prevention and response. Although mpox imposes a substantially lower disease burden than malaria, tuberculosis, or diarrheal disease in the Democratic Republic of the Congo (DRC), routine mpox vaccination would still be health-positive for more than half of the DRC population (53.5 million people), including 23.2 million children. From a local health benefits perspective, routine vaccination of children aged 0–9 years may be cost-effective at $10 per dose compared with no vaccination in the two highest-burden provinces of the DRC. From a global healthcare payer perspective, routine vaccination of 8.5 million children aged 0–9 years in endemic regions of the DRC over a 10-year period—at an estimated cost of $203 million—could reduce the probability and size of mpox pandemics outside Africa—yielding an return on investment exceeding 3:1, even if the vaccine is used considerably past the point of local cost-effectiveness. However, under current budget constraints, additional donor financing would be required to realize these benefits for global pandemic prevention. We recommend: (1) expanding data on mpox vaccine efficacy and epidemiology; (2) advancing realistic financing strategies that account for trade-offs; (3) assessing routine vaccination for other high-risk pathogens; and (4) convening partners to assess the development of combination vaccines for mpox and other pathogens.