• Jesse Knight, TanDarrell H SDHSMAP Centre for Urban Health Solutions (Knight, Tan, Mishra), Unity Health Toronto; Institute of Medical Science (Knight, Tan, Mishra), Institute of Health Policy, Management, and Evaluation (Tan, Mishra), and Division of Infectious Diseas, and Sharmistha Mishra.
• MAP Centre for Urban Health Solutions (Knight, Tan, Mishra), Unity Health Toronto; Institute of Medical Science (Knight, Tan, Mishra), Institute of Health Policy, Management, and Evaluation (Tan, Mishra), and Division of Infectious Diseases (Tan, Mishra), Department of Medicine, University of Toronto, Toronto, Ont. jesse.knight@mail.utoronto.ca.
• CMAJ. 2022 Nov 28; 194 (46): E1560E1567E1560-E1567.

BackgroundThe current global monkeypox virus (MPXV) outbreak has disproportionately affected gay, bisexual and other men who have sex with men (GBMSM). Given that many jurisdictions have been faced with limited supplies of MPXV vaccine, we aimed to explore optimal vaccine allocation between 2 linked GBMSM transmission networks over a short-term time horizon, across several epidemic conditions.MethodsWe constructed a deterministic compartmental MPXV transmission model. We parameterized the model to reflect 2 representative, partially connected GBMSM sexual networks ( cities), using 2022 data from Ontario. We simulated a roll-out of 5000 vaccine doses over 30 days that started 45 days after epidemic seeding with 10 imported cases. Within this model, we varied the relative city (network) sizes, epidemic potentials (R 0), between-city mixing and distribution of seed cases between cities. For each combination of varied factors, we identified the allocation of doses between cities that maximized infections averted by day 90.ResultsUnder our modelling assumptions, we found that a limited MPXV vaccine supply could generally avert more early infections when prioritized to networks that were larger, had more initial infections or had greater R 0. Greater between-city mixing decreased the influence of initial seed cases and increased the influence of city R 0 on optimal allocation. Under mixed conditions (e.g., fewer seed cases but greater R 0), optimal allocation required doses shared between cities.InterpretationIn the context of the current global MPXV outbreak, we showed that prioritization of a limited supply of vaccines based on network-level factors can help maximize infections averted during an emerging epidemic. Such prioritization should be grounded in an understanding of context-specific risk drivers and should acknowledge potential connectedness of multiple transmission networks.© 2022 CMA Impact Inc. or its licensors.

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