Editing Smallpox vaccine (section)

== Stockpiles ==
Since smallpox has been eradicated, the public is not routinely vaccinated against the disease. The World Health Organization maintained a stockpile of 200{{nbsp}}million doses in 1980, to guard against reemergence of the disease, but 99% of the stockpile was destroyed in the late 1980s when smallpox failed to return.<ref name="who2017_stockpile"/> After the [[September 11 attacks]] in 2001, many governments began building up vaccine stockpiles again for fear of bioterrorism. Several companies sold off their stockpiles of vaccines manufactured in the 1970s, and production of smallpox vaccines resumed.<ref name="spiegel20030126"/> Aventis Pasteur discovered a stockpile from the 1950s and donated it to the US government.<ref>{{cite news | vauthors = Lueck S |title=Aventis to Donate Smallpox Vaccine To the U.S. Government's Stockpile |url=https://www.wsj.com/articles/SB1017428453582730240 |work=[[The Wall Street Journal]] |date=1 April 2002 |access-date=4 July 2022 |archive-date=12 January 2018 |archive-url=https://web.archive.org/web/20180112192526/https://www.wsj.com/articles/SB1017428453582730240 |url-status=live }}</ref>

Stockpiles of newer vaccines must be repurchased periodically since they carry expiration dates. The United States had received 269 million doses of ACAM2000 and 28 million doses of MVA-BN by 2019,<ref>{{cite press release |title=Emergent BioSolutions Awarded 10-Year HHS Contract to Deliver ACAM2000, (Smallpox (Vaccinia) Vaccine, Live) Into the Strategic |url=https://www.bloomberg.com/press-releases/2019-09-03/emergent-biosolutions-awarded-10-year-hhs-contract-to-deliver-acam2000-smallpox-vaccinia-vaccine-live-into-the-strategic |author1=Emergent BioSolutions |date=3 September 2019 |access-date=4 July 2022 |archive-date=7 November 2023 |archive-url=https://web.archive.org/web/20231107171643/https://www.bloomberg.com/press-releases/2019-09-03/emergent-biosolutions-awarded-10-year-hhs-contract-to-deliver-acam2000-smallpox-vaccinia-vaccine-live-into-the-strategic |url-status=live }}</ref><ref>{{cite press release |author1=Bavarian Nordic |title=Bavarian Nordic Announces U.S. FDA Approval of Jynneos (Smallpox and Monkeypox Vaccine, Live, Non-Replicating) for Prevention of Smallpox and Monkeypox Disease in Adults |url=https://www.bavarian-nordic.com/investor/news/news.aspx?news=5758 |access-date=4 July 2022 |archive-date=28 June 2022 |archive-url=https://web.archive.org/web/20220628171758/https://www.bavarian-nordic.com/investor/news/news.aspx?news=5758 |url-status=live }}</ref> but only 100 million doses of ACAM2000 and 65,000 doses of MVA-BN were still available from the stockpile at the start of the [[2022–2023 mpox outbreak]].<ref name="hhs20220701">{{cite press release |author1=U.S. Department of Health and Human Services |title=HHS Orders 2.5 Million More Doses of JYNNEOS Vaccine For Monkeypox Preparedness |url=https://www.hhs.gov/about/news/2022/07/01/hhs-orders-2-point-5-million-more-doses-jynneos-vaccine-for-monkeypox-preparedness.html |date=1 July 2022 |access-date=4 July 2022 |archive-date=4 July 2022 |archive-url=https://web.archive.org/web/20220704005859/https://www.hhs.gov/about/news/2022/07/01/hhs-orders-2-point-5-million-more-doses-jynneos-vaccine-for-monkeypox-preparedness.html |url-status=live }}</ref> First-generation vaccines have no specified expiration date and remain viable indefinitely in deep freeze. The U.S. stockpile of WetVax was manufactured in 1956–1957 and maintained since then at {{convert|-4|°F}},<ref>{{cite journal | vauthors = Petersen BW, Damon IK, Pertowski CA, Meaney-Delman D, Guarnizo JT, Beigi RH, Edwards KM, Fisher MC, Frey SE, Lynfield R, Willoughby RE | title = Clinical guidance for smallpox vaccine use in a postevent vaccination program | journal = MMWR. Recommendations and Reports | date = February 2015 | volume = 64 | issue = RR-2 | pages = 1–26 | url = <!-- Official URL --> https://www.cdc.gov/mmwr/pdf/rr/rr6402.pdf | pmid = 25695372 | access-date = 11 August 2022 | archive-date = 19 January 2022 | archive-url = https://web.archive.org/web/20220119040039/http://www.cdc.gov/mmwr/pdf/rr/rr6402.pdf | url-status = live }}</ref> and it was still effective when tested in 2004.<ref name="talbot2004">{{cite journal | vauthors = Talbot TR, Stapleton JT, Brady RC, Winokur PL, Bernstein DI, Germanson T, Yoder SM, Rock MT, Crowe JE, Edwards KM |title=Vaccination success rate and reaction profile with diluted and undiluted smallpox vaccine: a randomized controlled trial |journal=JAMA |date=September 2004 |volume=292 |issue=10 |pages=1205–12 |doi=10.1001/jama.292.10.1205 |pmid=15353533 }}</ref> Replicating vaccines also remain effective even at 1:10 dilution, so a limited number of doses can be stretched to cover a much larger population.<ref name="talbot2004"/>

{| class="wikitable"
|+ Smallpox vaccine stockpiles
|-
! Country, region, or organization !! Year !! Doses (millions) !! Composition (generation)
|-
| {{flag|World Health Organization}} (Geneva) || 2013 || 2.7 ||
* 300,000 ACAM2000 (2nd)
* 2.4 million various (1st)
|-
| {{flag|World Health Organization}}<br />(pledged) || 2018 || 27 || Various (1st, 2nd, 3rd)<ref>{{cite web | vauthors = Costa A |title= Smallpox vaccine stockpile |url= http://terrance.who.int/mediacentre/data/sage/SAGE_Docs_Ppt_Nov2013/8_session_smallpox/Nov2013_session8_Presentation1_smallpox_vaccine_emergency_stockpile.pdf |publisher=[[World Health Organization]] (WHO) |date=5-7 November 2013 |access-date=4 July 2022 |archive-date=4 July 2022 |archive-url=https://web.archive.org/web/20220704202756/http://terrance.who.int/mediacentre/data/sage/SAGE_Docs_Ppt_Nov2013/8_session_smallpox/Nov2013_session8_Presentation1_smallpox_vaccine_emergency_stockpile.pdf |url-status=live }}</ref><ref>{{cite web |title=Smallpox eradication: destruction of variola virus stocks |url=https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_28-en.pdf |date=4 April 2019 |access-date=4 July 2022 |archive-date=16 May 2022 |archive-url=https://web.archive.org/web/20220516015609/https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_28-en.pdf |url-status=live }}</ref>
|-
| {{flag|France}} || 2006 || 55 || 55 million Pourquier (1st)<ref>{{cite web |title=Plan national de réponse à une menace de variole |url=https://solidarites-sante.gouv.fr/IMG/pdf/plan_variole_2006-2.pdf |publisher=Ministère de la Santé et des Solidarités (France) |date=August 2006 |access-date=4 July 2022 |archive-date=19 May 2022 |archive-url=https://web.archive.org/web/20220519223556/https://solidarites-sante.gouv.fr/IMG/pdf/plan_variole_2006-2.pdf |url-status=live }}</ref>
|-
| {{flag|Germany}} || 2022 || 100 ||
* MVA-BN (3rd)<ref name="spiegel20030126"/>
* 30+ million Lister/Elstree-BN (2nd)<ref name="spiegel20030126"/>
* 24 million various (1st)<ref name="spiegel20030126">{{cite news | vauthors = Kneip A |title=Pocken-Fieber |url=https://www.spiegel.de/panorama/pocken-fieber-a-91bca2ca-0002-0001-0000-000026218476 |work=Der Spiegel |date=26 January 2003 |language=de |access-date=4 July 2022 |archive-date=4 July 2022 |archive-url=https://web.archive.org/web/20220704005900/https://www.spiegel.de/panorama/pocken-fieber-a-91bca2ca-0002-0001-0000-000026218476 |url-status=live }}</ref>
|-
|{{Flag|Italy}}
|2022
|5<ref>{{cite web|url=https://www.adnkronos.com/vaiolo-delle-scimmie-abbiamo-5-milioni-dosi-di-vaccino-pronti-se-servira_3Xf2lbmIZJ1H4LXAfvoX6T|title=Vaiolo delle scimmie, 'abbiamo 5 milioni dosi di vaccino: pronti se servirà'|publisher=adnkronos|date=27 May 2022|access-date=14 July 2022|language=Italian|archive-date=14 July 2022|archive-url=https://web.archive.org/web/20220714041652/https://www.adnkronos.com/vaiolo-delle-scimmie-abbiamo-5-milioni-dosi-di-vaccino-pronti-se-servira_3Xf2lbmIZJ1H4LXAfvoX6T|url-status=live}}</ref>
|
|-
| {{flag|Japan}} || 2006 || 56 || LC16m8 (3rd)<ref name="kenner2006"/>
|-
| {{flag|Netherlands}} || 2017 || ?|| Lister/Elstree-RIVM (2nd)<ref name="Fenner_1988"/>{{rp|588–589}}
|-
| {{flag|South Korea}} || 2022 || 35|| Lancy-Vaxina (1st)<ref>{{cite web |url=https://n.news.naver.com/mnews/article/003/0011202227?sid=102 |title=15개국 퍼진 원숭이 두창, 불안 확산...백신·치료제는? |author=Jihyun Kim |date=23 May 2022 |access-date=23 May 2022 |newspaper=Newsis |location=Seoul |archive-date=23 May 2022 |archive-url=https://web.archive.org/web/20220523034625/https://n.news.naver.com/mnews/article/003/0011202227?sid=102 |url-status=live }}</ref><ref>{{cite journal | vauthors = Oh MD, Lee JK | title = Milestones in history of adult vaccination in Korea | journal = Clinical and Experimental Vaccine Research | volume = 1 | issue = 1 | pages = 9–17 | date = July 2012 | pmid = 23596574 | pmc = 3623517 | doi = 10.7774/cevr.2012.1.1.9 }}</ref>
|-
| {{flag|United States}} || 2022 || 185 ||
* 65,000 MVA-BN (3rd)<ref name="hhs20220701"/>
* 100 million ACAM2000 (2nd)<ref name="hhs20220701"/>
* 85 million WetVax (1st)<ref name="talbot2004"/>
|}