As health experts race to control the ongoing mpox outbreak, a decades-old medical tool—bifurcated needles—may play a crucial role in accelerating vaccination efforts, according to global health organization PATH.
Since 2022, mpox cases, caused by the monkeypox virus (MPXV), have been on the rise, particularly in the Democratic Republic of the Congo, with infections spreading to neighboring countries and reaching Asia and Europe. The World Health Organization (WHO) declared the outbreak a public health emergency of international concern last month, signaling the growing global threat posed by a new, potentially more transmissible strain of the virus.
In response, PATH, a global health nonprofit, is investigating whether bifurcated needles—used successfully in the eradication of smallpox—could once again be pivotal in controlling the spread of a virus. Courtney Jarrahian, Global Program Leader for Medical Devices and Health Technologies at PATH, sheds light on this critical tool and its potential impact.
What Are Bifurcated Needles?
Unlike the typical needle and syringe used for intradermal, subcutaneous, or intramuscular injections, bifurcated needles have two prongs that hold a small droplet of vaccine. These prongs penetrate the topmost layer of skin, delivering a minute amount of vaccine—less than one microliter, a fraction of a standard intradermal injection.
Historically, bifurcated needles played a significant role in WHO’s smallpox eradication campaigns, offering a low-cost and efficient method of administering vaccines. The smallpox vaccine, which replicates effectively when applied to the skin’s surface, only required a tiny dose to provoke a sufficient immune response. This approach was instrumental in the global elimination of smallpox.
How Can These Needles Aid in Mpox Vaccination?
Smallpox and mpox belong to the same virus family, and vaccines developed for smallpox provide cross-protection against MPXV. This opens the door for existing stockpiles of smallpox vaccines to be repurposed for mpox outbreaks. However, since the eradication of smallpox, both the vaccines and the bifurcated needles used in the global immunization effort have largely been phased out.
To effectively leverage the smallpox vaccine for mpox, ensuring a sufficient supply of bifurcated needles and training healthcare workers on their use is vital. The COVID-19 pandemic underscored the importance of aligning vaccine availability with the correct delivery devices—a lesson that applies to the mpox outbreak as well. Different vaccines may require specialized equipment for administration, further complicating logistical efforts.
For instance, COVID-19 vaccines often required new syringe sizes due to different dose volumes, prompting rapid development and global distribution of these devices. Similarly, mpox vaccines are delivered either via traditional subcutaneous or intradermal injections with a needle and syringe or by using bifurcated needles, depending on the formulation.
PATH’s Role in Supporting Mpox Vaccination Logistics
PATH is partnering with UNICEF to provide technical assistance for the procurement of bifurcated needles, conducting tests to ensure these devices meet the specifications needed for mpox vaccine delivery. Testing in PATH’s Product Engineering Development Laboratory will confirm that bifurcated needles from current suppliers are capable of delivering the appropriate dose of vaccine.
However, this effort represents just one aspect of the broader challenges facing mpox vaccination campaigns. Significant gaps remain, particularly in training healthcare workers who may be unfamiliar with bifurcated needles, as most were born after the last natural smallpox case was reported in 1977.
Comprehensive planning will be essential to ensure the success of immunization campaigns, encompassing logistics, training, needle safety, and clear communication with communities.
PATH’s Expertise in Immunization Efforts
PATH brings extensive experience to this mission, having worked with global partners during the COVID-19 pandemic to provide technical support and market analysis for immunization syringes. This knowledge is now being applied to ensure that the necessary devices are available for mpox vaccination efforts.
Additionally, PATH has a long history of evaluating alternative devices for intradermal vaccine delivery, assessing their safety, efficacy, usability, and cost-effectiveness. This expertise positions PATH to contribute meaningfully to ongoing mpox vaccine research and implementation.
As the world grapples with the resurgence of mpox, tools like bifurcated needles may prove essential in protecting vulnerable populations and controlling the spread of the virus.
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