Nipah vaccine and monoclonal antibody introduction: Understanding endemic and at-risk country perspectives to inform demand forecasting

BackgroundNipah virus (NiV) is a zoonotic pathogen in the Henipavirus genus that causes severe, often fatal disease in humans. The World Health Organization and the Coalition for Epidemic Preparedness Innovations (CEPI) have designated NiV as a priority pathogen with pandemic potential. While CEPI is funding research on medical countermeasures, including vaccines and monoclonal antibodies (mAbs), there remains limited understanding of how at-risk countries will use them. This study aims to address this gap through targeted interviews and demand forecasting for 10 countries: Australia, Bangladesh, Cambodia, India, Indonesia, Malaysia, the Philippines, Singapore, Thailand, and Vietnam. Methodology/Principal FindingsInterviews with country and global stakeholders gathered data on regional sentiment, financing, and affordability. Profiles were developed to summarize each countrys perceived outbreak risk and their likely use of countermeasures. Demand was estimated by integrating these perspectives into models of likely country-level responses to three NiV outbreak scenarios: Expected, Amplified, and Extended. In the Expected scenario, countries focused on reactive use with global annual demand ranging from approximately 800 to 5,000 doses for vaccine-only, mAb-only, and combination interventions. Ring strategies were preferred given outbreak size and infrequency. Demand was highest for vaccine-only and combination interventions, with lower demand for mAbs-only due to affordability concerns and less familiarity in Bangladesh and India. In Amplified and Extended scenarios, countries expanded their responses to include preventive campaigns for healthcare workers and rural populations. These campaigns would require approximately 410,000 and 6,300,000 doses, respectively, if introduced in all 10 countries. Conclusions/SignificanceThis study has revealed existing sentiments regarding Nipah disease and interventions and modeled demand across three outbreak scenarios. Given global annual demand based on current epidemiology, Nipah countermeasure markets are unlikely to be commercially viable solely on routine country-financed demand. Instead, market health will require external financing and stockpile mechanisms to maintain demand between sporadic outbreaks. Author SummaryNipah virus (NiV), which causes severe and often fatal disease in humans, is recognized by the Coalition for Epidemic Preparedness Innovations (CEPI) as a priority pathogen with pandemic potential. In response, CEPI has supported the development of vaccines and monoclonal antibodies (mAb). However, limited evidence exists on how at-risk countries will deploy these medical countermeasures. We interviewed key decision-makers across 10 at-risk countries, along with global experts on NiV, to better understand disease prioritization, financing and affordability considerations, and countermeasure preferences. Interview findings informed the development of a demand forecast in response to Nipah outbreaks of varying intensity. At expected outbreak levels, countries focused their response on reactive strategies given outbreak size and infrequency. As outbreaks grew in size, countries considered expanding their response to include preventive campaigns targeting healthcare workers and at-risk, rural populations. This study provides new insights into country-level perspectives on NiV and medical countermeasures and quantifies expected demand across three outbreak scenarios and 10 countries. Our findings can provide a foundation for the strategic development of an international Nipah countermeasure stockpile, designed to address episodic NiV outbreaks and enhance pandemic preparedness.