Title page 1

Contents 3

Abstract 1

Key messages 4

Motivation 5

Background on the epidemiology of orthopoxviruses and recent mpox emergencies 5

The potential value and associated challenges of routine mpox vaccination compared to outbreak response campaigns 7

Key findings of assessing routine mpox vaccination 8

Limitations 11

Data 11

Modelling 12

Implementation considerations 12

Policy recommendations 13

References 15

Appendix: Key terms 19

FIGURE 1. Population of areas where universal mpox vaccination is health-positive 9

FIGURE 2. Uncertainty around estimated ICERs for routine vaccination (in children ages 0-9 years) by province 10

FIGURE 3. Contribution of different components to ROI of more than 3:1 for routine mpox vaccination in Africa 11