Mpox: Africa’s next vaccine headache

African countries thought the insidious Covid-19 pandemic is behind them, having ridden one of the most vaccine inequalities the world has ever seen. Now Mpox is bringing that episode back.

Experts have this week admitted that access to tests, treatments, and vaccines for ongoing African active outbreak for Mpox is inadequate, signaling another round of scorpion fight to survive.

The situation is, in fact, an overall assessment of preparedness for any future outbreaks where the continent faces an unprecedented increase in infectious disease outbreaks, with over 100 outbreaks annually. The World Health Organisation ranks the continent as the most susceptible to infectious disease outbreaks.

Back to the current Mpox outbreak in Africa, cases have since increased by more than 160 percent compared to last year, with the most significant share of new cases reported in Africa, according to the Africa Centre of Diseases Control and Prevention (CDC) data.

So far, 15 African countries, including Burundi, Cameroon, Congo, Ghana, Liberia, Nigeria, Rwanda, the Democratic Republic of Congo, South Africa, Uganda, and Kenya, have reported most of the cases.

Africa CDC, in their latest Mpox situation this week, raised an alarm of an increased death of three per cent this year in African countries, with the spread resulting in 461 deaths reported in 10 countries, with over 13,791 cases and 450 deaths in DRC, where it is endemic.

The DRC has since approved two Mpox vaccines. The Coalition for Epidemic Preparedness Innovations announced it would team up with the Canadian Institutes of Health Research to invest $4.9 million in a clinical trial to test the idea in the DRC and other African countries.

However, even with the highest deaths and cases in DRC, their efforts to contain Mpox have been hampered by a lack of vaccines. While wealthy countries, including the United States, quickly stockpiled Mpox vaccines, only 50,000 doses of vaccines were released to DRC with over 99 million people, where the spread of Mpox clade I is countrywide and affecting people of all ages, leading to the deaths of children.  

There is also the difficulty of getting and paying for the vaccines, with African countries having no equitable access to vaccines and therapeutic agents for emerging diseases on the continent. This was the same story with Covid-19 when Africa struggled to get vaccines even when it was ready to pay for them.

This time, the US committed to providing enough doses to vaccinate 25,000 people in the DRC, but the shots have yet to reach the country. Japan has also pledged vaccines.

The DRC approved two vaccines used for Mpox in June. South Africa is also in the approval stage. Most countries need resources to move those vaccines to their respective countries.

In a Mpox surveillance report dated August 8, Dr Swabah Omar, County Executive Committee member at the Department of Health Services in Mombasa, noted that health officials in Mombasa County are struggling to effectively trace contacts of the infected long-distance truck drivers due to shortages of essential protective gear, drugs, and information, education, and communication materials on Mpox.

According to the World Health Organization (WHO), efficiently handling infections and suspicions is critical to stop the spread of Mpox, a very infectious disease.

The WHO recommends vaccinations for persons who have come into contact with an individual infected with Mpox. Three types of vaccines are available and recommended for those with close contact with infected patients. However, it does not recommend mass vaccination.

Dr Patrick Amoth, Kenya’s Director-General of health at the MOH, said that vaccines are yet to be made available in the country.

“There is no specific treatment for Mpox. First, it can be self-resolving. However, we give treatment for the symptoms. We may give you something to gargle if you have a sore throat. We may give you an antipyretic like paracetamol or aspirin if you have a fever. We will also be able to take care of the rash by covering it with emoluments to reduce itching,” he said.

What is available in the country, Dr Amoth said, are vaccines for smallpox, which is part of the same family as the virus that causes Mpox.

“In certain settings, this has been used to treat people exposed to smallpox and with good outcomes. Maybe like the healthcare workers, the people in the laboratory handling the specimens and those caring for the infected individuals,” he added.

However, the exact number of contacts traced remains unclear, and he indicated that this information could be provided later.
Mr Aggrey Aluso, Africa Director of Pandemic Action Network, called on African countries to stockpile emergency supplies to reduce the time to deliver lifesaving supplies from an average of 20 days to as little as 24-48 hours during emergencies.

“With the availability of the vaccines and other treatment gears, we will reduce our emergency response time, which will also help us save lives. Making Public Health Emergency Operations Centres (PHEOCs) fully operational, we will ensure the availability of equipment, supplies, and capacity needed to operate optimally,” he said.
The Africa CDC has since received an emergency approval of KSh1.3 billion ($10.4 million) from the African Union, money from the existing COVID-19 funds to combat the outbreak.

The funding is supposed to support Mpox surveillance and deployment surge capacity, boosting laboratory testing and genomic sequencing capacity, strengthening regional and national data collection and analytics, enhancing case management, infection prevention and control, and risk communication and community engagement, and improving access and delivery of vaccines, diagnostics, and supplies across the continent; Africa CDC said.

In a post on X, WHO Director-General Tedros Ghebreyesus called for more funding and support to interrupt disease transmission. “I am considering convening an International Health Regulations Emergency Committee to advise me on whether the outbreak of Mpox should be declared a public health emergency of international concern.”

“This virus can and must be contained with intensified public health measures, including surveillance, community engagement, treatment, and targeted deployment of vaccines for those at higher risk of infection,” Dr Tedros said.

Also, a new research consortium, MpoxReC, has been set up to help counter Africa’s surge in Mpox cases and urgently seeks funding.

The consortium coordinated by Jean Nachega, the committee chair, is securing funding for research activities across mpox-endemic countries to help mitigate recurring mpox epidemics.