Africa: The Mpox Outbreak’s Disturbing Echoes in Africa

Mpox is not COVID-19, but that pandemic’s bitter lessons have not all been learnt.

An ominous sense of déjà vu is emerging across Africa as the mpox outbreak spreads from its epicentre in the Democratic Republic of the Congo (DRC). Is this COVID-19 redux? The short answer is probably no, as mpox isn’t spread as easily as COVID-19, merely by breathing – it requires direct physical contact, including sex.

And it’s not a pandemic, as it’s so far known to have reached only 13 African countries and is mostly concentrated in the DRC. It’s also less lethal. Nevertheless on 13 August the Africa Centres for Disease Control and Prevention (Africa CDC) felt sufficiently concerned to declare it a Public Health Emergency of Continental Security. The next day the World Health Organization (WHO) declared it a Public Health Emergency of International Concern.

This week Africa CDC Director-General Dr Jean Kaseya announced that 3 953 new cases and 81 deaths had been reported continent-wide over the past week. This brought the total for the year to 22 863 cases and 622 deaths. He said of these cases, 3 641 were confirmed and 19 222 were suspected. Most cases (20 719) and 618 deaths had been in Central Africa, mostly in the DRC. Other regions had some; North Africa had none.

Apart from the alarming toll, mpox is becoming reminiscent of COVID because of rising criticism that, like in 2020, the world was slow to help Africa. The WHO has come under fire for taking so long to authorise international organisations like GAVI and the United Nations Children’s Fund to donate vaccines. Though mpox has been around for years, that permission has only just been granted. Kaseya says the first vaccines should start arriving in the DRC by 1 September.

Vaccine deliveries have hitherto been ‘trapped in a byzantine drug regulatory process at the [WHO],’ New York Times reported last week. It said Kinshasa had first asked for the shots two years ago.

‘Three years after the last worldwide mpox outbreak, the WHO still has neither officially approved the vaccines – although the United States (US) and Europe have – nor has it issued an emergency use licence that would speed access. One of these two approvals is necessary for UNICEF and GAVI, the organisation that helps facilitate immunisations in developing nations, to buy and distribute mpox vaccines in low-income countries like Congo.’

Helen Rees, an Africa CDC mpox emergency committee member and Wits RHI Executive Director in Johannesburg, said it was ‘really outrageous‘ that, after Africa struggled to access vaccines during COVID, it was again being left behind.

The WHO’s reasons for delay seem to arise largely from caution. One is that while the two available vaccines have been tested for the Clade 2 variant that attacked Europe in 2022, they haven’t been fully tested for the new, more dangerous Clade 1b variant driving Africa’s outbreak.

It also seems the WHO might have been waiting to fully assess the scale of the outbreak before granting an emergency use licence. Kaseya says WHO Director-General Dr Tedros Ghebreyesus told him he’d authorised GAVI and UNICEF to deliver the vaccines, pending the WHO’s issuing of an official emergency use licence.

So 215 000 doses donated by the European Union and Bavarian Nordic (which manufacturers the JYNNEOS vaccine), 100 000 from France, 50 000 from the US, and 15 000 from GAVI, should start arriving by 1 September.

Kaseya, reportedly saying previously that Africa would need 10 million doses by the end of 2025, this week said he expected other countries to donate too. Germany was waiting to see Africa’s continental response plan, which Kaseya said would be ready to show partners in draft form this week. He expected it to be endorsed and adopted by the African CDC governors and then African heads of state at a September meeting. Other leaders expected to pledge support would also attend.

Kaseya said there was no treatment for the Clade 1b variant, so Africa needed preventive measures and vaccines. Vaccines would be focused on sex workers, and on young children who were infected disproportionally, probably because of close classroom contact, and in eastern DRC especially, due to malnutrition.

But, as with COVID, Africa is suffering from not manufacturing its own vaccines. ‘Our continent is not ready for another pandemic,’ Kaseya lamented. ‘We didn’t have vaccines, medicines. We didn’t even have syringes, gloves, and were abandoned. Today we are in a similar situation where we start to look for vaccines because we don’t manufacture [them].’

But he said Africa CDC was talking to Bavarian Nordic about transferring its technology to African manufacturers. Of nine interested, though, only one had the capacity to manufacture JYNNEOS.

Aspen Pharmacare’s Stavros Nicolaou says however that for Africa to become more self-sufficient in vaccines to treat emergency outbreaks, it must first develop sustainable production of basic vaccines like those dispensed routinely to children for common diseases. African countries and international agencies like UNICEF will need to start procuring those from African pharmaceutical companies.

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‘You can’t expect African producers to produce outbreak vaccines only when you need them,’ he told ISS Today. ‘If they don’t have a base of routine vaccines coming through their production lines, you can’t sustain these companies.’ That requires a long-term strategy that should have begun with COVID.

Meanwhile Africa will largely remain dependent on donations from governments and agencies like GAVI for these vaccines, which at US$100 a dose aren’t cheap. Kaseya says he needs 10 million doses for five million people, as it’s a two-dose treatment.

An industry source says the first batch expected on 1 September will probably amount to no more than 40 000 doses, though Bavarian Nordic says it could produce two million this year and 10 million by the end of 2025.

It’s not only WHO taking blame though. The DRC was seemingly slow to authorise the vaccines. Dr Lenias Hwenda, Medicines for Africa CEO, asked why the Africa CDC began negotiating access to vaccines only last week, ‘following months of a gradually worsening outbreak.’

But the urgent focus must be on getting those 10 million doses to vulnerable Africans. And drafting a longer-term strategy to pre-empt the next emergency.

Peter Fabricius, Consultant, ISS Pretoria