The African Continent is experiencing a new wave of Mpox (formerly monkeypox virus) cases, driven by a new 'Clade 1b' variant, that is spreading quickly and expanding the virus's reach across the continent, primarily in countries surrounding the Democratic Republic of Congo (DRC), where it was first identified. .
Currently, 15 African countries are grappling with the outbreak, resulting in 2,030 confirmed cases and 13 deaths this year alone. A significant increase from the 1,145 cases and 7 fatalities recorded in 2023.
Since mid-July 2024, four previously unaffected countries -- Burundi, Kenya, Rwanda, and Uganda -- have reported their first Mpox cases. In response, the World Health Organization (WHO) has mobilized $1 million from its Contingency Fund for Emergencies to strengthen Africa's response , while the African Union allocated $10.4 million. As the crisis escalates, the WHO has convened an Emergency Committee meeting on August 14, to determine if the situation constitutes a Public health Emergency of International Concern (PHEIC).
While these are signs of progress, the "elephant in the room" is African governments' inability to integrate Mpox vaccines in their public health response since the beginning of the outbreak. As a global community, we seem unable to mobilise the resources to make vaccines available to countries facing this threat, as was done during the response to the outbreak in 2022. During the 2022 outbreak, vaccines played a critical role in mitigating the impact of the outbreak in high-income countries around the world. However, the lack of access to these life-saving vaccines in low-income countries hindered efforts to fully mitigate the disease. The disparity in vaccine access highlights the persistent inequities in healthcare, making it difficult to achieve universal eradication of similar diseases.
Mpox vaccine saga of 2022
Human cases of Mpox were recorded since 1970 in DRC. Before the 2022 global outbreak, Mpox cases outside of West and Central Africa were quite rare.
However, the 2022 outbreak represented a turning point when Mpox spread to Asia, Latin America and parts of North America. It also represented a watershed moment when high-income countries such as the United States of America (USA) built a stockpile of approximately 20 million doses of the Jynneos Vaccine, a dual-purpose smallpox and Mpox vaccine. Despite having these stockpiles, the US was unable to contain the outbreak in the country when the virus reached, since just 2,400 doses remained (enough to fully vaccinate only 1,200 people) because most of the stockpile had expired.
According to a New York Times report, a lack of urgency among federal officials in charge of maintaining the US stockpile of Jynneos Vaccine was a major contributor to its depletion. "The federal officials overseeing it had not viewed monkeypox as much of a problem, or at least as their problem," the report noted
Now what?
Two years have passed since the entire world woke up to the virus's deadly threat, but African countries, which have been plagued by Mpox outbreaks for decades, continue to be at the end of the queue for access for the vaccine.
There are very few Mpox vaccines available and affordable on the continent, and it is unclear whether any African country has licenced the use of any of the available vaccines, so there are many hurdles to overcome, including availability, affordability, licensure, vaccination strategy, defining a target population and raising awareness in the affected populations. As a result, urgent cooperation across several countries and international organisations is required to increase vaccination access in African countries.
Good news in the horizon?
Last year, BioNTech launched a combined Phase 1/2 clinical trial for their mRNA-based vaccine also known as BNT166, which aims to prevent Mpox. The Coalition for Epidemic Preparedness Innovations (CEPI) also pledged up to $90 million to fund the development of vaccine candidates, such as BNT166, to prevent Mpox and future outbreaks. The BNT166 is a key component of BioNTech's comprehensive programme to develop innovative preventive vaccines for infectious diseases with considerable unmet medical needs, especially those that disproportionately affect low-income countries.
What can be done now?
WHO officials have made public its efforts to accelerate the delivery of the available Mpox vaccines to the DRC, the epicentre of the virus. While this was stated in March 2024, the organisation did not provide a clear timeline or quantity for the rollout owing to ongoing negotiations with the only two global manufacturers of the vaccine. This shows the very complex vaccine manufacturing ecosystem. As of August 7, 2024, the DRC still lacks widespread access to the available Mpox vaccine, which claims to protect against all strains of the virus.
The Africa Centre for Disease Control and Prevention (Africa CDC) stated that it needs 10 million doses to effectively curb the spread of the virus, but only 200,000 are available. No strategy has been shared for how the 200,000 doses will be received, distributed and utilised. However during an online Special Press Briefing on Health Emergencies on the 13th August 2024, Africa CDC declared the Mpox a Public Health Emergency of Continental Security (PHECS). This urgency in response has now been heightened further.
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Self-sufficiency is relevant now more than ever
With challenges in access to vaccines, the urgency of vaccine self-sufficiency is again high on the agenda. Africa CDC took a significant step towards this goal in 2021 by launching the Partnerships for African Vaccine Manufacturing (PAVM) Framework for Action, which proposes that in 16 years, at least 60% of the vaccines needed in Africa -- approximately 1.7 billion doses per year -- should be produced locally, reducing dependence on external supplies and ensuring faster access to essential vaccines. However, beyond announcements, the right investments need to be made, by African countries and the private sector in African countries to bring this to life.
Countries should also prioritise the enhancement of data systems to ensure accurate tracking of vaccine distribution, coverage, and impact. This will enable them to identify and address any gaps in vaccine access, particularly in vulnerable communities, and make informed decisions to optimise their vaccination strategies.
There is a significant need to engage and empower local communities through education and awareness initiatives, fostering a culture of vaccine acceptance and generating demand for vaccines. By involving communities in the vaccination process and addressing their concerns and misconceptions, governments and health organisations can increase vaccine uptake for such diseases.
