Nineteen African states--those currently reporting or that have reported Mpox cases within this outbreak--gathered in a 'back-to-school' style meeting in Congo Brazzaville in the first week of November. They shared expertise on developing Mpox vaccination plans, according to the continental Incident Management Support Team (IMST) vaccination pillar.
A review of plans submitted to the IMST revealed some concerning issues. Some plans fell short of expectations, with crucial data elements missing, and the presentation of plans across the board lacked standardization, said Dr. Charles Ibeneme, Africa CDC National Coordinator and Field Epidemiologist, who supports the coordination of the IMST vaccination pillar in the Democratic Republic of Congo.
"We consulted with stakeholders and learned from experience. Now, we need to come together to develop a standard template," said Dr. Ibeneme.
The Continental Incident Management Support Team, co-led by Dr. Ngashi Ngongo of Africa CDC and Dr. Jean Marie Vianny Yameogo of WHO, has been stationed in the DRC since early this year, when Mpox cases began to rise.
The response involves ten pillars: Coordination and Leadership, Risk Communication and Community Engagement, Surveillance, Laboratory, Case Management, Infection Prevention and Control, Vaccination, Research and Innovation, Operations Support and Logistics, and Continuity of Essential Services. Their efforts have been bolstered by the declaration of a Public Health Emergency of Continental Security by Africa CDC and a Public Health Emergency of International Concern by WHO.
At the heart of response operations in Kinshasa, the team is ready to support any African country affected by Mpox. Dr. Dhoud Samba, the vaccination team lead, outlined the readiness and allocation criteria expected from member states to access the vaccine. "We need to ensure comprehensive response coordination at the country level, which includes an existing response structure and an integrated approach," he said.
"There is a need for a robust vaccination plan with all stakeholders involved, following an integrated approach," said Dr. Samba. "The vaccination plan will include a preparedness checklist we've developed, which is critical for member states as they prepare for the vaccine."
He emphasized the need for a national regulatory framework to facilitate vaccine importation and use, which would include regulatory approval, emergency use listing, and pre-qualification. These steps are essential to meet the vaccine allocation criteria.
"We also need to ensure that logistics at the national level are prepared to conduct targeted vaccinations safely and efficiently, particularly for high-risk populations," Dr. Samba noted, highlighting the vaccine's shorter shelf life.
The national vaccination teams must review their response plans, as these vaccines are intended for immediate rollout and not for long-term storage, he added.
"We also need a robust communication plan using appropriate risk communication methods for target populations and in crisis management," Dr. Samba said.
Communities need to be engaged through strategies targeting high-risk populations to ensure vaccine access and uptake.
"When all these criteria are met, a country is prepared to accept the vaccine. If operational criteria are not met, additional support will be provided to member states to help them achieve operational readiness," Dr. Samba stated.
He added that countries must consider the vaccine type, whether it's the MVA-BN or LC 16, and assess efficacy, safety profile, and the needs of the affected population. Countries must also evaluate vaccine storage requirements and the need for supplies.
As they assess the overall strategy, Dr. Samba advised that countries remain flexible, ensuring smooth vaccine allocation and operational readiness with national frameworks in place for receiving vaccines.
Countries are urged to stand in solidarity, maintaining impartial distribution so that all high-risk populations have equal access to vaccines, in line with programmatic needs. "We don't want anyone left behind; the vaccine must be distributed equitably, without discrimination based on epidemiology or risk groups," he said.
A need to secure Mpox vaccine supplies via alternative sources, including donations, was emphasized. "We are ready to support countries, ensuring all steps are respected," Dr. Samba said.
The IMST team has developed a flowchart illustrating the process for national response teams submitting a National Mpox Vaccine Deployment Plan to the Continental Technical Review Committee. After a pre-review of country requests, the vaccine pillar conducts a comprehensive review of vaccination plans, sharing feedback with the Technical Review Committee for further assessment and recommendations. Input from major agencies--WHO, Africa CDC, UNICEF, and GAVI--is also considered.
Ana Maria Henao-Restrepo, the WHO lead for research and development for epidemics and health emergencies, said it is essential to use country data to inform strategies. For 175 years, the response to smallpox outbreaks was mass vaccination campaigns. However, in Nigeria and other parts of Africa with limited vaccine doses, a new strategy emerged. Henao-Restrepo explained that this approach targeted doses to high-risk areas, a strategy now known as surveillance and containment.
"They used surveillance teams to identify hotspots and then vaccinated people at risk of infection in those areas. This targeted approach became a leading strategy for controlling and eradicating smallpox in Latin America, Asia, the Horn of Africa, and beyond," she explained.
It took years to demonstrate that a targeted strategy was more effective for smallpox than mass campaigns, as mass campaigns often missed high-risk individuals, she said.
Henao-Restrepo outlined three steps in outbreak control: setting objectives, determining the best approach, and creating a detailed execution plan. "When you reach your goal, you must prove it--like climbers who take photos at Mount Everest's peak to say, 'Here we are."'
This approach was a primary reason for the declaration of both a Public Health Emergency of International Concern and a Continental Emergency, she added. As human-to-human transmission rises, the goal is to curb transmission immediately.
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Vaccines should be deployed strategically to protect high-risk contacts and healthcare workers on the frontline, Henao-Restrepo said.
Africa currently faces three Mpox outbreaks across different clades: Clade 1A (endemic, with mainly rural transmission and periodic human-to-human cases), Clade 1B (urban and rural, with sustained human-to-human transmission across all age groups), and Clade IIb (also urban but affecting young adults).
"This information helps control the outbreak and reduce human-to-human transmission by reviewing epidemiological data to identify high-risk populations," said Henao-Restrepo. "This is not a mass campaign; it's a tailored, targeted response."
Henao-Restrepo encouraged countries to understand the clades and epidemiological curves, examining local epidemiology to develop effective plans. Teams analyzed cases from recent weeks to identify areas with high incidence, avoiding older data since the virus may have shifted.
Countries received guidance on creating quality plans that streamline the response. "This is an integrated, targeted outbreak response strategy," said Dr. Imran Mirza, Health Specialist with UNICEF in New York. "We recommend one plan, one budget. Countries need a detailed, costed operational budget with funding sources, including both secured funding and budget gaps. Transparency is key to indicate which partners support which activities," Dr. Mirza added.
