Apathy Continues: On Africa and the Mpox Vaccine Response

The World Health Organization (WHO) has declared mpox a ‘Public Health Emergency of International Concern’ (PHEIC) for the second time in two years, following its outbreak in the Democratic Republic of the Congo (DRC) and its spread to over a dozen countries in Africa.

About Mpox

• Mpox (Monkeypox) is an infectious disease caused by the monkeypox virus, first reported in humans in the DRC in 1970. 
• It is a zoonotic disease, transmitted between humans and animals, and is characterised by fever, pain, rash, and skin bumps. 
• It is also one of the species of pox virus (such as smallpox and cowpox).
• The Pox viruses have oval shape and double-stranded DNA. 
• It spreads through contact with infected persons via fluids during coughing or sexual contact.

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Strains

• Clade I: The dominant and more dangerous strain, with a mortality rate between 3-6%, primarily affecting young children and immunocompromised individuals. It has been recently observed in new cases and spreads through both sexual and non-sexual contact. It originated in Central Africa.
• Clade II: A comparatively less dangerous strain with a case fatality rate of about 0.1%, originating from West Africa. It was prevalent in 2022.

The Apathy Continues

• The 2022 mpox outbreak in the U.K., caused by the milder clade 2b virus, spread to over 100 countries, mainly affecting men who have sex with men.
•  In contrast, the current outbreak is driven by the more lethal clade 1b, spreading through both sexual and non-sexual contact. 
• This year, there have been 2,863 confirmed cases and 517 deaths, primarily in the DRC, with two-thirds of infections occurring in children under 15.
• The WHO has declared mpox a PHEIC for the second time, following its initial declaration in 2022.
• This announcement follows the Africa Centers for Disease Control and Prevention (Africa CDC’s) designation of the outbreak as a public health emergency of continental security (PHECS), marking the first instance of a regional and global health emergency for a disease outbreak. 
• In the DRC, about two-thirds of the infections are among children under 15 years old.

Cause for Concern

• A critical issue is the acute shortage of vaccines. 
• Against a need for 10 million doses to control the outbreak, only about 0.21 million doses may be supplied immediately. 
• Despite mpox being endemic in Africa for years, vaccines were not supplied to the continent even when they were available in Europe and the U.S. 
• Currently, only the DRC and Nigeria have granted emergency use authorization for the vaccine.
• If a company seeks WHO’s emergency use listing, it could facilitate broader vaccine distribution, but Africa may only receive the necessary doses by the end of 2025.

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Conclusion

This situation emphasises a significant issue of vaccine inequity, where poor countries like those in Africa struggle to access essential vaccines during emergencies. The urgent need for a coordinated global response, ensuring equitable vaccine distribution and strengthening health infrastructure are crucial for managing this and future outbreaks.