Mpox has long been a reality in Africa, but the continent still lacks access to vaccines, highlighting stark inequalities in global distribution as wealthier nations vaccinate populations at much lower risk.
Experts warn that this disparity – combined with competing health crises and sluggish regulatory processes – puts millions of Africans at risk as the virus mutates rapidly, spreads from person to person and crosses borders at an alarming rate.
“The shortfall in the distribution of mpox vaccines in Africa is due to challenges in terms of supply, funding and infrastructure, and the disease’s low prevalence compared to other health priorities,” Duduzile Ndwandwe, a researcher at the South African Medical Research Council, said in emailed comments.
Mpox had been circulating in the Democratic Republic of Congo since January last year but only became a major problem in January when scientists discovered the worrying new mutation.
Two mpox vaccines made by Denmark’s Bavarian Nordic and Japan’s KM Biologics, which are being used to fight an outbreak in 2022, have been widely available in at least 70 countries outside Africa – even administered for free in some US and European clinics.
But before Nigeria received 10,000 doses from the US this week, no mpox vaccine was available in any country in Africa, and the strain now circulating in vulnerable, displaced populations in the DRC is even more virulent than previous strains.
Serious epidemic
Mpox, formerly known as monkeypox, has been a public health problem in parts of Africa since the 1970s but received little global attention until an international outbreak in 2022.
It usually causes flu-like symptoms and pus-filled lesions and can be fatal. Coverage costs approximately $100 per person.
Jimmy Whitworth, professor of epidemiology at the London School of Hygiene and Tropical Medicine, described the new variant, clade 1b, as “quite deadly”.
“This appears to be spread through sexual contact, and this time it’s person-to-person,” Whitworth said. “There is now a need to move it up the priority list because this is a serious epidemic.”
Since January 2023, there have been more than 27,000 suspected cases and 1,100 deaths in Congo, according to government figures, mostly among children.
Moussa Niyonkuru (L) scratches his arm as he plays with his friend after recovering from mpox, outside his house in Kinama zone, Bujumbura, Burundi, August 28, 2024. (Reuters Photo)
The virus infection has spread from the Democratic Republic of Congo to 12 neighboring countries, prompting the World Health Organization (WHO) to declare the outbreak a public health disaster.
Many African nations are struggling to meet the challenge.
Whitworth said the $100 needed to distribute a dose of the vaccine is prohibitive for governments that must eliminate multiple threats — measles, malaria, cholera — with limited budgets.
“It’s a huge cost to just vaccinate the DRC. If you asked people in the DRC last year what the higher priority was—was it the measles or mpox vaccine?—they would have said ‘measles vaccine.'” And it would everyone else in public health does too because it was a bigger threat then, the epidemiologist said.
National regulations are also a problem.
Despite the seriousness of the mpox crisis and the risk of it spreading across the DRC’s borders, local regulatory authorities only approved a vaccine in June with no date yet for distribution.
Why the delay?
By 2022, two mpox vaccines, along with public health campaigns against risk behavior, effectively controlled an outbreak that had affected 100 countries globally.
But African countries have so far been underserved, with efforts only now mounting to strengthen their protections.
The Africa Centers for Disease Control and Prevention said it had been granted 9.34 million euros ($10.43 million) in emergency funding from the African Union for its mpox response and said it would need 10 million doses of vaccine.
Bavarian Nordic said it can make 10 million doses of its vaccine by the end of 2025 and offered 2 million doses this year.
The WHO gave its partner agencies, including the global vaccine agency Gavi and UNICEF, the go-ahead to buy mpox vaccines prior approval to speed up delivery to Africa.
The DRC had expected to receive its first vaccines the week of August 26 after the US and Japan both promised supplies but has since said it would take longer.
European Union countries have also pledged donations to help Africa fight the current outbreak.
Whitworth said regulators in Rwanda, Burundi, Uganda and Kenya — all countries where cases have been detected — should approve vaccines soon without waiting for a full outbreak.
“The vaccine is not even licensed in these countries,” Whitworth said. “These countries need to speed up the process.”
Weak health systems
Even before mpox, Congo’s health system was at breaking point — burdened by epidemics of measles and Ebola and years of conflict — and activists say short-term solutions won’t work.
Katharina Schroeder of Save the Children said long-term investment in social welfare and healthcare infrastructure is critical to preventing future outbreaks, with many remote health centers lacking basic test kits or trained staff.
“The health centers outside the city have to be equipped to triage patients … because they’re often looking for things like gloves and masks,” Schroeder said.
Save the Children has trained staff about the disease, but even when diagnoses are speeded up, few sick patients can afford to isolate themselves for the four weeks.
“They understand that this is mpox, they understand that this is dangerous for their family. But they still don’t go into isolation because they live day by day. They don’t have enough to eat,” Schroeder said.
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