Africa is set to receive its first 10,000 doses of mpox vaccines next week, despite having battled the virus for decades and facing a newly emerging, more dangerous strain.
Public health officials and scientists pointed out that the delayed delivery of the vaccines, which have already been distributed to over 70 countries outside Africa, highlights the slow progress in addressing global healthcare disparities, despite the lessons from the COVID-19 pandemic.
One major obstacle has been the delay in the World Health Organisation’s (WHO) efforts to streamline access to mpox vaccines for low-income countries.
Despite having the capacity to initiate this process earlier, the WHO only began the formal procedures this month, according to several officials and scientists.
Mpox, a potentially fatal virus causing flu-like symptoms and pus-filled sores, has been spreading through close contact.
The WHO declared it a global health emergency on August 14, after the more virulent Clade Ib variant began spreading from the Democratic Republic of Congo to other African nations.
In response to questions about delays in vaccine distribution, the WHO announced on Friday that it will ease certain procedures to expedite access to mpox vaccines for poorer nations.
Many low-income countries cannot afford to purchase the costly vaccines themselves.
The two main vaccines for mpox are produced by Denmark’s Bavarian Nordic, priced at $100 per dose, and Japan’s KM Biologics, though the cost for the latter remains undisclosed.
The delay in obtaining WHO approval for international agencies to purchase and distribute mpox vaccines has led African governments and the Africa Centres for Disease Control and Prevention (CDC) to rely on donations from wealthy nations.
This slow and unreliable process can falter if donor countries prioritise their own needs over aiding others.
The initial shipment of 10,000 mpox vaccines, manufactured by Bavarian Nordic, was donated by the United States rather than provided through the U.N. system.
Helen Rees, a member of the Africa CDC’s mpox emergency committee and executive director of the Wits RHI Research Institute in Johannesburg, condemned the situation, describing it as “really outrageous” that Africa, which struggled with vaccine access during the COVID pandemic, is now encountering similar difficulties
In 2022, following the spread of a different mpox strain outside Africa, smallpox vaccines were quickly repurposed and authorized for use in about 70 high- and middle-income countries to protect at-risk populations.
These vaccines have already reached 1.2 million people in the U.S., according to the CDC. However, Africa has only seen mpox vaccines through clinical trials.
A major obstacle has been the need for WHO approval before public health organizations like Gavi, the Vaccine Alliance, can purchase and distribute them. Gavi, which supports vaccine access in poorer countries and managed global vaccine distribution during COVID-19, has up to $500 million allocated for mpox vaccines and logistics.
The Africa CDC estimates a need for 10 million doses of mpox vaccine across the continent.
However, the WHO only recently requested vaccine manufacturers to submit data for emergency licensing, which is the WHO’s expedited approval process.
The WHO has called on countries to provide vaccine donations until the approval process is completed in September.
Additionally, the WHO is collaborating with Congolese authorities to create a vaccination plan and has allowed Gavi to begin discussions on distribution while finalizing emergency approval.
Sonia Nishtar, Gavi’s CEO, highlighted that the WHO’s accelerated approach to approvals and funding represents “the somewhat brighter side of where we are compared to COVID,” and expressed hope that the delays serve as “another learning moment for us.”
WHO Faces Criticism
The WHO has transformed vaccine access in low-income countries, where local facilities often lack the capability to evaluate new products. However, it has faced criticism for its slow and complex approval process.
The Geneva-based agency explained on Friday that it did not have enough data during the 2022 mpox emergency to initiate vaccine approval and has since been working with manufacturers to assess the available data.
Since 2022, mpox has led to 99,000 confirmed cases and 208 deaths globally, according to the WHO. This number is likely an underestimate due to many unreported cases.
Infections Under Control in Wealthy Regions
In wealthier regions, mpox infections have been managed through a mix of vaccination and behavioral changes among high-risk groups.
Previously, the main strain primarily affected men who have sex with men, but the new clade Ib variant appears to spread more readily through various forms of close contact, including among children and through heterosexual sexual activity.
Currently, Congo is the most severely impacted by mpox, with over 27,000 suspected cases and 1,100 deaths reported since January 2023, according to government data. The majority of deaths have been among children.
The initial 10,000 vaccine doses donated by the United States are headed for Nigeria rather than Congo, due to negotiations between the two governments, according to an insider involved in the process.
Nigeria has reported 786 suspected cases of mpox this year but no deaths. Although the Nigerian health ministry has not commented, USAID confirmed that it has also committed to donating 50,000 doses to Congo, though the arrival date has yet to be determined.
Children Vulnerable
The ongoing challenges in Congo’s administration have contributed to delays in accessing mpox vaccines. Burdened by conflict and multiple disease outbreaks, the government has yet to officially request vaccine supplies from Gavi and took several months to engage with donor countries.
The country’s medicine regulator only approved the two main vaccines in June. Bavarian Nordic has called for orders to be placed soon to ensure production can meet demand this year.
While Congo’s government has expressed hope of receiving vaccine donations soon, donor sources have indicated uncertainty, with Europe’s pandemic agency stating its 215,000 doses won’t arrive until at least September.
A spokesperson for USAID mentioned that Bavarian Nordic and Congo are finalising pre-shipment protocols, ensuring the vaccines are stored properly at -20°C.
In conflict-ridden eastern Congo, around 750,000 people reside in camps, including seven-year-old Sagesse Hakizimana and his mother, Elisabeth Furaha.
He is one of more than 100 children infected with mpox near Goma, doctors reported. “Imagine fleeing a war and then losing your child to this illness,” said Furaha, 30, applying ointment to her son’s rash. His condition was slowly improving under treatment at a former Ebola center.
“We need a vaccine for this disease. It’s a bad disease that weakens our children.”
Although vaccines are on their way, uncertainties remain about their application. Bavarian Nordic’s vaccine, widely used globally, is only approved for adults, while the KM Biologics version can be administered to children but is more difficult to use.
Scientists are still debating which groups should receive the shots first, with ring vaccination—targeting contacts of confirmed cases—being the most probable approach.
Jean Jacques Muyembe, co-discoverer of the Ebola virus and director of the Institut National de Recherche Biomédicale (INRB) in Kinshasa, highlighted that even when vaccines are available, public hesitation could pose a problem, as seen during the COVID-19 pandemic.
Muyembe and other experts stress that raising awareness and improving diagnosis in Africa will be essential to combating mpox, emphasizing that vaccines alone are not the solution.
Urgent Matters
Some international health experts argue that the WHO and other organizations should have prioritized improving access to mpox vaccines, tests, and treatments sooner.
Ayoade Alakija, co-chair of a global health partnership focused on equitable mpox responses, stated, “The processes {at WHO for vaccines} and funding for diagnostics for mpox should have started a few years ago.”
She clarified that her remarks were not a critique of the WHO itself but rather a reflection on global priorities, noting, “It is a matter of what the world considers to be a priority, and [that is not] diseases that primarily affect black and brown people.”
The WHO issued a statement calling on “all partners including countries, manufacturers, and communities to step up efforts, increase vaccine donations, lower prices, and provide essential support to protect those at risk during this outbreak.”
Jean Kaseya, head of the Africa CDC, mentioned that he is striving to involve African vaccine producers to ramp up supply and bring down costs, though he acknowledged this will require time.
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