Overnight, mpox in Africa just became a health emergency of international concern - what now? I Medicines for Africa
We are not dealing with one outbreak of one clade – we are dealing with several outbreaks of different clades in different countries with different modes of transmission and different levels of risk.” Director General of the World Health Organization
Africa's worst fear now a reality
Overnight, Africa's mpox outbreak, recently declared a regional security concern, became a public health emergency of international concern. Since the beginning of the year, the worst fear for many African people has been that the mpox outbreak might evolve into an epidemic that spreads across the continent and possibly beyond. Their worst fears have now been confirmed with the recent announcement by the Africa CDC that the outbreak is now a public health emergency of security concern, followed a day later by the World Health Organization (WHO) declaring mpox in Africa a global health emergency of international concern. The outbreak has spread to countries where mpox is not endemic - Kenya, Rwanda, Burundi and Uganda which are experiencing mpox for the first time, and can be expected to spread to other non-endemic countries globally as well. In all likelihood, it is already spreading silently.
What is notable is that the Africa CDC took the historic step of declaring the mpox a regional public health emergency without waiting for the West to dictate when an African public health emergency warrants action. This may have, in fact, forced the WHO to take the decision to declare it a public health emergency of international concern more quickly than it might otherwise have done. To respond, the Africa CDC says it is negotiating for 200’000 doses of mpox vaccine out of the 10 million that it says are needed to effectively contain this public health emergency of international concern. What may not be reassuring for Africans is that so far into this outbreak, the Africa CDC is still negotiating with Bavarian Nordic , one of two companies that manufactures the mpox vaccine. The outbreak has been ongoing since the beginning of the year. Africans wonder if the need for vaccines could have been anticipated earlier and talks initiated sooner. The Africa CDC’s plan for securing the 10 million doses needed to protect populations has not been articulated and is unclear. The Africa CDC has, however, called for solidarity to make vaccines available.
What the continent needs
Africans will be heartened that South Africa and Ghana appear not to be counting on global solidarity to save African lives. A delegation of the Minister of Health of Ghana, Dr. Bernard Okoe-Boye and the Deputy Director General of South Africa, Dr Anban Pillay , met to explore avenues to strengthen vaccine production and accessibility across the continent through companies that are at the forefront of vaccine development in Africa - Biovac and Afrigen Biologics (Pty) Ltd . At the same time, the Director General of the World Health Organization has triggered the process of emergency use authorization of mpox vaccines to expedite the availability of unlicensed medical products like vaccines needed to respond to mpox as a public health emergency. This could bring more products to the market. These plans will take time to execute.
Africa’s immediate need for vaccines to break the chain of transmission is time critical. The problem is that vaccines are not available at the moment. A token quantity of 200’000 doses of the 10 million needed may be available. It is not certain that even this negligible quantity will be available since the CDC says it is still negotiating with the manufacturer.
Africa’s immediate need for vaccines to break the chain of transmission is time critical. The problem is that vaccines are not available at the moment. A token quantity of 200’000 doses of the 10 million needed may be available. It is not certain that even this negligible quantity will be available since the CDC says it is still negotiating with the manufacturer. In the absence of vaccines, Africa needs a contingency plan that could stop a bad situation from getting worse. This could be a losing proposition because the virus is already way ahead and public health must now play catch up. According to the WHO Director General, “we are not dealing with one outbreak of one clade – we are dealing with several outbreaks of different clades in different countries with different modes of transmission and different levels of risk.” The outbreak is no longer confined to rural communities. It is now present in sprawling big cities of more than a million residents like Bukavi in the Democratic Republic of Congo (DRC).
The virus itself has evolved into a more lethal variant - clade 1b which appears to spread more easily through routine contact, particularly among children. Unlike the endemic clade 1 that started the 2022 outbreak in the DRC, the transmission of the new virulent variant no longer requires intimate sexual contact. It appears to be transmissible through routine touch and now causes flu-like symptoms in addition to its previous manifestation.
The virus itself has evolved into a more lethal variant - clade 1b which appears to spread more easily through routine contact, particularly among children. Unlike the endemic clade 1 that started the 2022 outbreak in the DRC, the transmission of the new virulent variant no longer requires intimate sexual contact. It appears to be transmissible through routine touch and now causes flu-like symptoms in addition to its previous manifestation. Women and children are particularly vulnerable. According to a Nature publication, an estimated two thirds of people affected in the DRC are children under the age of fifteen. Mortality rates in children are alarmingly high- as high as 10%. The declaration of mpox as a public health emergency of international concern will trigger a vaccine, therapeutics and diagnostics stockpiling frenzy that will push vaccines further from the reach of affected communities and countries. In the context of an ongoing humanitarian crisis in the DRC and an ongoing cholera outbreak, bringing the mpox emergency under control using with public health measures and no vaccine will be challenging but not impossible if interventions put people at the centre of the response.
African communities are disheartened by the reality of another public health emergency following on the heels of a just-ended Covid-19 pandemic that caused much social and economic upheaval from which communities have barely recovered. What may reassure African people is seeing their leaders doing everything it takes to bring this outbreak rapidly under control. Getting vaccines to protect people is a big part of that. Africa needs to come together and make a regional plan that should guide the regional response and to which partners can contribute. This plan must do more than call for solidarity - global-health-speak for charity. It should leverage public health control measures whilst ensuring that people and communities remain at its core including by raising awareness. It would include increasing surveillance, screening, detection, contact tracing and information sharing between and across countries to break the chain of transmission and protect populations. Whilst what Africa needs to bring this emergency under control and what it can realistically expect to get are worlds apart, at a minimum, regional leaders must act with great urgency to do what is necessary to protect African lives. People on the continent of Africa are counting on them.
#africa #medicines #vaccines #diagnostics #medicaldevices #health #healthcare #publichealth #pandemic #arvs #qualitymedicines #safemedicines #substandardmedicines #counterfeitedmedicines #diabetes #insulin #ncds #medicinesforafrica #leniashwenda #mpox #drc #kenya #rwanda #southafrica #uganda #burundi #ghana
📌For all the latest health developments on medicines subscribe to our Newsletter and Youtube channel and share.
📌Follow us on LinkedIn, Facebook, Twitter and like us on Instagram.
Senior pharmaceutical executive passionate about regulatory and developmental strategy and building and leading high-performing teams
1yExcellent article - thankyou - time is of the essence and the leaders need to respond quickly