No African country affected by the outbreak of a new variant of mpox has received the promised vaccine, delaying the rollout planned for last week.
The Democratic Republic of Congo (DRC) is at the centre of an outbreak of the new clade 1b variant, with 18,000 suspected cases and 629 deaths this year, the World Health Organization (WHO) said.
The variant has also been found in Burundi, Uganda, Rwanda, Kenya, Sweden and Thailand.
WHO chief Tedros Adhanom Ghebreyesus said on Friday that the first doses should arrive in the DRC “within days,” but similar statements were made recently about donated vaccines from the US, which did not arrive on time.
There has been no coordinated response, with Spain promising as many as 500,000 doses, while France and Germany have each promised 100,000 and the US has said it will donate 50,000. None of the promises have been fulfilled so far.
The Africa Centres for Disease Control and Prevention (Africa CDC) reported on Wednesday that the $245 million (£187 million) it had requested to combat the outbreak had been only 10% funded.
Although mpox was first identified in humans in the Democratic Republic of Congo in 1970, African countries vulnerable to its spread rely on vaccine donations from wealthier nations’ supplies.
According to Dr. Dimie Ogoina, an infectious disease physician at the Niger Delta University Hospital, neglect, both internationally and by African governments, means that, decades after mpox was first identified, there are still not enough vaccines or even treatments available to affected countries.
He said it was only during the global outbreak in 2022, which saw the virus spread to Europe and North America, that a broader international response to the disease was seen.
Ogoina said it is important for African countries to invest in protection against diseases like mpox themselves, so that they do not become dependent on donors.
“The manufacturers are not based in Africa,” he said. “They tend to, consciously or unconsciously, favour the Global North. So when there is a list of people to be brought in, Africa is always at the bottom of the list and we are always the last to get supplies.”
The WHO declared a public health emergency in mid-August in response to the spread of clade 1b, a recently identified variant that spreads through close physical contact, including sexual contact, as well as within households.
Concerns have been raised about the high number of deaths among children, with mortality rates as high as 8% for children under 15 years of age. According to WHOThe latest update from Africa CDC on Tuesday showed a sharp increase in cases to nearly 4,000, compared to 1,200 the previous week.
Last week, social organizations a letter published to Gavi, the global vaccine alliance, asking it to advocate for lower prices for the vaccine produced by pharmaceutical company Bavarian Nordic. Currently, a dose costs between $50 and $75.
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“The continuing injustice of MPOX is due to long-standing indifference and inequality, stigma, inertia, bloodless use of public power and, yes, greed,” said Peter Maybarduk, director of access to medicines at the US-based campaign group Public Citizen, which signed the letter.
He said that while the US government had invested in the development of the Jynneos vaccine used against mpox, production and “exorbitant” prices were now controlled by Bavarian Nordic.
Victorine de Milliano, policy advisor at Doctors Without Borders’ arm that campaigns for fair medical treatment, MSF Access, said there was a “systemic problem” that left lower-income countries struggling to access medical supplies in public health emergencies, which was highlighted during the Covid pandemic when wealthier countries were able to stockpile vaccines, tests and treatments.
“It’s really a sense of déjà vu. You would think that we would learn lessons from the Covid-19 pandemic, but we are seeing the same patterns again,” she said. “Low- and middle-income countries are now also dependent on those donations from high-income countries that do have access to the vaccines. And we are also seeing a vaccine monopoly, (where they) are being sold to the highest bidder.”
Bavarian Nordic told Africa CDC it can deliver 2 million doses this year if orders are approved, allowing the company to reallocate resources from other production lines.
A spokesperson for the company told the Guardian it had donated 55,000 doses and would provide an update once an agreement was reached to supply doses on a larger scale.
The company also said it was open to tiered pricing so that countries with smaller economies pay less and countries that can order more vaccines, over a longer period, also pay less.
Ogoina said there were promising signs that political leaders in Africa were vigilant in responding to the public health emergency and were discussing how to invest in addressing it. There were also pledges of support from outside the continent, but this needed to be sustained.
“(There have been) a lot of commitments, statements, promises made, but what happens after three months? What happens after six months? What happens after a year? Will people still be interested, or will they lose interest?” he asked.
