Africa: Mpox Outbreak Exposes Need for Robust Global Vaccine Distribution

A “unprecedented” spike in mpox cases has been reported in 15 countries since January 2024.

The African region, particularly in the Democratic Republic of the Congo (DR Congo), has seen a significant surge in mpox cases, spreading to previously unaffected countries. There have been 3,800 confirmed cases of mpox reported across 15 African nations since January 2024. Over 90% of cases come from the DR Congo, where a new variant emerged in September 2023.

The Democratic Republic of the Congo – at the epicenter of the crisis – has reported more than 18,000 suspected cases of mpox this year, including 629 deaths. After the DR Congo, Burundi is the second most affected country.

Liberia reported a confirmed case on August 30. In Southern and Eastern Africa, 367 confirmed mpox cases, including three deaths, have been recorded in five countries: Burundi (328), South Africa (24), Uganda (7), Rwanda (4), and Kenya (4) as of September 2.

As part of its comprehensive response to health emergencies and outbreaks, the World Health Organization Regional Office for Africa (WHO AFRO) offers support to African countries. WHO declared the current situation a public health emergency of international concern on August 14, warning that it poses a threat to further spread across Africa and beyond. It is the second time such a declaration has been made in the past two years, urging coordinated global efforts, including increased vaccine access and surveillance.

“WHO AFRO has been working closely with governments and partners to bolster mpox control efforts in affected countries,” said Dr. Abdou Salam Gueye, Regional Emergency Director at WHO AFRO. “We have provided initial funding to accelerate outbreak response, deployed rapid response teams to support case investigations and contact tracing, and intensified risk communication and community engagement.”

“To enhance national diagnostic capabilities, WHO AFRO is providing testing kits, reagents, and machines to decentralize testing. We are also supporting genomic sequencing efforts to identify the circulating mpox clades,” he said.

WHO AFRO is ramping up its efforts to combat the ongoing mpox outbreak across the continent. According to Dr. Gueye, “They’re mobilizing funding through the newly launched global Strategic Preparedness and Response Plan, which aims to stop the human-to-human transmission of the virus. With a dedicated budget of $135 million, this plan ensures that our efforts are aligned with global health priorities and fully resourced to meet the challenge head-on.”

The funding releases under this plan have been pivotal in supporting procurement, training, and operations across affected regions.

In the DR Congo, WHO AFRO has deployed surge response teams, including epidemiologists and case management specialists, to strengthen on-ground efforts.

Dr. Gueye added that the organization is also enhancing transparency and communication through a newly launched online portal, which provides real-time updates on the mpox situation in Africa. “This portal is a centralized platform for guiding documents and situation reports on the mpox response,” said Dr. Gueye.

“To ensure vaccine rollout readiness by supporting national regulatory authorities to accelerate approvals. WHO, through the Emergency Use Authorization of Vaccines initiative led by the African Vaccine Regulatory Forum (AVAREF), has triggered the process for accelerated listing of mpox vaccines, which will enhance vaccine access for African countries that have not yet issued their own national regulatory approvals,” he said.

“The Emergency Use Listing is critical for all parties to work together to make mpox vaccines available in high-risk countries.”

He added that carrying out risk communication and community engagement activities including bilateral discussions with countries to tailor support and build capacity in risk communication, which is required for accurate information-sharing with communities and managing misinformation.

Dr. Gueye also acknowledged ongoing collaborations with the U.S. Centers for Disease Control (CDC) to ensure the availability of diagnostic tools.

Closing the Vaccine Equity Divide

In vaccine equity, vaccines are distributed according to need, regardless of economic status. Nigeria became the first African country to obtain vaccines aimed at combating the spread of the new strain of the mpox virus. Despite the increased availability of vaccine doses, experts note that high costs and regulatory challenges have hindered their delivery to central African countries.

WHO has described vaccine shortages and antiviral shortages in Africa as a global health emergency.

“Vaccine distribution must be guided by epidemiological data, which helps us identify priority groups most vulnerable to the virus,” said Dr. Gueye. “We are supporting Member States in developing national plans guided by accurate data to ensure that vaccines are delivered where they are needed most, and we are also negotiating with vaccine manufacturers to secure supplies for African countries at affordable prices and in sufficient quantities.”

Dr. Gueye also emphasized WHO AFRO’s commitment to enhancing equitable access to vaccines.

“To further enhance equitable access, WHO and African Vaccine Regulatory Forum (AVAREF) have collaborated with the United States Agency for International Development (USAID) to secure 50,000 doses of MVA-BN vaccines for DR Congo, and WHO is further engaging the Government of Korea to secure additional resources. Our ongoing efforts are focused on logistics and ensuring the safe and effective distribution of vaccines,” he said.

Why WHO Holds Off on Mass Mpox Vaccination

The WHO is not recommending mass vaccination as it did during the COVID-19 pandemic because of several factors, including the nature of the disease in question, the availability of vaccines, and the epidemiological context of outbreaks. To ensure that vaccination efforts are effective and equitable, the WHO recommends a more targeted approach that takes into account population immunity levels, transmission risk, and logistical capacity of health systems.

“COVID-19 was declared a Public Health Emergency of International Concern, like mpox, but the viruses are very different, said Dr. Gueye. “For some outbreaks, it makes sense to try and vaccinate everyone, and for some, it can be more sensible to use a more targeted approach. Remember with COVID-19 too, that at first, the focus was on vaccinating those at highest risk of infection and poor outcomes. With mpox we will start by doing the same, to drive down transmission and save lives.”

“While vaccines are a crucial component of the mpox response, they are not the only intervention. Other interventions equally essential in preventing the spread of the disease and used to contain the 2022 mpox outbreak, include ramping up surveillance, contact tracing, and risk communication and community engagement,” he said.

Dr. Gueye said that WHO has also introduced a Vaccine Introduction Readiness Assessment Tool (VIRAT) to support countries in their immunization strategies. VIRAT provides a structured approach to help countries evaluate their readiness to introduce and implement new vaccines into their national immunization programs. “By using VIRAT, countries can identify gaps and prioritize areas for improvement. WHO has created a vaccine pillar budget to support its activities related to vaccines and is collaborating closely with national immunization technical advisory groups (NITAGs) to align vaccination strategies and prepare for vaccine deployment,” he said.

Strengthening Healthcare for Future Outbreaks

“Successful strategies were utilized during the Ebola outbreak in West Africa and in the COVID-19 response framework, which should also be implemented during this current emergency. We have also applied these strategies here at VillageReach and witnessed their effectiveness,” said Dr. Bannet Ndyanabangi, VP of Global Programs, at VillageReach.

According to Dr. Ndyanabangi, “The best health systems are responsive and have three essential qualities: They are available when needed for even the hardest-to-reach communities; they adapt to shocks and stresses, such as what we are seeing now with mpox; and they routinely factor in and respond to the needs and preferences of under-reached communities. These are strategies that we know work to maintain these principles.”

He said that the critical role of effective risk communication and community engagement, particularly through local leaders and health workers, in maintaining routine services and promoting immunization. He highlighted that ongoing awareness campaigns and the integration of health promotion into community efforts have led to increased vaccination rates. Dr. Ndyanabangi also said the importance of combining routine health interventions with mpox response efforts to ensure the continued delivery of essential services. Outreach services are vital in overcoming fear and stigma related to health facilities, which can otherwise prevent people from accessing critical care. He said that the necessity of flexible funding to support both routine and emergency health services, helps alleviate the financial burden on health systems and ensures uninterrupted service delivery.

“Due to mobile devices’ ubiquitous nature, telehealth solutions create powerful options for reaching communities that fear visiting health facilities during outbreaks. They offer a safe way to connect people with trained health workers who can address routine health questions and questions related to the outbreak. We have seen them used during the height of the COVID-19 pandemic in Malawi through our Chipatala cha pa Foni  (Health Center by Phone in Chichewa, a local language spoken in Malawi),” he said.

WHO AFRO is developing a long-term strategy to improve outbreak preparedness.

“Our role as a partner that is enabling countries to prevent, detect, and respond to disease outbreaks makes us part of a larger ecosystem of stakeholders who are also working to deliver quality, timely care during times of emergency,” Dr. Gueye said. “While we may not be directly involved in vaccine distribution for example, we play a key part in helping countries access these vaccines through our AVAREF initiative, which has been spearheading Emergency Use Listing to help countries procure vaccines faster. In this way, we are contributing toward strengthening countries’ preparedness by collaborating with other health actors to address specific needs within our health systems and provide solutions to safeguard our communities.”

“To support Member States’ long-term emergency preparedness and response capabilities, WHO AFRO has launched three flagship initiatives. These initiatives aim to build more resilient and responsive health systems that are better equipped to anticipate and effectively manage outbreaks,” said Dr. Gueye.

Dr. Ndyanabangi added, “To combat the mpox outbreak and ensure equitable distribution of medical supplies, we must focus on accelerating local production, fostering public-private partnerships, utilizing digital supply chain management, and investing in training and capacity building. These measures will reduce dependency on international supply chains, optimize distribution, and improve our overall response to health emergencies.”

Learning from COVID-19 for a Better Mpox Response

“COVID-19 taught us, among other critical lessons, the interconnectedness of global health. A health crisis in one region can rapidly spread to others,” said Dr. Gueye.

The resurgence and declaration of mpox as a Public Health Emergency of International Concern by the WHO should be a wake-up call for all global health leaders in the aftermath of COVID-19. During the coronavirus outbreak, it was demonstrated that health security and strong pandemic responses were not just about having the right vaccines available, though they remain a critical tool, but that collaboration for rapid response was also driven by the right systems and structures, according to GAVI.

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The delayed distribution of vaccines shows that healthcare inequities in global healthcare have not yet been addressed in a significant way after the COVID-19 pandemic.

“This is another wake-up call,” said Dr. Ndyanabangi. “The pandemic highlighted the need for equitable distribution of vaccines. Future responses must prioritize fair access, ensuring it is not side-lined in global health strategies. One way is to establish agreements with manufacturers to ensure timely delivery during emergencies. The Africa Medical Supplies Platform (AMSP) is uniquely positioned to play this role. Countries should prioritize planning and negotiation for vaccine access to stay ahead of outbreaks.”

“Africa has been affected by a series of events in recent years that have had major health impacts including disease outbreaks such as Ebola and the COVID-19 pandemic, as well as the devastating effects of climate change. These health threats are far more frequent on the continent than in other regions, with a minimum of 2-3 health emergencies occurring each week and an average of 100 disease outbreaks tackled each year,” said Dr. Gueye.

WHO AFRO is building on its experience supporting countries to navigate the ongoing health crises. Its Emergency Preparedness and Response (EPR) Cluster for example is working with countries across the continent to build stronger pandemic preparedness and response capabilities through the three flagship initiatives pioneered in 2022, aimed at improving preparedness, detection, and response in all Member States.

“Through these initiatives, we are supporting countries to build resilient health systems that can manage emergencies effectively, transforming disease surveillance systems to build capacity to detect health threats, and strengthening on-ground support by training emergency responders who can be deployed within 1-2 days of a reported emergency,” he said. Today, for example, countries affected by the mpox outbreak have swift access to essential supplies including Personal Protective Equipment (PPE) and testing kits,” said Dr. Gueye.

According to WHO AFRO, hubs in Senegal and Kenya are strategically positioned to ensure that critical supplies reach their destinations in the shortest time possible, and are leading efforts to slash outbreak response time from 21 days to 24-48 hours. In just 48 hours, over 30 first responders were deployed to the epicenter in DR Congo and other affected Member States to support surveillance and response activities.

“The progress we’ve made is a testament to the power of collaboration, innovation, and relentless commitment to global health. More than ever before, we are better equipped to mitigate the spread of disease, reduce mortality, and protect communities,” said Dr. Gueye.

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