The first 10,000 doses of mpox vaccines are set to arrive next week in Africa, marking a significant step forward for the continent grappling with the mpox virus, which has caused considerable alarm globally. This rollout is seen as both urgent and necessary, especially since the virus’s new strain, clade Ib, has circulated for years and has recently expanded its reach beyond the Democratic Republic of Congo.
The slow distribution of these vaccines—while over 70 countries outside Africa have already received them—highlights the persistent inequities within global health systems, as per public health officials and scientists. They argue the lessons learned from the COVID-19 pandemic about vaccine distribution and healthcare access have not been effectively acted upon. The World Health Organization (WHO) only recently initiated processes to ease vaccine procurement for poorer regions, initiating what could have been started years prior.
Mpox, which manifests with flu-like symptoms and painful, pus-filled lesions, can spread via close contact between individuals. On August 14, the WHO termed it as a global health emergency, highlighting the urgent need for vaccination efforts, particularly as the new strain is believed to spread more readily than its predecessors.
Responding to inquiries about these delays, the WHO announced they would simplify some approval procedures to expedite access to vaccines for countries with limited resources. Many poorer nations are unable to afford the costly vaccines via direct purchase. Currently, two vaccines are on the market—one developed by Denmark's Bavarian Nordic priced at approximately $100 per dose, and the other by Japan’s KM Biologics, for which pricing remains undisclosed.
Due to the protracted timeline for WHO approval, many African nations, as well as the Africa Centres for Disease Control and Prevention (CDC), have resorted to soliciting donations of vaccines from wealthier countries. This complicated process often falters when richer countries prioritize their own vaccine supply over donations intended for poorer nations. Interestingly, the first mpox vaccines on their way to Africa are being donated by the United States, rather than provided through the U.N.
Helen Rees, who serves on the Africa CDC's mpox emergency committee and also helms the Wits RHI Research Institute based in Johannesburg, expressed frustration at the latest delays, dubbing the current state of vaccine access for Africa 'outrageous.' Following the previous mpox outbreak, swift repurposing of smallpox vaccines allowed many countries to protect those at higher risk efficiently. Yet, this speed has not translated to the present situation, as Africa continues to wait for access.
Compounding the issue, WHO’s hesitance to permit vaccine purchases delayed intervention at multiple levels. Although CDC data from the U.S. indicates 1.2 million vaccinations have been administered within its borders, affected regions within Africa waited for the green light to purchase these same vaccines.
Public health officials estimate at least 10 million doses may be necessary for Africa. But the WHO has insisted on obtaining comprehensive manufacturer data before granting emergency licenses for the mpox vaccines, delaying distribution plans. The need for vaccines has intensified as reported cases of mpox have soared, with over 99,000 confirmed cases and 208 fatalities recorded globally since the start of 2022, figures likely less than the actual rate due to underreporting.
Currently, the situation is dire, particularly in the Democratic Republic of Congo, which is considered the epicenter of the outbreak. Reports indicate over 27,000 suspected cases and at least 1,100 deaths since January 2023, predominantly affecting vulnerable populations like children caught up amid armed conflicts and other disease outbreaks.
These vaccines are set to go to Nigeria first rather than the DRC, as prior discussions had seen the U.S. partner with Nigeria for direct vaccine assistance. Nigeria itself has seen nearly 800 suspected cases without any reported deaths this year. While the U.S. Agency for International Development has also pledged vaccines for the Congo, the exact timelines for their arrival remain unclear.
Compounding the delays, the Congolese government struggles with political instability and logistical challenges, hampering timely requests for vaccine supplies from agencies like Gavi. The necessary approvals for use of the vaccines were only issued recently, and it remains uncertain whether donations expected from Europe will arrive on schedule.
Personal stories from those affected paint the grim reality of the outbreak. One of many children infected—with some estimates reaching over 100 recent cases in specific areas—is seven-year-old Sagesse Hakizimana from eastern Congo. His family, fleeing from conflict, is now facing the uncertainty of health outcomes due to mpox. His mother, Elisabeth Furaha, poignantly described the tragedy of hoping for safety from war only to contend with illness devastating her child. 'We need a vaccine for this disease. It’s bad, and it weakens our children,' she implores.
Even once the vaccines arrive, numerous challenges loom, particularly concerning vaccination strategies. Currently, Bavarian Nordic’s vaccine is targeted at adults, whereas KM Biologics can be administered to children, albeit it poses unique logistical hurdles. Experts remain divided on which demographics should be prioritized, though proposals include focusing on close contacts of verified cases.
One notable figure, Jean Jacques Muyembe—who co-discovered the Ebola virus—underscored the importance of public health messaging alongside vaccination efforts. Highlighting previous hesitance toward vaccination during the COVID-19 pandemic, he pointed out the need for broad community consensus to effectively control mpox spread.
Looking forward, experts argue there should have been greater preemptive focus on the mpox vaccine supply protocols and diagnostic processes earlier on. Ayoade Alakija, who co-chairs a global health partnership, suggested the urgency with which the WHO responded signals broader inequities, indicating diseases affecting populations of color often remain sidelined.
The WHO, recognizing its previous delays, now urges all global stakeholders—governments, manufacturers, and community organizations—to rally efforts to increase vaccine availability. The head of the Africa CDC, Jean Kaseya, is actively working to get more African manufacturers involved to improve supply chains, aiming to reduce costs for vaccines.
