Stages of lesion development Monkeypox from left to right, top: early vesicle 3mm; small pustule 2mm; umbilicated pustule 3-4mm; ulcerated lesion 5mm; crusting of a mature lesion; partially removed scab. – Picture: Wikimedia Commons
By Kim Heller
A perilous new strain of Mpox is adding to the Continent’s sorrows. While a handful of Mpox cases have been reported in Asia and Europe, the lion’s share is in Africa. Since the start of this year, there have been over twenty-one thousand Mpox cases and over five hundred Mpox related deaths in twelve African Union member states.
Over 90 percent of these are in the DRC, where high levels of displacements have seen the disease spreading rapidly and widely. Most of the fatalities have been children below the age of fifteen years. A highly contagious virus, Mpox is marked by flu-like symptoms and pus-filled lacerations.
The Mpox outbreak was declared a public health emergency of continental security, by the AU’s Africa Centres for Disease Control and Prevention on August 13, 2024. A day later, the World Health Organisation declared Clade Ib, the new strain of Mpox, as a Public Health Emergency of International Concern.
Despite the alarm, the WHO has stated that the Mpox outbreak in Central Africa can be stopped if a comprehensive global response is harnessed. Dr Matshidiso Moeti WHO regional director for Africa, has called for worldwide support and solidarity.
Lancet Global Health has cautioned that limited understanding of how the disease is transmitted, inadequate response capacity, vaccine shortages and extensive cross border movement all pose severe challenges to containment. Lancet warns that the risk of Mpox spreading to neighbouring countries and globally is high.
Without efficient funding, effective networks of collaboration and capacity to study how the disease is spread, the outlook looks bleak. The WHO has acted swiftly to put together a strategic preparedness and response plan, which is set to commence in September.
The WHO has released $1.5 million from its emergency reserve fund to kickstart this initiative, which is estimated to cost $135 million. Africa CDC estimates that a holistic approach to the Mpox outbreak, which would include vaccination, monitoring and public education, across the Continent, could cost as much as $4 billion.
Just days after the declarations by Africa CDC and the WHO on Mpox, South Africa’s President, Cyril Ramaphosa, who serves as the AU’s Champion on Pandemic Prevention, Preparedness, and Response (PPPR), implored AU Member States to increase domestic resource allocation, develop a united approach to capacity building, community engagement, case detection, contact tracing, and cross-border surveillance.
There are real concerns that the ugly face of global inequalities in access to resources, diagnosis, vaccines, and treatment, that was so visible during the Covid-19 pandemic may emerge once again.
President Cyril Ramaphosa called upon WHO and its partners to work closely with Africa CDC to unlock international funding and support and deploy stockpiles of vaccines to the Continent “in order to deliver equitable access to medical countermeasures, including diagnostics, therapeutics, and vaccines”.
The WHO has said that in the two years since the last outbreak “there hasn’t been a single penny of donor money invested at a global level for controlling mpox”.
Ramaphosa spoke of the need to correct the 2022 response to the Mpox outbreak “which had seen vaccines and therapeutics being developed and made available primarily to Western countries, with little support extended to Africa”.
In an article in Bloomberg this week, entitled ‘Missed Warnings, $100 Vaccines and Red Tape — Why Mpox Was an Avoidable Emergency’, authors Asheigh Furlong, Janice Kew, Jason Gale, Antony Squazzin and Naomi Kresge argue that missteps and inaction from governments, health agencies and the funders of scientific research have created the perfect environment for the virus to mutate into the new dangerous strain.
The authors write “despite the availability of an effective vaccine — which costs about $100 a shot — and countries like the US having stockpiled millions of doses, DRC has yet to receive any.
The authors also argue that delays by the WHO in authorizing vaccines has seen localised localized outbreaks spread in and beyond Africa.
Despite the urgency of the current situation, international response has been sluggish. There have been limited donations of vaccinations. Germany has answered the clarion call. The country’s donation of 100,000 Mpox vaccines has almost depleted its stockpile. France has donated 100,000 and the US 50,000, although it has the capacity to produce and provide millions.
Medical anthropologist, Laura Meek recently wrote “the Covid-19 pandemic and the AIDS pandemic that came before it made clear that medical knowledge and access to treatments play out unevenly in a world marred by deep and ongoing colonial legacies”.
The current Mpox outbreak in Africa, and the predicament of those affected, is a tell-tale symptom of the chronically ill and weak state of the Continent, as it still battles against colonial power relations.
Indicative of this is that Africa spends more on servicing debt than on health care. This leaves little resources for mass scale vaccination campaigns, or for research and diagnostic facilities in Africa which are currently extremely limited and inadequate.
On the positive side, there have been some learnings from the Covid-19 pandemic. The Global Pandemic Treaty, developed by the 194 member states of WHO over the last two years aims to increase global collaboration on pandemics, and ensure greater equity in terms of resource allocation. But for now, the Treaty is a work in progress and will provide little relief for Mpox sufferers in Africa.
There are programmes in play that aim to shift the paradigm of Africa as a passive and helpless recipient of health aid and intervention. In February 2024, Africa CDC and the Coalition for Epidemic Preparedness Innovations (CEPI) jointly hosted the African Vaccine Manufacturing Supply Chain Forum.
This forum focussed on supporting and enabling local vaccine manufacturing, through the establishment of local supply chains. The aim was to produce close to 60 percent “of the total vaccines doses required by 2040”.
A recent editorial in The Guardian newspaper centred on how after two years of post-Covid talks, member states of the World Health Organization (WHO) failed to agree plans for a more equitable distribution of vaccines to developing countries. The editorial reads, “Ensuring that life-saving doses are available to countries most in need of them, rather than merely to those with the deepest pockets, is not only a moral imperative.
“It is in the self-interest of every nation, given the propensity of viruses to mutate and migrate. But achieving this requires big money and big concessions from pharmaceutical firms. And so, dispiritingly, the haggling goes on. Maybe the warnings over a new, more severe strain of mpox in Africa will finally concentrate minds.”
For now, the Continent is not ready to manage the Mpox outbreak and will need to rely on the goodwill of the globe. And the prayers of Pope Francis who has said he is praying for all of those affected by Mpox. It may not be enough to save Mpox sufferers, especially in the desperately plagued DRC.
* Kim Heller is a political analyst and author of ‘No White Lies: Black Politics and White Power in South Africa’. This article was written exclusively for The African. To republish, see terms and conditions.
** The views expressed in this article are those of the writer and do not necessarily reflect the views of The African