Monkeypox: Urgent Need to Deliver Monkeypox Vaccines to Africa | Future Planet

On August 14, 2024, the World Health Organization (WHO) declared a smallpox epidemic, formerly known as monkeypox, an international public health emergency. This is the second time in two years that this has happened, but it is not and should not be such a common occurrence.

Endemic in the Democratic Republic of Congo (DRC), the country where most of the cases in this outbreak are concentrated, the disease is now also present in several neighboring countries: Burundi, the Central African Republic, Rwanda, Uganda, Kenya and the Ivory Coast. It has also made the leap to Europe, where the first case was reported in Sweden, and Asia, where the first case was detected in Pakistan just a week ago. In 2024 alone, a total of 18,910 cases and 541 deaths have been reported in Africa, an increase of 160% over the same period last year, and these numbers are growing rapidly. Moreover, it should be taken into account that these numbers could be much higher, since many patients are not diagnosed (in the DRC, it is estimated that only 24% of patients undergo diagnostic tests).

The situation is even more dire in the overcrowded camps for displaced people in North Kivu and South Kivu provinces, where almost a million people live in overcrowded conditions and where the spread of MPOX is spreading at breakneck speed.

In case of epidemics, it is essential to react as soon as possible and take all necessary measures: strengthening surveillance, raising public awareness, training health personnel in case management, creating isolation zones in hospitals, distributing protective equipment and conducting vaccination campaigns (if there is a vaccine for the disease, as in the case of MPOC).

Preventive measures are difficult to talk about in rural areas of the DRC, as the harsh living conditions make them very difficult to implement. Families consist of an average of six people and live in small spaces (many houses have one or at most two rooms, with several people sharing a bed), there is often no sanitation and houses usually do not have drinking water or adequate places to practice proper hygiene. In addition, the resources available to the population are very limited, food is shared and people eat with their hands. The situation is even more difficult in the overcrowded camps for displaced people in the provinces of North Kivu and South Kivu, where almost a million people live in overcrowded conditions in deplorable conditions due to the conflict between the government and the M23 rebels and where mpox is expanding at a dizzying rate.

In these circumstances, one of the most effective measures to stop transmission is vaccination. And, unfortunately, we have not yet been able to begin implementing it.

The first vaccines in the world were against smallpox. These vaccines (derived from cow cells) were used until 1980, when the disease was eradicated, but it has been shown that this vaccine provides some protection against MPOX, since both viruses belong to the same family. There are now third-generation vaccines that are much safer than the first ones: MVA-BN, produced by a Danish pharmaceutical company (Bavarian Nordic), and another called LC16, which is produced in Japan. The first was widely used in Europe, the United States and Canada during the 2022 epidemic and requires two doses 28 days apart, with an estimated price of 100 euros each.

WHO recommends vaccinating only people who are most at risk: close contacts of sick patients, health care and laboratory workers, and sex workers or people with multiple partners.

Unlike the Covid pandemic, the vaccines against mpox are not intended to vaccinate the entire population, as infection is not easy. Therefore, WHO recommends vaccinating only those people who are most at risk: close contacts of infected patients, health care and laboratory staff, and sex workers or people with multiple partners.

The DRC government has had a plan in place for months to begin a vaccination campaign until vaccines become available. The Africa Centres for Disease Control and Prevention (the African Union’s public health agency for disease control and prevention) estimates that the continent needs 10 million doses, including more than 3 million for the DRC. But there are two problems why this is not happening: a lack of manufacturing capacity worldwide and a shortage of vaccines in the DRC.

Production capacity is currently insufficient (Bavarian Nordic only ensures production of 10 million vaccines by the end of 2025, which is clearly too late to respond to this epidemic). However, it is possible to transfer technical capabilities to increase production on the African continent. This will reduce costs and production capacity and lead to lower vaccine prices.

We ask all governments that have previously purchased their available doses to urgently transfer them to countries in need. The sooner appropriate measures are taken, the fewer cases there will be and the more lives will be saved.

The declaration of a public health emergency of international concern by WHO primarily allows for the mobilization of resources and the coordination of efforts to contain the spread. It facilitates the allocation of emergency funds, accelerates the inclusion of vaccines in the emergency use list, and allows for the procurement of vaccines between countries, ensuring that those affected can receive the support they need to effectively control the epidemic.

We therefore ask all governments to urgently transfer the previously acquired doses they have at their disposal to countries in need. The sooner action is taken, the fewer cases there will be and the more lives will be saved. At MSF, we are on the front lines of the outbreak in the DRC and have treated over 1,000 patients to date, provided information sessions to thousands of people, are working with the country’s Ministry of Health to diagnose and monitor cases, and we are training local health workers, but for now the priority is to deliver the vaccines and we can start vaccinating.

Spain has announced that it will send 500,000 doses of the vaccine in the near future, enough to vaccinate 250,000 people. This is a first step and an example to follow, but many more vaccines will be needed and more countries will need to join the initiative, as requested by the Ministry of Health.

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