WeeklySA_AdminIMPASSE: Vaccine maker says there is ample production capacity to supply Africa with some two million mpox doses by end of this year – but no funds donors up to now…
By Monk Nkomo
With more than 16 000 cases reported in more than 75 countries and the number of confirmed mpox infections having risen by 77% from late June through early July, according to WHO and UN data, Africa’s access to vaccines to stem the virus remains uncertain.
Meanwhile, global health officials have confirmed an infection with a new strain of the mpox virus in Sweden and linked it to a growing outbreak in Africa, the first sign of its spread outside the continent a day after the WHO declared the disease a global public health emergency.
The WHO’s declaration on Wednesday of the outbreak in Africa as a public health emergency of international concern, its highest level of alert, comes after cases in the Democratic Republic of Congo (DRC) spread to nearby countries.
In DRC, there have been 27 000 cases and more than 1 100 deaths, mainly among children, since the current outbreak began in January 2023. Experts fear that the number of infections is higher. The disease, caused by the monkeypox virus, can cause a painful rash, enlarged lymph nodes and fever and can make some people very ill.
The Swedish health authorities have confirmed the first case outside the African continent.
“The case in Sweden takes place in a person who became infected while staying in an area in Africa where there is currently a major outbreak,” Swedish health authorities said.
Congo is regarded as the centre of the infections. Four African countries have recently recorded the first cases: Burundi, Kenya, Rwanda and Uganda. And mpox cases have also already been identified in Morocco, Egypt, Nigeria and South Africa. And now also in Europe.
WHO experts decided at an emergency committee in Switzerland to declare a top-level international medical emergency. In those ways, it wants to alert authorities around the world to prepare for possible outbreaks. The new variant of mpox is said to have a mortality rate as high as 10 percent.
Meanwhile vials of Bavarian Nordic mpox vaccines are now in ample supply, officials say. But Bavarian Nordic has been quoted as saying it has no plans to sell its vaccines directly to African countries.
Yesterday, the company’s vice-president of Investor Relations told Health Policy Watch said donations from rich countries would likely be the main source of supplies.
WHO’s announcement sent a wake-up call to the world regarding the ‘perfect storm’ of mpox virus transmission brewing in the DRC and a dozen other neighbouring countries in central and southern Africa.
And, contrary to the situation in 2022-23, there is now ample production capacity to supply Africa with some two million mpox doses by the end of this year, and another eight million doses by end 2025, Bavarian Nordic’s CEO Paul Chaplin, told Bloomberg News on Wednesday.
“What we are missing are the orders,” Chaplin said. Even so, the high costs of the vaccine, estimated at $100 (approx. R1 800) a dose, as well as the huge challenges of deploying jabs in conflict-ridden DRC create a headache to actually matching supply with need, observers say.
While Africa CDC officials talked about their aims to deploy millions of mpox vaccine doses, to counter the continental health emergency, declared on Tuesday, near-term procurement is likely to be far more limited, if it relies on third party donations – as was the case with COVID vaccines.
Shortly after the WHO emergency announcement on Wednesday, the United States offered to donate 50 000 doses of the BVN vaccine from its stockpiles, while the European Union announced a donation of 175 000 doses to be combined with a pledge of 40 000 by Bavarian Nordic itself.
The Africa Union’s health watchdog has also declared a public emergency over the growing mpox outbreak on the continent saying the move was a clarion call for action.
“I declare with a heavy heart but with an unyielding commitment to our people, to our African citizens, mpox as public health emergency of continental security,’’ Jean Kaseya, Head of the Africa Centres for Disease Control and Presentation (Africa CDC) said during a media briefing this week.
South Africa has also been affected by the disease with 22 cases reported so far since May this year and three deaths confirmed in KwaZulu-Natal and Gauteng provinces.
The WHO Regional Director for Africa, Dr Matshidiso Moeti, said :“Significant efforts are already underway in close collaboration with communities and governments, with our country teams working on the frontlines to help reinforce measures to curb mpox. With the growing spread of the virus, we are scaling up further through coordinated international action to support countries to bring the outbreaks to an end.”
Committee Chair, Professor Dimie Ogoina said the current upsurge of mpox in parts of Africa, along with the spread of a new sexually transmissible strain of the monkeypox virus, was an emergency, not only for Africa, but for the entire globe. ‘’Mpox, originating in Africa, was neglected there, and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself.”
This PHEIC determination was the second in two years relating to mpox. Caused by an Orthopoxvirus, mpox was first detected in humans in 1970, in the DRC. The disease was considered endemic to countries in central and west Africa.
In July 2022, the multi-country outbreak of mpox was declared a PHEIC as it spread rapidly via sexual contact across a range of countries where the virus had not been seen before. That PHEIC was declared over in May 2023 after there had been a sustained decline in global cases.
Mpox has been reported in the DRC for more than a decade, and the number of cases reported each year has increased steadily over that period. Last year, reported cases increased significantly, and already the number of cases reported so far this year had exceeded last year’s total, with more than 15 600 cases and 537 deaths.
According to WHO, the emergence last year and rapid spread of a new virus strain in DRC, clade 1b, which appeared to be spreading mainly through sexual networks, and its detection in countries neighbouring the DRC was especially concerning, and one of the main reasons for the declaration of the PHEIC.
In the past month, over 100 laboratory-confirmed cases of clade 1b have been reported in four countries neighbouring the DRC that have not reported mpox before.
These included Burundi, Kenya, Rwanda and Uganda. Experts believed the true number of cases to be higher as a large proportion of clinically compatible cases had not been tested.
Several outbreaks of different clades of mpox had occurred in different countries, with different modes of transmission and different levels of risk.
The two vaccines currently in use for mpox have been recommended by WHO’s Strategic Advisory Group of Experts on Immunization and were also approved by WHO-listed national regulatory authorities, as well as by individual countries including Nigeria and the DRC.
