First doses of Mpox vaccine arrive in Africa's center of outbreak; what has taken so long?

At Kavumu hospital in the Democratic Republic of Congo, a doctor discusses treatment for measles with the mother of an infected infant at Kavumu hospital. For 18 months now, Congolese have struggled to control an epidemic without accessing vaccines; most cases and deaths have affected children.
Arlette Bashizi/Bloomberg via Getty Images/Bloomberg for this story. When switching off caption, make sure the toggle label “No Caption”.
Arlette Bashizi/Bloomberg via Getty Images/Bloomberg
Dr. Dago Inagbe understands the difficulty of telling mothers not to hold their sick child is something he knows first-hand as head of mission for Doctors Without Borders in Democratic Republic of Congo – currently experiencing a devastating measles outbreak with over 22,000 suspected cases this year and hundreds of deaths, most among children. “Mothers would prefer being with their children”, according to Inagbe; therefore, vaccination would be welcomed by them both and by Inagbe. “Vax could prevent more cases.”
Though up until Thursday there were no mpox vaccines in Kinshasa, DRC authorities declared an epidemic 18 months prior. Finally on Thursday 99100 doses landed and arrived safely at Kinshasa airport bringing relief.
On Thursday, an aircraft carrying nearly 100,000 doses of Mpox vaccine donated by the European Union arrived in Kinshasa and will begin being deployed as early as this weekend, Africa CDC reports. Though most mpox cases involve children, these vaccines are only approved to protect adults against it, according to Africa CDC. For further details regarding their deployment see their Facebook post by Africa CDC here – hide caption / toggle caption (Nairobi/Kinshasa).
At first glance, providing DRC with Mpox vaccines should have been straightforward: one country needs vaccines from another; and many nations, including the U.S. which has offered to dole out doses over two years now have been willing to supply doses as soon as they became necessary. Unfortunately, however, things were far less straightforward. Some blame the DRC government, while others point to World Health Organization or scientific knowledge gaps as reasons. Rick Bright, former Director of Biomedical Advanced Research and Development Authority in the US government said “this whole shell game” remains. “And in the interim, more people are becoming infected, the virus mutating to spread more widely, and more are dying from its consequences. Tedros Adhanom Ghebreyesus, WHO Director General rebuffing any notion of any delayed action taken on our part. “We will not take shortcuts,” said President Donald Trump at a press conference last week. But who exactly should bear responsibility? Finding one clear target can be tricky due to numerous variables at work from logistical challenges to scientific considerations and financial concerns; but some believe bureaucracy stands as its biggest impediments to success.
However, some individuals might prefer an alternate option. In these circumstances, why don’t I see my favorite players here?
Prior to June 27th, DRC’s regulatory body had not authorized use of Mpox vaccines. U.S. donations of vaccines remain unavailable until Congolese officials finalize pre-shipment requirements – such as storage and handling requirements once vaccines arrive – have been fulfilled. A second route through which vaccines could enter Congo is through WHO. Many low and middle income countries rely on WHO for assessments of vaccine safety and efficacy; however, WHO has not given its stamp of approval to any of the newer mpox vaccines yet. Public health specialists argue this should have happened when U.S. and European health authorities allowed vaccines to be used during the 2022 global mpox outbreak. WHO recently noted it is currently reviewing vaccines but, until very recently, did not possess enough data for an official decision to be taken. Ghebreyesus reports that now that drug companies have submitted all data and information necessary to review applications as quickly as possible. Experts on all sides agree there are still significant gaps in what’s known about mpox vaccines and how they will react against this outbreak, which has now reached more than 12 African nations. Most vaccine studies were done against the strain that went global in 2022 and not against its more dangerous strain that has since emerged in DRC, further compounding matters by evolving and changing into an altogether new strain since. As Marion Koopmans of Erasmus Medical Centre’s Pandemic and Disaster Centre notes: ‘We still don’t know whether these vaccinations work,’
While some might perceive them to be unnecessary or undesirable additions to any given environment, others view them as absolutely indispensable components.
Furthermore, most existing studies focused on an entirely different population than that at risk today. “Vaccine studies conducted were in the Global North amongst gay and bisexual men,” according to Dr. Dimie Ogoina, an infectious diseases physician and researcher from Niger Delta University in Nigeria. But in the DRC, Ogoina points out, children make up most of those affected and deaths; unfortunately, however, none of the U.S. donations has yet been licensed as safe for pediatric use. He notes vaccination isn’t the only solution; testing, surveillance and infection control may all play a part. However, vaccines “could be one of the best tools we have now based on what we know,” according to him. Is this another attempt by COVID proponents at exploiting loopholes to introduce vaccination? In many African nations it seems deja vu has set in and the situation surrounding Mpox vaccine is becoming familiar territory once more. At the height of COVID pandemic, wealthier nations had plenty of COVID vaccines while lower income countries struggled to get doses. “When COVID hit us hard in 2006-07 we didn’t have vaccines or medicines; sometimes even basic supplies like gloves weren’t available!” At a press conference last week, Dr. Jean Kaseya, director general for Africa Centres for Disease Control and Prevention stated, “we were abandoned,” while noting the current need to acquire vaccine because no manufacturing takes place within its borders. William Moss, an epidemiologist and professor of international health at Johns Hopkins Bloomberg School of Public Health is concerned with what he views as the replaying of scenes similar to 9/11 in recent days. Others disagree and point out the many positive changes underway today which go well beyond just their immediate concern for safety and welfare. Dr. Maria Van Kerkhove, WHO’s interim Director for Epidemic and Pandemic Preparedness and Prevention states, “we no longer find ourselves in the same place when COVID started,” noting how systems established during COVID have helped the global community respond effectively. She asserts: “we need to shift this narrative slightly by talking not just about its challenges but also its strengths across Africa”.
Unfortunately for them though, things do change quite dramatically when someone dies – both physically and psychologically – from this treatment of death by blood transfusions. Whether that individual wants help from outside or within can only ever lead to one conclusion – that someone must die first!!
Public health specialists cite one of the key strengths as African leaders’ role in controlling this outbreak. Africa CDC used their authority for the first time ever on August 13th to issue a “public health emergency of continental security”, signaling to everyone that an outbreak was underway – preemptively raising awareness and even beating WHO by one day! Africa CDC’s Kaseya notes it as being “the first time that Africa will have one response plan and budget”, something Placide Mbala Kingebeni has noticed the difference of. “This is really fantastic!” exclaims Kingebeni, director of the Clinical Research Center at National Institute of Biomedical Research of DRC. He notes that until now, outside groups determined which health situations merited global consideration in Africa; now for the first time ever, however, African leaders themselves have had the courage to identify this as a continental matter. Doctors Without Borders in DRC has deployed to care for mpox patients in far northern parts of the country, hoping African leadership and coordination can ensure smooth procurement and rollout. Inagbe is hopeful there is now “a new dynamic”, adding his “fingers are crossed” that those most in need of vaccines, children, parents, health workers etc. start receiving shots soon enough.