The Global Response to Mpox: Challenges, Progress, and Future Directions
The rapid spread of Mpox in Africa has raised significant concerns about the virus’s infectiousness and severity. The Democratic Republic of the Congo (DRC) has been particularly hard-hit, with a two-year-old child currently being treated for the disease. This outbreak has not been contained within Congo’s borders; it has spread to neighboring countries, exacerbating public health challenges in the region. When the virus first emerged in 2022, many countries, including the United States, prioritized developing vaccines for the related smallpox virus. However, it wasn’t until 2024 that Africa received its first doses of the vaccine, highlighting a critical delay in addressing the continent’s needs.
Congo has found itself at the epicenter of the current Mpox outbreak, which the World Health Organization (WHO) has declared a public health emergency. Mpox has long been a persistent problem in Africa, causing symptoms such as fever, muscle aches, and a rash. Historically, most cases have occurred sporadically in young children, often following exposure to infected animals. However, the situation in Congo has worsened over the last decade, driven by viruses from a subgroup called clade i. This subgroup has been spreading through person-to-person contact and sexual networks, complicating efforts to contain the virus.
Scientists had been warning about the potential for such an outbreak for years, but these warnings were largely unheeded. Now, researchers are scrambling to develop vaccines, drugs, and diagnostic tools to combat this neglected disease. The previous Mpox outbreak in the Americas and Europe, caused by clade ii viruses, was successfully contained in 2023. However, little attention was given to Mpox in Africa, allowing the virus to continue spreading unchecked. A new subgroup of clade i viruses, called clade ib, has recently emerged in Congo and appears to be more easily transmitted between humans, raising further alarm among public health experts.
According to experts, viruses thrive on opportunity and can adapt in ways that make them more dangerous to humans. There are still many unanswered questions about how clade ia and ib viruses are spreading and how they affect different populations. The rise in Mpox cases is partly due to a decline in immunity from the related smallpox virus. It remains unclear how effective existing smallpox vaccines are against clade ib viruses, adding another layer of complexity to the public health response. Researchers are also exploring other potential treatments for Mpox, as there are currently only a few drugs available to combat the disease.
In addition to medical interventions, changing behavior and promoting preventative measures are key to controlling the spread of Mpox. The lessons learned from the COVID-19 pandemic have enabled rapid access to vaccine financing for Mpox. The global health community has acted swiftly, applying what it learned about rapid access to vaccine financing during the COVID-19 crisis. For instance, Gavi, the Vaccine Alliance, has committed to building a stockpile of Mpox vaccines for future outbreaks. A significant transaction between Gavi and vaccine manufacturer Bavarian Nordic has been concluded, procuring 500,000 doses of the MVA-BN vaccine. This agreement marks an important milestone in the international Mpox response.
The addition of Bavarian Nordic’s MVA-BN vaccine to WHO’s prequalification list is a crucial step forward. This agreement represents the largest contribution of vaccines to the Mpox response to date, bringing the total number of secured doses to 765,000. Affected countries can now plan for an effective vaccine rollout with greater certainty. Donors have pledged at least 3.5 million additional doses, making the target of 4 million doses achievable. Funding for this agreement comes from Gavi’s new first response fund, established in June, which initiated this deal within 50 days, meeting the benchmark for rapid response.
Gavi’s African Vaccine Manufacturing Accelerator (AVMA) aims to address the absence of an ecosystem for vaccine manufacturing in Africa. AVMA will help bring down the cost of Mpox vaccines and provide certainty for local demand during crises. However, vaccines can only make a difference if they are turned into vaccinations. To this end, funding for operational costs was made available immediately after the emergency was declared through Gavi’s first response fund. With operational funds and a clear timeline for vaccine availability, countries can better plan for the vaccine rollout. A comprehensive response to Mpox includes infection prevention, surveillance, and engagement with affected communities.
Gavi’s next strategic period and replenishment will be crucial for maintaining strategic vaccine stockpiles and responding to future health threats. The organization has already purchased 500,000 Mpox vaccines for delivery to African countries, although an estimated 10 million vaccines are needed to meet the continent’s demand. The Democratic Republic of Congo has received 100,000 vaccines despite reporting over 700 deaths and 22,000 cases of the new clade ib strain. Neighboring countries have also reported cases, underscoring the regional nature of the outbreak. Gavi is committed to working with governments and partners to turn vaccines into vaccinations and build a global vaccine stockpile.
The first response fund has been used for the first time to quickly buy vaccines in health emergencies. Gavi will spend up to $50 million on these vaccines, a decision made after the WHO declared Mpox a public health emergency. Campaigners are urging for quicker delivery of vaccines and lower prices from manufacturers. While rich countries like Japan, the US, and Canada have stockpiles of Mpox vaccines, only a small proportion has been pledged to Africa. The UK, for example, has ordered 150,000 vaccines for its own preparations. Manufacturer Bavarian Nordic has praised the deal, saying it will increase the number of available vaccines in Africa.
Gavi will now work on securing funding for a vaccine stockpile. The Bill and Melinda Gates Foundation is a significant contributor to Gavi and also supports independent journalism on global development topics. Gavi’s work is supported by various partnerships and donations, including from the Gates Foundation. The focus remains on providing access to medical treatment and reducing vaccine prices. More information on these topics can be found on the global development site, which offers comprehensive coverage of the ongoing efforts to combat Mpox and other public health emergencies.
The global response to Mpox has been shaped by the lessons learned from the COVID-19 pandemic. While Covid-19 is now considered to be in the past for most countries, the world is grappling with a new global pandemic known as Mpox. The US Centers for Disease Control has reported over 100,000 cases in 122 countries, including 115 countries where Mpox was not previously reported. The World Health Organization declared a public health emergency in August, and while Africa has the majority of cases, the virus has spread to other parts of the world. Pakistan and India, for instance, have both recorded their first confirmed cases of Mpox.
There are currently six confirmed cases of Mpox in Pakistan, but thankfully, no deaths related to the disease have been reported in the country. Health experts believe that the world is better equipped to handle Mpox compared to Covid-19, thanks to the lessons learned from the previous pandemic. Gavi has established a fund of $500 million to secure vaccines during health emergencies and has made a deal to secure 500,000 doses of the MVA-BN Mpox vaccine for African countries. However, Pakistan is still struggling with detecting infected individuals at entry points, with poor surveillance reported at all entry points except Peshawar.
While more help may be available to secure vaccines, it is crucial for local health authorities to ensure timely detection and isolation of cases. Neglecting basic preventative measures could lead to unnecessary loss of lives and health emergencies. This raises questions about whether health authorities in Pakistan have learned any lessons from the Covid-19 pandemic. Proper monitoring, surveillance, and containment measures are essential in preventing the spread of diseases. The global health community must continue to act swiftly and decisively to address the challenges posed by Mpox, leveraging the lessons learned from past pandemics to ensure a more effective and equitable response.