Are Mpox Africa unstoppable?

New cases appear every week and more than a thousand people have died: African health authorities have been battling Mpox disease for months. Although vaccination campaigns have begun, there appears to be no end in sight to the pandemic.

“Mpox in Africa is not yet under control,” Jean Kaseya, director of Africa's health agency Africa Centers for Disease Control and Prevention, repeats in his weekly situation reports.

For Cassia and other health experts, the situation has a sense of déjà vu. As has been the case during the pandemic, the weaknesses of the continent's healthcare infrastructure are becoming increasingly apparent: too few laboratories and testing capacity, but most importantly too little in-house vaccine production. Health authorities on the continent rely on wealthy countries to provide vaccines from their stocks to protect against the virus.

Outbreaks in 20 countries

According to the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), there are now cases of Mpox in 20 African countries, with the first case appearing in Angola last week. The number of cases has risen to nearly 60,000 since the start of the year, and 1,164 people have died from Mpox so far this year.

Mpox treatment in Congo.Image: trapezoid

Mpox, formerly known as monkeypox, occurs repeatedly in central Africa and is primarily transmitted to humans by rodents. There have not been any major outbreaks in decades, largely due to the formerly common smallpox vaccinations. It also protects against the closely related Mpox virus. Since 1980, smallpox has been considered eradicated and vaccination has been discontinued.

Global Mpox Alerts

In mid-August, the Centers for Disease Control and Prevention (CDC Africa) and the World Health Organization (WHO) announced the highest alert level due to the Mpox outbreak in Africa and new, potentially more dangerous Ib variants. The aim is to encourage authorities around the world to be more vigilant. A common strategy is also needed across the continent as cases spread from the worst-affected Democratic Republic of Congo to an increasing number of countries outside Central Africa. However, more than 90% of cases still occur in Central Africa. Of the 2,680 new cases last week, 95.5% were also in Congo, Uganda and Burundi.

Delays in vaccination campaign

As of the first half of November, the Democratic Republic of Congo, Rwanda and Nigeria had received a total of 280,000 doses of vaccine. But vaccinations have been delayed in Congo and Nigeria. Weak infrastructure, lack of cooling options and power bottlenecks across large areas have made vaccine distribution more difficult, especially in rural areas.

Moreover, the vaccine doses delivered so far are ultimately just a drop in the ocean: When the alert was announced, Kasea had said the continent would need at least 10 million doses to stem the outbreak.

No solution for childhood vaccinations

In addition, particularly affected groups include children and adolescents under the age of 15. In various countries, their prevalence ranges from 40% to more than 50%. However, data are not available for all affected countries as not all countries record cases of the disease individually in children.

However, the existing Mpox vaccine has not yet been approved for use in children. There is now hope here, CDC Africa's Mpox manager Ngashi Ngongo said in an updated assessment on Thursday. Japan has pledged to provide three million doses of the vaccine, which is also available to children one year and older, to the Democratic Republic of Congo. However, the ratification process in African countries is still pending.

Distancing and hygiene measures have been put in place to minimize infections during the coronavirus pandemic, but with limited success, especially in hard-hit eastern Congo. Some 7 million people have fled armed fighting in conflict areas and live in extremely cramped refugee camps.

“You can't even think about isolating all suspected cases because there are so many people there and there's no space or facilities,” said Agnese Commelli, a doctor with the aid group Doctors Without Borders in Goma, eastern Congo, according to the German news agency.

Health authorities are already having trouble recording cases. Only a small proportion of suspected cases can be officially confirmed. Without rapid testing, samples must be sent to labs and patients, and the medical staff treating them have only days or weeks to know whether an infectious disease has been confirmed.

People who are sick can only wait and see

Comelli explained that many people only seek medical care in the late stages of the disease. “They don't walk four kilometers or more to the nearest health post just because they have a fever. They come when they feel worse and the rash has worsened.” Doctors also found that fear of Mpox infection was not particularly evident : “This is not Ebola.”

Relatives and neighbors often become infected during visits to the doctor, especially where people live in close proximity. In addition to the characteristic rash, typical symptoms include chills, fever, headache, muscle aches and back pain. Fatal cases occur mainly in areas with limited medical services. They often affect children, especially malnourished children and people with weakened immune systems.

After you have Mpox disease, you develop immunity against reinfection that lasts for several years. Therefore, people who are already sick do not need to be vaccinated initially. “The more severe the outbreak, the less effective the vaccine will be,” Comelli said.

The fight against Mpox comes at the expense of other areas

As Comeli explains, the hard fight against the spread of the virus is already having an impact on other areas of the continent’s health systems: the prevention and treatment of other diseases, such as malaria and cholera, is affected by the fact that Mpox takes up already very Low capacity – battle is inevitable. (DAB/Sudan Development Authority/Department of Political Affairs)

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