On August 14, 2024, the World Health Organization (WHO) declared the mpox epidemic — formerly known as monkeypox — a public health emergency of international concern. This is the second time this has happened in two years, but this occurrence is not, and should not be, so frequent.
This disease, which is endemic in the Democratic Republic of the Congo (DRC) – the country that accounts for most of the cases in this outbreak – is now also present in several neighbouring countries: Burundi, the Central African Republic, Rwanda, Uganda, Kenya and the Ivory Coast. It has also jumped to Europe, with the first case in Sweden, and to Asia, with the first case detected in Pakistan just a week ago. So far in 2024 alone, a total of 18,910 cases and 541 deaths have been reported in Africa, 160% more than last year during the same period of time, figures that are increasing rapidly. In addition, it must be considered that these figures 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 complex in the crowded camps for displaced people in North and South Kivu provinces, where almost a million people are living in overcrowded conditions and where the epidemic is spreading at breakneck speed.
In epidemics, it is crucial to react as quickly as possible and implement all necessary measures: increase surveillance, raise awareness among the population, train medical staff to manage cases, establish isolation areas in hospitals, distribute protective equipment and establish vaccination campaigns (if there is a vaccine for such a disease, as is the case with mpox).
Talking about prevention measures in rural areas of the DRC is complicated, as the harsh living conditions make it very difficult to implement them. Families have an average of six members and live in small spaces (many houses have one room or at most two, with a bed shared by several people), sanitation is often non-existent and houses do not usually have drinking water or suitable places to carry out proper hygiene. In addition, the resources available to the population are very limited, people share dishes and eat with their hands. This situation is even more complex in the crowded camps for displaced persons in the provinces of North Kivu and South Kivu, where almost a million people live crowded together in deplorable conditions due to the conflict between the government and the M23 rebels, and where the MPOX is spreading at a dizzying speed.
In these contexts, one of the most efficient measures to stop transmission is vaccination. And, unfortunately, we have not yet been able to start implementing it.
The first vaccines ever to exist were against smallpox. These vaccines (derived from cow cells) were used until 1980, when the disease was eradicated, but it has been proven that this vaccine provides some protection against mpox, because both viruses belong to the same family. Now there are third-generation vaccines, much safer than the first ones: MVA-BN, produced by a Danish pharmaceutical company (Bavarian Nordic), and another called LC16, produced in Japan. The first was widely used in Europe, the USA and Canada in the 2022 epidemic and requires two doses 28 days apart, each with an approximate price of 100 euros.
WHO recommends vaccinating only those people who are at higher risk: close contacts of affected patients, frontline health and laboratory personnel, as well as sex workers or people with multiple partners.
Unlike the Covid pandemic, the MPOX vaccines are not intended to vaccinate the entire population, as contagion is not so easy. For this reason, the WHO recommends vaccinating only those people who are at greatest risk: close contacts of affected patients, frontline health and laboratory personnel, as well as sex workers or people with multiple partners.
The DRC government has had a clear plan for several months to begin the vaccination campaign, pending the availability of vaccines. Africa CDC (the African Union’s public health agency for Disease Control and Prevention) estimates that 10 million doses are needed for the continent, including more than 3 million for the DRC. But there are two problems preventing this from happening: the lack of production capacity worldwide and the lack of vaccines in the DRC.
Production capacity is currently insufficient (Bavarian Nordic only guarantees production of 10 million vaccines by the end of 2025, which would clearly be too late to respond to this epidemic). However, it would be possible to transfer technical capacities to increase production on the African continent. This would reduce production costs and capacity and would also result in a reduction in the price of vaccines.
We call on all governments to urgently donate previously purchased doses in their possession to countries in need. The sooner appropriate measures are put in place, the fewer infections there will be and the more lives will be saved.
The declaration of a public health emergency of international concern by the WHO makes it possible to mobilise resources and coordinate efforts to contain the spread. It facilitates the release of emergency funds, accelerates the listing of vaccines for emergency use, and enables the purchase of vaccines between countries, ensuring that those affected can receive the necessary support to effectively control the epidemic.
We are therefore calling on all governments to urgently donate the previously purchased doses they have in their possession to countries in need. The sooner appropriate measures are put in place, the fewer infections there will be and the more lives will be saved. At Doctors Without Borders, we are on the front line fighting the spread of the outbreak in the DRC, and to date we have treated more than 1,000 patients, organised awareness sessions for thousands of people, are collaborating with the country’s Ministry of Health in diagnosing and monitoring cases, and are training local medical staff. But right now, the priority is to get the vaccines to where we can start vaccinating.
Spain has announced that in the coming days will send 500,000 doses of vaccines, enough to vaccinate 250,000 people. It is a first step and an example to follow, but many more vaccines will be needed and many more countries will have to join the initiative, as requested by the Ministry of Health.
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