Mpox outbreak: Congo lacks vaccines to curb infections

The first 10,000 mpox vaccines have reached Africa, but instead of the Democratic Republic of Congo (Congo), the epicenter of the epidemic, they are going to Nigeria. The vaccines were a donation from the US government.

Nigerian health authorities had already launched an early campaign to secure the vaccines after the outbreak of the virus in 2022.

The West African country has so far recorded no deaths and no cases of Clade 1b, a new variant in eastern Congo that has also spread to neighboring countries and beyond Africa.

Still no vaccinations for Congo

Congo, on the other hand, has given up hope of receiving vaccines this week. The central African nation has recorded more than 18,000 suspected cases of mpox and 615 deaths so far this year.

The US Agency for International Development (USAID) has promised 50,000 vaccine doses, but no delivery date has been announced. Japan followed suit with a pledge to deliver up to three million doses, but it has not yet been delivered.

Germany, France, the EU and Spain, as well as the vaccine manufacturers Emergent BioSolutions and Bavarian Nordic, have also pledged donations, bringing the number of pledged doses to a maximum of 4,030,420.

The European Commission has asked member states to indicate by the end of August whether they intend to donate mpox vaccines to African countries.

Some countries, including the Netherlands, have opted to keep their national stocks.

'Concentrate on the DRC'- epidemiologist says

"The number of doses is too small," Fred Binka, an epidemiologist at the University of Health and Allied Sciences in Ghana. "It simply won't have any effect on mpox. Look at how it has spread in the DR Congo alone," Binka told DW.

According to the epidemiologist, it's not worth sending that number of doses to Nigeria, "If we have no vaccines at all, we should concentrate the vaccines in Congo first to prevent the spread to other countries."

Binka said it is up to the African Union and the Africa CDC to create a level playing field and organize the distribution of vaccines. "Those who are still storing their vaccines should hand them in so that we can contain the spread of the virus."

Vaccination should be prioritized, Placide Mbala, a virologist and head of the Department of Epidemiology and Global Health at the National Institute for Biomedical Research in Congo, told DW.

In addition to children, "sex workers, teenagers and other high-risk groups are particularly eligible for this vaccination," Mbala said.

The 'most effective' vaccine against mpox

According to the US Centers for Disease Control and Prevention (CDC), the "best protection" against mpox is two doses of the Jynneos vaccine from Danish manufacturer Bavarian Nordic.

The pharmaceutical company is currently awaiting approval in Europe to extend the use of the Jynneos vaccine to adolescents and has announced a new clinical trial later this year to evaluate the safety of the vaccine for children aged two to 12 years in Congo. At least 75% of current mpox cases in Congo are minors.

"We can look at supervised administration of vaccines to children in small groups in the DRC," Binka said, adding that there are now over 10 countries where scientists could test and study the immunogenicity of this vaccine in children and then use that information to improve distribution and use in the DRC. "Let's collect the data quickly. And let's be very cautious in our decisions."

The LC16 single vaccine produced by KM Biologics in Japan is not yet on the international market but has already been approved in Japan. In June, it received emergency authorization from the DRC. LC16 is also the only vaccine approved for children so far — but only in Japan.

"For the DRC, it is recommended to give LC16 to children and Jynneos to adolescents and adults," Mbala added.

A third vaccine, ACAM2000, produced by Emergent BioSolutions, is being studied against mpox, although it results in more side effects than the other two.

According to the World Health Organization (WHO), none of these vaccine options for mpox had been tested by the end of August.

A battle on several fronts

Experts have criticized the WHO's complicated approval process, which is slowing down the purchase of vaccines by international agencies.

Although two years have already passed since the last mpox outbreak, the WHO has not yet officially approved the available vaccines as the necessary data is not available.

It was only this August that the UN health agency asked vaccine manufacturers to register their interest in an emergency license for mpox vaccinations. This would allow the WHO to speed up its approvals, which is expected to happen in September.

However, purchasing the vaccines is extremely expensive for many African countries: the Bavarian Nordic vaccine, for example, costs at least $100 (€90) per dose.

According to Binka, the WHO missed the starting gun two years ago, "It's not too late, and now the WHO realizes that we need to take a two-pronged approach to raise the funds to distribute the vaccines, but also to do the basic research to show how well they will work in our part of the world."

Such an approach could prevent a larger outbreak, Binka added. The WHO said it now wants to "significantly" increase its staff in countries affected by mpox.

This is part of a six-month plan to facilitate access to vaccines and improve prevention and response. To accomplish that, the UN body needs $135 million, which doesn't include the cost of 2 million vaccine doses.

But as Mbala noted, these steps are just a drop in the ocean if African countries do not have the means "to themselves produce vaccines on the continent in the future."

Adjoa-Sika Assignon contributed to this article

Editor: Chrispin Mwakideu