Governments and donors have pledged around $1 billion to combat Africa’s mpox outbreak in the past few weeks, with the US pledging $500 million this weeksaid Dr Jean Kaseya, Director-General of the Africa Centres for Disease Control and Prevention.
But the continent’s response is confounded by poor surveillance, problems with testingm virtually non-existant contact tracing (less than 4%) and insufficient knowledge about transmission, Kaseya tols a media briefing on Thursday.
Africa CDC and the World Health Organization (WHO), who are coordinating the continental response, were due to meet US Health Secretary Xavier Beccera late Thursday to discuss how the US money would be allocated.
However, the White House stated earlier in the week that the money will address a range of needs identified by the Africa CDC and WHO, including “training frontline health workers, disease surveillance, laboratory diagnostic supplies and testing, clinical case management, risk communication and community engagement, infection prevention and control, and research”.
The Pandemic Fund has made $129 million available for 10 countries, while African countries have availed around 10% of funds raised.
Vaccine donations hit 4.3 million
Some 4,3 million vaccine donations have also been pledged. The bulk – three million – are from Japan for the Democratic Republic of Congo (DRC), the epicentre of the outbreak. The US also promised one million vaccines this week.
The Coalition for Epidemic Preparedness Innovations (Cepi) has allocated around $72 million (in partnership with vaccine producer BioNTech) for mpox vaccine development, and $145 million to support the expansion of the manufacturing capacity in Africa, especially in Rwanda, said Kaseya.
But only a small percentage of the vaccine donations have touched down on African soil. The DRC is due to roll out its vaccination efforts next week but it has to navigate poor roads, lack of trained staff and armed conflict.
Given the scarcity of vaccines, vaccines will be confined to priority groups starting with the contacts of confirmed cases and healthcare workers, explained Dr Ngashi Ngongo, Africa CDC’s Chief of Staff, at a media briefing on Thursday.
Dr Ngashi Ngongo, Africa CDC Chief of staffOthers priority groups are “key populations, meaning commercial sex workers and men and having sex with men”, children, people in refugee camps, prisoners, truck drivers, cross-border traders and those who are immunocompromised, particularly those living with HIV.
Fifteen African countries have reported mpox cases since the beginning of the year while a further 15 are vulnerable, Kaseya told the media briefing.
In the past week, 2,910 new cases have been reported but only 436 have been confirmed, said Kaseya. Since the beginning of the year, over 32,000 suspected cases have been reported yet less than one-fifth have been confirmed.
Major weaknesses in surveillance, laboratories and research are confounding efforts to stem the spread of mpox.
“Our immediate priorities are enhanced surveillance, contact tracing and laboratory testing,” said Kaseya.
Only about half the suspected mpox cases are being tested, and around 40% positivity rate – but the results were tainted by the quality of the specimens, poorly trained staff as well as tests picking up other diseases such as measles and chicken pox, explained Ngongo.
About a third of cases have no apparent links to other cases, but Ngongo said this was likely because contact tracing is weak – with health workers only reaching around 3% of those who had been in contact with cases.
“Community-based surveillance is weak because the community health workers and community health programs have not been involved fully involved into the mpox response,” Ngongo noted.
The mpox incidence management team, headed by Africa CDC and WHO, is encouraging countries to increase the number of community health workers, and the DRC plans to roll out the 40,000 community networkers, he added.
West’s failure to act on mpox Clade I
Africa CDC Director-General Dr Jean Kaseya.Kaseya said that “our colleagues from Western countries” are also responsible for the huge rise in mpox cases in Africa.
“When we had the mpox public health emergence of international concern in 2022, they focused just on Clade II because that was in Europe and the US. They knew that there was a Clade I in Africa but didn’t conduct research on Clade I.”
Clade I has mutated into Clade Ib, which appears more infectious and more deadly. But because of international neglect, there is no rapid test for Clade I.
“We do not have a full understanding of the epidemiology of mpox and the transmission dynamics,” said Kaseya. “What are some of the factors that, for example, explain the high numbers of children that are being infected?
“About 80% of unknowns are mostly because our colleagues and partners didn’t want to see the reality,” he added.
Africa CDC has also sounded the alarm about possible cross-border transmission via truck drivers, who were key in transmitting HIV across the continent.
“Uganda’s 212 cases are just the tip of the iceberg. Knowing the cross border movement, mostly with truck drivers, and the weakness of our surveillance system, no one can say that these 212 suspected cases are accurate,” said Kaseya.
He also questioned whether Tanzania, which has not officially reported any cases, really is mpox-free given its proximity to affected neighbours.
Image Credits: Africa CDC.
Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.