After two years of post-Covid talks, member states of the World Health Organization (WHO) failed this summer to agree plans for a more equitable distribution of vaccines to developing countries. Ensuring that life-saving doses are available to countries most in need of them, rather than merely to those with the deepest pockets, is not only a moral imperative. It is in the self-interest of every nation, given the propensity of viruses to mutate and migrate. But achieving this requires big money and big concessions from pharmaceutical firms. And so, dispiritingly, the haggling goes on.
Maybe the warnings over a new, more severe strain of mpox in Africa will finally concentrate minds. Last week, the WHO declared the current outbreak of the virus “a public health emergency of international concern”. Highly contagious, mpox can be spread through skin-on-skin contact, the sharing of contaminated materials and contact with animals. The new “clade 1” variant appears to have a significantly higher mortality rate of about 4%. Cases have now been detected in 13 African countries, the overwhelming majority in the Democratic Republic of the Congo (DRC). More than 500 people have died so far.
The UK Health Security Agency has updated its guidance to doctors in relation to the new strain, and last Thursday the first infection outside Africa was recorded in Sweden. Production of a vaccine, based on those developed to eradicate smallpox, is meanwhile being scaled up by the Danish biotech firm Bavarian Nordic. The company’s share price dramatically spiked over the past week, as new orders came in.
As yet unaffected countries are of course right to be concerned. But while governments in the global north marshal resources, mpox is being allowed to spread almost unchecked in its regional epicentre. A disastrous combination of domestic regulatory delays, a sluggish international response and sheer lack of funds means that DRC has next to no access to vaccines. The price of an mpox shot has been estimated at $100 (£77). That puts mass vaccination programmes far beyond the reach of governments already unjustly burdened by disproportionate debt repayments to western creditors. Acts of generosity on the part of richer countries have so far been small-scale and inadequate. The US has pledged 50,000 shots, but has the capacity to provide far more of the millions of doses that will be required.
Along with other wealthier nations, the US should step up to the plate. The African Union’s public health agency estimates that, continent-wide, about $4bn will be needed to undertake vaccination, surveillance and education, focusing on a region already blighted by poverty, malnutrition and conflict. Only a fraction of that has so far been pledged. Having collectively taken its eye off the ball after last year’s less serious mpox outbreak in central Africa, the international community now finds itself confronted with a more dangerous situation for which it has failed to prepare.
During Covid, richer countries notoriously hoarded vaccines to a scandalous degree. Boosters were delivered to the citizens of the global north while low-income nations scrambled for cash and access to deliver first doses to their populations. In the future, there must be long-term solutions to promote greater vaccine equity, including technology transfer to poorer countries. Right now though, a belated sense of urgency and focus is needed to address a foreseeable crisis in DRC and neighbouring central African states.
This article was amended on 20 August 2024 to clarify that the UK Health Security Agency updated its guidance before the reporting of a new case in Sweden.
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