The Monkeypox Outbreak once again reveals Vaccine Inequity in Africa
By Dr. Esther Anyango, Project Manager, Africa Health Business
The outbreak of the Monkeypox virus has once again exposed Africa’s vulnerability in access to vaccines, vital drugs, and health technologies. During the COVID-19 pandemic and the subsequent global COVID-19 vaccine roll-out, it was evident that the exercise was not all inclusive nor was it adequately planned. Africa received a very small proportion of vaccines, about 6%, from the global supply whilst some countries were able to even offer booster shots. As of January 2022, less than 10% of the African population was fully vaccinated with over 1.2 billion having not received even a single dose[1]. This narrative of vaccine inequity in Africa continues with the outbreak of Monkeypox disease.
Monkeypox virus outbreaks have occurred in Central and Western Africa for decades, but researchers in Africa have not been able to tap into vaccine resources despite their warnings of its potential spread [2]. The World Health Organization (WHO) recently raised a high global alert concerning the Monkeypox virus outbreak in many countries where Monkeypox has never been reported before [3].
As of June 2022, had been reported outside Central and Western Africa, and although most of these cases have mild symptoms with no associated deaths, officials in Africa report that more than 70 deaths are suspected to have been caused by Monkeypox virus. The reality is that this number may be even higher given the deficiencies in testing and disease surveillance [2], [4]. In response to the Monkeypox outbreak, countries such as Canada, the United States of America, and United Kingdom immediately embarked on a vaccination strategy using one of the vaccines formerly used against the eradicated smallpox virus. Currently, the WHO does not recommend mass vaccination but only for those at risk and those who have been in close contact with another individual infected with Monkeypox [3], [5]. The frustration that currently exists in Africa is that the current global outbreak is unlikely to change the Monkeypox situation in the continent but will more likely only address the cases in the Western world[2].
That notwithstanding, African scientists have grappled with identifying the source of the virus in a bid to find a cure or vaccine against it, but despite its name, the source of the virus remains unknown. The only knowledge available is that the virus spreads and circulates among rodents with the ability of spreading to human beings [6]. Researchers also fear that the Monkeypox cases might have increased due to the halting of smallpox vaccination after its eradication in 1980. They argue that the virus that caused smallpox closely resembled the Monkeypox virus thus vaccination against smallpox would naturally have a protective effect against smallpox. With the halting of vaccination, immune defenses against Monkeypox may have compromised giving an opportunity for the outbreak currently being witnessed in Sub-Saharan Africa [2].
Western countries are said to have retained smallpox vaccine stockpiles as a mitigation strategy against possible future weaponization of the virus. It is these stockpiles that scientists are currently utilizing to develop a vaccine against the Monkeypox virus. These stockpiles, unfortunately, are not available in African countries. Developing a vaccine for Monkeypox in Africa has proven a challenge considering the insufficient vaccine development infrastructure on the continent. The Western countries, through the WHO, would do well to donate some of their shots to the African countries where the disease burden is greater, and a more virulent strain exists, with a mortality rate of about 10%. The impeding issues, including, regulatory and investment issues, surrounding the 31 million smallpox vaccine doses that were pledged by WHO member states to the agency for smallpox emergencies should be resolved and the Monkeypox outbreak in Africa addressed [2].
Nevertheless, the world is beginning to acknowledge the public health inequalities facing Africa. As a reflection of a unified response to Monkeypox, the WHO removed the distinction between endemic and non-endemic countries while reporting Monkeypox disease [7]. The agency has also agreed to rename the virus after researchers advocated for a “non-discriminatory and non-stigmatizing” nomenclature, to reduce its stigma [8]. Further, a US pharmaceutical firm, Tonix Pharmaceutical Holdings Corporation, in collaboration with the Kenya Medical Research Institute (KEMRI), has embarked on a Phase 1 clinical trial in Kenya to develop a vaccine that would protect the population against smallpox and Monkeypox [9]. This investment, coupled with other similar investments in vaccine manufacturing in Africa will boost vaccine supply in the continent. Ultimately, partnerships between African governments, the private sector, development partners, and philanthropists, will be vital in boosting vaccine development and self-reliance of the continent.
All you need to know about Monkeypox:
A rare zoonotic disease caused by Monkeypox virus. This means that it can be spread from animals to human beings and from person to person.
The virus spreads through direct contact with the monkeypox rash or body fluids of an infected person, through contact with items handled or clothes worn by an infected person or through contact with respiratory secretions from an infected person.
Pregnant women, children, those with low immunity.
Most of the signs and symptoms caused by monkeypox are mild, variable, and non-specific. They include:
- • Fever
- • Headache
- • Muscle ache
- • Backpain
- • Muscle aches
- • Swollen lymph nodes
- • Tiredness
- • Rash
Most people will develop a rash which progresses to itchy, painful pimples and pus-filled blisters. The monkeypox rash may develop on or around the genitals and anus or in other areas like arms, face, chest, or mouth.
Individuals will experience these symptoms within 3 weeks of exposure to the virus.
From the time the symptoms start to when the rash is completely healed, and a new skin has formed.
The disease, including the symptoms will persist for about 2-4 weeks and go away on their own or with supportive care. Most patients are left with scarred marks on their skin after the disease resolves.
• Limit close contact with people or animals infected or suspected to be infected with monkeypox.
• Wash your hands and disinfect your surroundings regularly using an alcohol-based disinfectant.
• Keep yourself informed about the status of monkeypox within your area and practice open conversations about the disease.
• If you have had close contact with an infected person, or an environment contaminated with the virus, monitor yourself for at least 21 days and limit close contacts for this period.
• Should you develop signs and symptoms of the disease, visit your healthcare provider for further tests and management advice. Consider isolating from people while infected.
• A vaccine has recently been approved for monkeypox and some countries are recommending vaccination for persons at risk.
References
[1]. “Vaccine inequity: Ensuring Africa is not left out.” (accessed Aug. 11, 2022).
[2]. M. Kozlov, “Monkeypox in Africa: the science the world ignored,” Nature, Jul. 2022, doi: 10.1038/D41586-022-01686-Z.
[3]. “Monkeypox.” (accessed Aug. 04, 2022).
[4]. “Multi-country monkeypox outbreak: situation update.” (accessed Aug. 11, 2022).
[5]. M. Kozlov, “Monkeypox vaccination begins — can the global outbreaks be contained?,” Nature, vol. 606, no. 7914, pp. 444–445, Jun. 2022, doi: 10.1038/D41586-022-01587-1.
[6]. “Monkeypox | Poxvirus | CDC.” (accessed Aug. 04, 2022).
[7]. “Multi-country monkeypox outbreak: situation update.” (accessed Aug. 11, 2022).
[9]. “US firm picks Kenya for monkeypox vaccine trials – Business Daily.” (accessed Aug. 11, 2022).
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