Africa has once again captured global attention due to a public health crisis marked by the outbreak of the monkeypox virus, also known as “monkeypox” or “simianpox.” Monkeypox is a zoonotic infectious disease, meaning it can be transmitted from animals to humans and vice versa. Scientists classify it into two main clades: Clade 1, which includes subclades 1a and 1b, and Clade 2. Clade 1 is endemic in Central Africa and causes more severe illness compared to Clade 2, with a fatality rate of 3.9%. In contrast, Clade 2, which was reported in Nigeria and other countries in 2022, has a fatality rate of 0.2%.
While most current concerns are focused on Central Africa, where some countries have reported high rates of infection attributed to Clade 1a and 1b, the spread of the virus exacerbates existing economic and security challenges across many African nations. The delay in approving and distributing vaccines to Africa has raised several concerns, reminding many of the struggles faced during the recent COVID-19 pandemic.
Monkeypox Virus in Africa
The World Health Organization (WHO) reported that the first discovery of monkeypox occurred in laboratory monkeys in Denmark in 1958. The first human case was recorded in 1970 in the Democratic Republic of Congo (DRC). The global eradication of smallpox in 1980 led to the cessation of smallpox vaccination worldwide. However, monkeypox gradually spread through Central, East, and West Africa, with sporadic cases in the United States in 2003, the DRC since 2005, and Nigeria in 2017.
A global outbreak of the virus between 2022 and 2023, primarily affecting Europe and the Americas among “men who have sex with men,” marked a significant shift. Scientists attribute the current outbreak to late 2023, with a new, more severe variant (Clade 1b) emerging in the DRC, transforming monkeypox from a disease associated with contact with wild animals into one that spreads between humans. Cases have now been recorded outside Africa.
On August 13, 2024, for the first time since its establishment, the Africa Centers for Disease Control and Prevention (Africa CDC) declared the new monkeypox outbreak a public health emergency in Africa. The following day, the WHO declared it a Public Health Emergency of International Concern. WHO Director-General Tedros Adhanom Ghebreyesus stated that efforts are underway to facilitate equitable access to vaccines.
The DRC, at the epicenter of the current outbreak, has reported 18,000 suspected cases and 629 deaths as of August 31, 2024. However, cases have been reported in many countries both within and outside Africa, including Burundi, Cameroon, the Central African Republic, Ghana, Ivory Coast, Kenya, Liberia, Mozambique, Nigeria, Pakistan, the Philippines, the Republic of Congo, Rwanda, South Africa, Thailand, Sweden, Uganda, and Gabon.
Monkeypox Virus Amid Security and Economic Challenges
The current monkeypox outbreak coincides with ongoing economic repercussions from the recent COVID-19 pandemic and the Russia-Ukraine war, alongside security challenges in various regions of Africa. Although some reports suggest that the current monkeypox outbreak is not expected to reach the scale of the COVID-19 pandemic, the rise in cases across multiple African regions could impact supply chains and production processes if raw materials are disrupted. It may also affect the tourism sector due to travel restrictions, leading to higher unemployment rates and deterring investment necessary for growth and stability in African governments.
In the DRC, which has recorded the highest number of cases so far, multiple challenges persist, including inadequate resources to manage the virus amid escalating security issues and armed conflicts in the eastern part of the country. The rapid spread of Clade 1b, first detected in a gold-mining region in Kamituga, South Kivu, has exacerbated the situation. This area is a hub for artisanal miners from Burundi, Rwanda, and Uganda.
The complexity of the current outbreak is heightened by ongoing violent attacks in South and North Kivu, where around a hundred armed groups, including the March 23 Movement (M23), are active. The M23, which emerged in 2012, resumed its violent activities two years ago and has become one of the most lethal groups in the country, controlling large areas in the Masisi and Rutshuru regions since 2022. These security crises and violence have displaced millions of Congolese, many of whom have sought refuge in overcrowded camps lacking food, water, and medical care.
Additionally, there are growing concerns in East and Central Africa’s border areas due to reported monkeypox cases, especially at the borders between Kenya and Uganda, DRC and Uganda, and Rwanda and Uganda. The economic reliance of these border regions on cross-border movements means that increased cases have led health officials in Kenya and Uganda to enhance border surveillance and testing, impacting local trade and economic activities.
In Nigeria, the Nigerian Center for Disease Control reported 48 cases since investigations began 33 weeks ago (as of September 2, 2024). Despite the relatively low number of cases, there are 868 suspected cases in the country. Although Nigeria remains one of the least affected countries and has experience handling health crises like Ebola and COVID-19, a rise in monkeypox cases in the coming days or weeks could prompt the government to enact regulations that might negatively impact businesses and small trades. Such regulations could be exploited by armed and extremist groups in the northeast, northwest, and southeast to regain strength and expand their control in new areas.
How African Countries Are Addressing the Spread of the Virus
The response to the outbreak of monkeypox in many African countries has been notably lax, possibly due to other ongoing crises, particularly security and economic issues. This lack of urgency might stem from the fact that some African governments do not perceive the outbreak as a significant threat due to the relatively low number of recorded cases within their territories. In countries such as Rwanda, Kenya, and Uganda, most cases have been linked to travel from the Democratic Republic of the Congo.
Here are some measures that African countries have taken:
1. Monitoring Suspected Cases and Implementing Precautionary Measures: Nigeria has led the efforts to contain the current outbreak on the African continent. Since August 11, the Nigerian government and its Ministry of Health have introduced new entry requirements for air travelers to the country. Other nations, such as South Africa and Kenya, have also announced their monitoring of developments related to the virus, expressing readiness to launch precautionary initiatives and increase awareness.
On a continental level, the African Centers for Disease Control and Prevention (CDC) has announced the development of a continental response plan for monkeypox, tailored to the individual needs of each country. This plan is expected to be presented to African heads of state for approval in the coming weeks. The World Health Organization (WHO) has also released a global strategic plan for preparedness and response, which requires $87.4 million from September 2024 to February 2025.
2. Vaccine Distribution Scheduling: The current outbreak of monkeypox reveals that many African countries have not invested in strategies to handle recurring health crises and viruses despite the recent health emergencies. This dependency on international donors for emergency response has become evident. The increase in cases in Central Africa underscores the need for vaccines to help control the sudden rise in virus spread, especially in light of new virus variants. However, these vaccines are not readily available in Africa, leading the continent to rely once again on northern countries, which have pledged to donate doses to affected African nations.
According to medical reports, two vaccines have proven effective against the virus: the Jynneos vaccine, produced by Bavarian Nordic in Denmark, and the LC16m8 vaccine, manufactured by KM Biologics in Kumamoto, Japan. The United States has provided 10,000 doses of the Jynneos vaccine to Nigeria, which received them on August 27, 2024, becoming the first African country to receive vaccines aimed at combating the virus. The Nigerian government has stated that it is conducting tests and regulatory approvals and will release 5,000 doses for vaccination starting on October 8 in five states with the highest number of cases.
The Democratic Republic of the Congo, the most affected country, is expecting to receive 65,000 doses of vaccine in September. The United States has pledged 50,000 doses, while the Global Alliance for Vaccines and Immunization (GAVI) will provide the remaining 15,000 doses. Additionally, the Global Fund to Fight AIDS, Tuberculosis, and Malaria has committed to responding quickly to countries’ requests for reinvestment of grant funding to strengthen their responses to the outbreak.
3. The Need for More Research: The lax response to the current monkeypox outbreak in Africa, coupled with the ambiguity surrounding the data on recorded cases and reliance on vaccines donated by Western countries, highlights the weaknesses in African scientific research and funding for specialized scientists. This has been underscored by several statements from heads of various health organizations.
For example, Tedros Adhanom Ghebreyesus, Director-General of the WHO, emphasized the need for more research and surveillance of monkeypox through partnerships with African organizations such as the African CDC. This approach aims to enable rapid control of the outbreak and prepare for future pandemics in Africa. Similarly, the African CDC has announced that it will send 72 epidemiologists to affected areas in September to support field teams and gather more data on actual case numbers to address challenges related to data reliability and decision-making.
Delays in Monkeypox Vaccines: A Repeat of COVID-19 Scenarios?
The current situation of delayed delivery of monkeypox vaccines to affected African countries and the fact that most governments on the continent are still unable to access adequate treatments after decades of the virus being known, mirrors scenarios from the recent COVID-19 crisis. In 2020, northern countries monopolized vaccines, ignoring Africa’s call for equitable distribution despite the continent’s readiness to purchase and fund them. Africa had to appeal to northern countries to waive intellectual property rights so that it could produce its own vaccines to combat the pandemic.
In the case of monkeypox vaccines, the WHO has faced criticism for taking too long to allow international organizations and alliances, such as GAVI and UNICEF, to donate vaccines. Although vaccines have been available for some time, the WHO delayed their approval due to the need to prove their reliability and effectiveness. As a result of this delay, the Democratic Republic of the Congo, the most affected country, had not received the first batch of vaccines as of September 2, despite requesting them two years ago.
Finally, the lack of funding for scientific research on viruses in Africa presents a significant problem evident in the current outbreak, where the majority of monkeypox cases are not being reported. Although the outbreak is complex and involves many countries, the resources for monitoring and tracking it are limited. Health officials in most affected countries are uncertain about which areas should be prioritized in their responses due to the low vaccine supplies. While the level of disease transmission outside the Democratic Republic of the Congo and other affected countries remains limited, the virus could spread across the continent if all African nations do not take serious individual and collective health measures.
References
Centers for Disease Control and Prevention (CDC) – Mpox Overview
https://www.cdc.gov/poxvirus/mpox/about/index.html
World Health Organization (WHO) – Mpox Fact Sheet
https://www.who.int/news-room/fact-sheets/detail/mpox
The Lancet – Comprehensive Review on Monkeypox
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02075-X/fulltext
National Center for Biotechnology Information (NCBI) – Monkeypox Review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9671644/
BMC Public Health – Systematic Review on Monkeypox Information Sources
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-17741-5
NCBI – Review on 2022 Monkeypox Outbreak
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9791242/
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