There are no vaccines for mpox available in the Democratic Republic of Congo, the epicenter of a global health emergency declared last week, even though the country first asked for the shots two years ago and the manufacturers say they have supplies.
The most important thing we need right now are the vaccines, said Dr. Samuel-Roger Kamba, health minister of Congo.
So where are the shots? They are trapped in a byzantine drug regulatory process at the World Health Organization.
Three years after the last worldwide mpox outbreak, the W.H.O. still has neither officially approved the vaccines although the United States and Europe have nor has it issued an emergency use license that would speed access.
One of these two approvals is necessary for UNICEF and Gavi, the organization that helps facilitate immunizations in developing nations, to buy and distribute mpox vaccines in low-income countries like Congo.
While high-income nations rely on their own drug regulators, such as the Food and Drug Administration in the United States, many low- and middle-income countries depend on the W.H.O. to judge what vaccines and treatments are safe and effective, a process called prequalification.
We are having trouble retrieving the article content.
Please enable JavaScript in your browser settings.
Thank you for your patience while we verify access. If you are in Reader mode please exit andlog intoyour Times account, orsubscribefor all of The Times.
Thank you for your patience while we verify access.
Already a subscriber?Log in.
Want all of The Times?Subscribe.
Following the Angelus, Pope Francis offers his solidarity with Mpox sufferers, especially in the Democratic Republic of Congo, struggling with the outbreak, now a global health emergency.. He also offers his consolation to the people of Nicaragua, encouraging them to renew their hope in Jesus.
By Vatican News
At the conclusion of Sunday's Angelus, Pope Francis offered his solidarity with the thousands globally affected by Mpox (monkeypox), which is now a global health emergency. He said he is praying for all those who have the disease, especially in theDemocratic Republic of Congo where an outbreak is underway, a nation "suffering greatly" he lamented.
I express my sympathy to the local Churches in the countries most affected by this disease and I encourage governments and private industries to share available technology and treatments so that no one lacks adequate medical care.
The Pope also offered words of encouragement for the "beloved people of Nicaragua" asking them to renew their hope in Jesus.
Remember that the Holy Spirit always guides history towards higher projects. May the Immaculate Virgin protect you in times of trial and help you feel her motherly tenderness. May Our Lady accompany the beloved people of Nicaragua.
All of Nzigire Kanigo's children have contracted mpox, including two-year-old Ansima
Children in the east of the Democratic Republic of Congo are worst-affected by the current outbreak of mpox, which has been declared a public health emergency of international concern by the World Health Organization. The country accounts for nearly all of this years recorded cases and more than 450 deaths.
It began like a small, inflamed spot. The mother squeezed it and watery discharge came out. Then another developed, and after a short period, they were all over the body, says Alain Matabaro, describing how mpox developed in his six-year-old son Amani.
He started recovering after four days of treatment at a clinic in Munigi, close to the major eastern Congolese city of Goma.
Some 75% of the cases being seen by medics there are under the age of 10, according to Dr Pierre-Olivier Ngadjole who works for the charity Medair.
Young people seem to be particularly badly affected by the mpox outbreak because of their less developed immune systems.
Dr Ngadjole also blames overcrowding at a nearby camp set up for people forced from their homes by conflict in the region. One way mpox is spread is through very close contact and children are always playing together. They dont really care about social distance, he tells the BBC.
You can also see in the households, they even spend the night in the same bed. You can find three, four, five children. The transmission is present on a daily basis.
Since June, the clinic in Munigi, which provides free treatment including antibiotics to treat skin infections, paracetamol and safe drinking water, has dealt with 310 mpox cases. It is now seeing between five and 10 new admissions each day.
No-one has died from the disease there and Dr Ngadjole believes it is because people are seeking help early.
I think its very important to provide free health services especially in this context [It] means people dont face any financial barrier, they come early to the health facility.
It is a different story 80km (50 miles) south-west of Munigi, on the other side of Lake Kivu, at a hospital in Kavumu.
Eight-hundred patients have been seen there since June and eight have died all under the age of five.
Two-year-old Ansima Kanigo caught mpox from one of her four siblings, who have all had the disease.
Her mother, Nzigire Kanigo, 35, had no idea what it was at first.
"This is the first time I've seen it. When my child got sick, the other parents told me it might be measles, but we started treating measles and failed, so we decided to come here.
God bless the doctor who has brought the drugs Three [children] are cured - they are at home. I only have two who I am admitted with now in this hospital. I thank God.
The medical director at the hospital, Dr Robert Musole, says the outbreak should not be underestimated by the authorities.
The situation is really serious, and we're so overwhelmed, because we have a small capacity, but we're in great demand.
The first challenge we face in this response is the accommodation of patients. The second challenge is the availability of medicines, which we don't have.
Across eastern DR Congo, there are several camps for the millions who have fled their homes as various rebel groups operate in the area.
People are often crammed into makeshift structures and living in poor conditions without good sanitation - the perfect place for mpox to run rampant.
Health workers have been visiting places like Mudja camp near Mount Nyiragongo, to educate people on what to do when they spot symptoms, such as limiting contact with others.
This disease has brought us a lot of fear that we shall all get sick, says Josephine Sirangunza, who lives in the camp with her five children.
She says the government needs to give out some basic equipment to help stop the disease spreading.
When we see someone getting sick, we worry about how to protect ourselves.
It is a sentiment shared by Bosco Sebuke, 52, who has 10 children.
We have been sensitised [about mpox], but we are full of fear because we are crowded in our shelters. We sleep in very poor conditions, we share bedding, so prevention is difficult and because of that, we are afraid, he says.
The outbreak in eastern DR Congo is of a new strain of mpox called Clade 1b and it has now spread to neighbouring countries.
Last week, the Congolese government said it hoped that vaccines would start to arrive from the US and Japan soon. Until then, the country does not have any vaccines despite being at the epicentre of the virus.
Mr Matabaro, the father of Amani who is now recovering from mpox, says he is hopeful with news that vaccines could be on their way.
But the distribution will be extremely limited and, as Dr Ngadjole says, vaccination is just one aspect of reducing the spread of the virus.
The [easiest] action to put in place is to improve the hygiene. When we improve the hygiene at household level, when we improve the hygiene at community level, its very easy to decrease the risk of transmission.
Ms Sirangunza echoes the doctors thoughts: Tell our leaders to send us medicine, soap, and other protective measures so that we dont get infected."
Overview
This position paper is concerned with vaccines and vaccination against mpox and smallpox. Since the publication of the 2014 meeting report on smallpox vaccines, and the 2022 interim guidance on mpox vaccines and immunization, there have been reported changes in the epidemiology of mpox, particularly in endemic settings, and new evidence has emerged regarding effectiveness, safety and public health benefits of vaccines. This document replaces the 2022 interim guidance on mpox vaccination and the 2014 meeting report on smallpox vaccines and smallpox vaccination. It contains off-label recommendations.
LONDON, Aug. 28, 2024 /PRNewswire/ -- Virax Biolabs Group Limited (NASDAQ: VRAX) ("Virax" or the "Company"), an innovative biotechnology company focused on the detection of immune responses and diagnosis of viral diseases, today announced that it has entered into a distribution agreement with a supplier of (RT) PCR Mpox virus detection kits to commercialize them in 13 European countries as well as members of the Gulf Cooperation Council ("GCC") including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates.
The RT PCR Mpox virus detection kits are CE-marked for sale in Europe and also authorized by the Medicines and Healthcare products Regulatory Agency (MHRA), the product regulatory agency for the United Kingdom. These tests perform with asensitivityof 96.7% and specificity of 93.72%, with the ability to deliver results in under 70minutes.
"Mpox virus poses a serious threat, and we continue to be committed to equipping healthcare professionals with the necessary tools to diagnose and mitigate its spread," James Foster, CEO of Virax Biolabs. "Our partnership with our suppliers, a leader in sales of diagnostic reagents and equipment related to infectious pathogens, underscores our commitment and enables us to reach at-risk communities across major geographies."
Under the terms of the agreement, Virax is authorized to import, sell and distribute Virax-branded Mpox virus Nucleic Acid Detection Kits in European countries including the United Kingdom, France, Portugal, The Netherlands, Belgium, Sweden, Finland, Denmark, Norway, Germany, Spain, Switzerland, Austria, as well as the GCC set of nations.
Potential interested parties in our Early Release Partnership Program ("ERPP") for the Mpox RT-PCR Detection kits can contact our sales representatives through our dedicated website www.viraxclear.com.
About Virax Biolabs Group Limited
Virax Biolabs Group Limited is an innovative biotechnology company focused on the detection of immune responses to and diagnosis of viral diseases. Virax Biolabs Group Limited is currently developing T-Cell-based test technologies with the intention of providing an immunology profiling platform. T-Cell testing can be particularly effective in the diagnosis and therapeutics of post-viral syndromes such as Long COVID and other chronic conditions linked to immune dysregulation.
For more information, please visitwww.viraxbiolabs.com.
Investor Relations Contact:Russo Partners, LLC Nic Johnson and Adanna G. Alexander, Ph.D. M: 303-482-6405 [emailprotected]
SOURCE Virax Biolabs
An illustration of the mpox virus. Credit: Stephanie Rossow via CDC Public Health Image Library.
Beginning in the spring of 2022, mpox (formerly monkeypox) began spreading around the globe in countries outside of Africa that had rarely seen cases in the past. The mpox virus involved has infected nearly 100,000 people in two years. Though the outbreak virus caused serious symptoms, the low death rate (about 200 people have died), stands in contrast to the toll mpox had been exacting in Central Africa for years, where as many as 10 percent of the infected might die. But now a novel strain of the virus is spreading in the Democratic Republic of the Congo and other African countries and at least one case, that of an infected returning traveler, has been reported in Sweden.
The current outbreak began in the fall of 2023, when a wave of mpox cases struck Kamituga, a town in the South Kivu province of the Democratic Republic of the Congo that had been mpox-free. The most affected group were sex workers, who were numerous in the mining epicenter. And the first cases were close to the city of Bukavu, located near the countrys borders with Rwanda and Burundia prime location for mpox to spread in other countries. And spread it has.
The natural history of the virus in Central Africa changed.
Mpox went from being a rural zoonotic disease with secondary limited human-to-human transmission in family settings to one primarily spread from person to person, present in urban centers, and positioned to rapidly spread to other regions and countries.
But will the new version of mpox cascade around the globe again? Will it be as severe as it has been in some African countries? And is the world doing enough to deal with the outbreak in Africa? These questions and others are worth considering: The World Health Organization (WHO) has rung the alarm bell that another mpox crises may be developing.
The World Health Organization is concerned about a second mpox emergency in two years. Why? There are two main strains, or clades, of mpox. Until 2022, neither was frequently reported outside of a handful of African countries. But that changed when the Clade IIb, a virus causing a milder version of mpox, spread from Nigeria to Europe and elsewhere, igniting global concern and a large-scale effort to produce vaccines and immunize newly at-risk populations. Although interventions eventually brought the international Clade IIb outbreak under control, mpox continued to circulate, including Clade I, the more virulent strain endemic in Democratic Republic of the Congo.
Last week, the WHO declared an emergency involving the more lethal Clade I for two reasons: the increased dissemination of Clade I cases in Africa, even in areas and countries where it had never been detected before, and the appearance of a novel subtype of the clade called Ib. Clade Ib possesses genotypic and epidemiologic characteristics favoring human-to-human transmission.
Whats the difference between the two mpox varieties? Historically Clade II, was found in West Africa, not Central Africa like Clade I. Clade II is considered the more benign of the strains, while Clade I has caused case clusters with significant (and predominantly pediatric) mortality, sometimes with rates reaching 10 percent. Animal models suggest that Clade I virulence is indeed more significant that Clade II virulence. And that appears to be particularly true with respect to Clade IIb, the virus responsible for the 2022-2023 global outbreak, during which infections were rarely fatal.
Until 2022, the most studied outbreak of mpox outside of Africa involved the importation of Clade II-infected rodents from Ghana to the United States. The virus subsequently spread animal-to-animal among pet prairie dogs housed with the Ghanaian rodents before finally leaping from prairie dogs to their new owners. That limited outbreak belied the explosive potential of mpox. In 2022, the mainly sexually transmitted Clade IIb strain spread rapidly in non-endemic countries through networks of close contacts.
A rapid response that involved activists sharing information, contact tracing, and vaccination brought the outbreak under control; WHO ended the state of Public Health Emergency of International Concern (PHEIC) in May 2023. Clade IIb is still circulating at low levels, however. In Europe, 100 cases were diagnosed in the four-week period that ended July 4.
What is alarming about the situation with Clade I in Africa? According to the latest information from the Africa Centers for Disease Control and Prevention (Africa CDC), there has been an alarming increase in mpox Clade I cases in 2024, one that continues the trend of increased cases first observed in 2023. Cases are up 160 percent in 2024 compared to the same period in 2023, and deaths are up 19 percent. The Democratic Republic of the Congo (DRC), which has seen the brunt of the outbreak, reported 17,794 confirmed and suspected cases in 2024, with 535 deaths. Its still unclear whether these deaths are a result of Clade Ib, or the older Clade I virus, although Clade Ib was first identified in the country.
And mpox has been moving into areas where it hasnt been seen before. Burundi, in East Africa, has recorded its first cases, with a rapid escalation in recent weeks to 399. Authorities have also detected mpox in Rwanda, Kenya, and Uganda for the first time. Each of these countries has confirmed the new Clade Ib strain. The Central African Republic has reported 263 cases in 2024, and Congo 169 cases. Both countries have deal with mpox before. During the past week, 1,200 cases and 24 deaths were reported from Africa (a few of the cases, but not deaths, were recorded in Nigeria, in West Africa, where the more benign Clade II has been circulating since 2022.).
The majority of cases and the vast majority of deaths from Clade I have been recorded in children. Children accounted for 66 percent of cases and 82 percent of deaths, according to the latest Africa CDC update. In Burundi, where Clade Ib has been reported, 38 percent of cases are among children under five. While a Nature article on the initial South Kivu outbreak that identified Clade Ib for the first time found it mainly affecting adolescents and young adults, including sex workers, historically, mpox in the Democratic Republic of the Congo has affected children, and the new strain seems to be amply capable of spreading among them.
So far mpox isnt killing people at the same rate as it has in the past. Historically, mpox Clade I is thought to have a 10 percent mortality rate. Reports show the new subtype, Clade Ib, has a 3.2 percent mortality rate. Thats still high, of course, and may reflect health disparities and challenges as well as characteristics of the virus.
Will Clade Ib be able to induce a pandemic? The Clade Ib detection in Sweden will not be the last case spotted outside of Central Africa. A subtype that can readily transmit between humans will create transmission chains if given the opportunity, just as happened with the less virulent Clade IIb beginning in 2022. One silver lining, however, is that the Clade Ib virus will need sustained transmission in order to develop an animal reservoir outside the African continent, which would give it the ability to refuel human outbreakshistorically infections have been the result of animal to human transmission. Scientists have so far not seen that happen with the milder Clade IIb virus, for example.
But the two clades that have been causing outbreaks in recent yearsfirst Clade IIb and now Clade Ibhave shown human-to-human transmission. To get infected, one must be in close physical contact (including sexual) with an individual with mpox. We still dont know whether pre-symptomatic transmission occurs.
Mpox can be airborne, tooalthough not in the range of SARS-CoV-2, the COVID virus. Whereas with COVID, microscopic infectious particles can linger in the air and infect others who subsequently enter the same space, airborne transmission of mpox seems only possible through protracted close contact, possibly through larger respiratory droplets and less through aerosols. One review in The Lancet showed that the few symptomatic people who boarded planes or trains for long trips didnt infect other travelers. Mpox, though, can also be transmitted by aerosolization of particles on contaminated surfaces, since viral survival in the environment can be protracted. On the other hand, we still dont know how transmissible the novel Clade Ib subtypedescribed only recentlyis.
But we do have a vaccine and treatments, right? A third generation Orthopoxvirus vaccine, Jynneos, developed by Bavarian Nordic initially for smallpox preparedness, was used extensively during the 2022-2023 Clade IIb surge. It has been shown to be safe for use, even for immunocompromised patients who were excluded from older vaccine generations.
Nevertheless, it is important to remember that vaccination is approved for adults. But in Africa, mpox is predominantly an infection of children, and children comprise most deaths. Vaccination may have limited effect, even if implemented extensively; one will have to hope that by vaccinating adults, chains of transmission reaching children in households will be halted. This is why, donating vaccines for adults, for a predominantly pediatric plague, as European countries have done, seems more symbolic than practically useful.
There is also no vaccine abundance. Bavarian Nordic has stated that it can speed up production up to 2 million doses by the end of 2024, with another 8 million potentially available by the end of 2025. But one has to remember that this vaccine is also a potential smallpox vaccine, and contracts existing even before the 2022 outbreak for preparedness stockpiling may interfere with the availability of the vaccine for current mpox needs.
On the therapy front, a drug called tecovirimat was developed as an antiviral for smallpox and orthopoxviruses like mpox in general. Clinical trials have been lacking, but a worrying US Centers for Disease Control and Prevention press release a few days ago stressed that despite the drugs excellent safety profile, a clinical trial in the Democratic Republic of the Congo did not show any positive effect in Clade I infections.
What is the international community doing about mpox? In the mpox-affected areas of the Democratic Republic of the Congo and the Central African Republic, local health care systems may lack in capabilities to deal with threats like mpox. At the same time, political instability can be a barrier to improving health care facilities. Furthermore, malnutrition in the region predisposes children to unfavorable mpox outcomes. The WHOs declaration of Public Health Emergency of International Concern (PHEIC), the designation the body gives to the most threatening crises, should have served as a chance to support this lacking health infrastructure. But the proposals so far to address the crisis dont appear to be rising to the occasion.
The International Health Regulations Emergency Committee, a WHO advisory body, suggested that affected African countries should increase their diagnostic and surveillance capabilities, improve care for patients, including through the development of isolation care centers, and make efforts to reduce gaps in research. But the recommendations say nothing about how these targets can be achieved in countries with inadequate health care infrastructure and social unrest that has in the recent past resulted in mortal attacks against health practitioners.
The developed world asking too much from these countries after having consistently ignored, all along, the mpox threat in themespecially the threat to children suffering from malnutrition who are without access to appropriate health care. Likewise, the announcement, by the European Commission that 215,000 adult vaccine doses for a disease mainly affecting children will be donated to these countries is mostly a symbolic gesture. One might think that the international community and WHO will probably scale up their support. But in the meantime, the African mpox epidemic might continue unabated.
Anne Rimoin, one of the worlds leading experts on mpox, recently posted online, an infection anywhere is potentially an infection everywhere. Declaring a Public Health Emergency of International Concern only when the risk becomes tangible for the developed countries, as the WHO has done, and issuing recommendations that essentially demand things from the mpox-stricken countries instead of outlining in detail how international help will support them, isnt the way forward in a public health emergency. Its the way toward further mpox spread.
Gabon's health ministry today announced the nation's first mpox case, which involves a resident who had recently spent 2 weeks in Uganda, another country recently affected by expanding outbreaks in Africa.
Meanwhile, the World Health Organization (WHO) yesterday posted an update on the latest African countries affected by mpox outbreaks, noting that the expansion in the region is unprecedented. "The modes of transmission in these countries are not fully described yet and are likely to include exclusive human-to-human transmission," it said, adding that the virus seems to be spreading through sexual networks, then on to households and other settings.
In other related developments, in an exclusive report today, Reuters said the WHO has said that Gavi, the Vaccine Alliance, and UNICEF can start buying mpox vaccine before WHO clearance as a way to speed up immunization. WHO authorization is expected in the next few weeks.
As the epicenter of the outbreak rages in the Democratic Republic of the Congo (DRC), social media reactions following the WHO's emergency declaration reflect mistrust and skepticism, especially toward local authorities, the group Insecurity Insight reported today. It examined 650 Facebook comments published this month. For example, they accuse local officials of exploiting the situation for financial gain and allege embezzlement of aid funds.
In a statement, Gabon's health ministry said its surveillance system has detected six suspected cases, and one sample has tested positive.
A few days before the 30-year-old man arrived back from Uganda, he experienced fever and fatigue, followed by a rash. He was hospitalized and placed in isolation on August 21. Contact tracing is under way.
Gabon's case lifts the number of African countries affected since the start of the year to at least 14.
The WHO said of the latest African countries affected by mpox outbreaks, Burundi, is the hardest-hit of five countries covered in the report.
As of August 17, officials have reported 474 suspected cases, and, of 358 patients tested, 142 were positive for mpox, which was identified as the novel clade 1b virus circulating in eastern DRC.
Confirmed cases have been reported in 26 of Burundi's 49 districts, with Bujumbura Nord, an urban area,accounting for roughly one third of the cases. Of patients, 55.6% are male, and children younger than 5 years old make up 60.3% of cases. No deaths have been reported.
Meanwhile, only a few cases have been confirmed in three other newly affected countries.
Kenya has confirmed one case, which involves clade 1b. The 42-year-old Kenyan man had recently visited Uganda and was traveling through Rwanda to Tanzania when his mpox illness was identified. Results are pending on another suspected case, and tests were negative for 12 others.
Rwanda in July reported two lab-confirmed cases, one involving a 33-year-old woman who frequently travels to the DRC and whose illness was detected at an entry point. In addition, a 34-year-old man had recently visited the country; his infection was found at a hospital.
In August Rwanda reported two additional cases, involving a man who had been in Burundi and a man who had visited the DRC. Sequencing has confirmed clade 1b.
Uganda's first two confirmed were identified in July, both of which involved clade 1b. The patients, women ages 37 and 22, were identified at a screening point at the DRC border.
Finally, Ivory Coast has confirmed seven cases this year from three health districts, which belong to the clade 2 strain circulating globally. Four of the patients are male, and all are older than 15 years.
The country has reported mpox before, but not since clade 2 began circulating.
A deadlier, more transmissible strain of the mpox virus has killed about 575 people in Congo in 2024.
The World Health Organization declared the last mpox global emergency over in May 2023. And just over a year later, here we are again.
Since the start of 2024, a deadlier, more transmissible strain of the virus has killed about 575 people in the Democratic Republic of Congo and infected 30 times more. New cases have recently appeared in Europe and Asia. In August, the WHO declared a new mpox global health emergency.
Bloomberg's Ashleigh Furlong joins host Sarah Holder to explain why the latest outbreak could have been avoided - and what it will cost to beat it.
Sarah Holder: Mozart had it. So did Beethoven, George Washington and Abraham Lincoln. For nearly 3,000 years, smallpox wreaked havoc, killing a third of people who were infected, and severely disfiguring many others.
Archive: Because it is here that most of the fatal cases of smallpox have occurred...
Holder: Even though a vaccine - the world's first vaccine! - was created in 1796 - it took hundreds of years to figure out how to get it to enough people.
Archive: The focus, of course, is on Bradford, where tens of thousands of people have waited their turn for vaccination.
Holder: A concentrated effort to vaccinate the world against smallpox started in 1959. Two decades later, it had mostly succeeded.
Archive: In October, the Somalia smallpox eradication program recorded the last case in Merca town. And it seems to me that this was the last known case of smallpox in the world.
Holder: By 1980, health officials announced that smallpox was officially eradicated. And with that came the end of the vaccination push that had led to one of the greatest achievements in public health history. But that achievement also had some unintended consequences.
Ashleigh Furlong: We had the smallpox vaccines and that actually also protected against mpox. When we eradicated smallpox, stopped giving people smallpox vaccines, that's when we started to see mpox cases rise in certain countries in Africa.
Holder: Ashleigh Furlong is a health reporter for Bloomberg. She says that mpox has been infecting humans in West and Central Africa with increasing frequency since it was first reported in a nine-month-old boy in the Democratic Republic of Congo in 1970.
Furlong: It's been spreading in Africa for decades. It's called endemic at the moment because it's sort of constantly there. It's not sporadic.
Holder: Allowing that spread - and not instituting a comprehensive vaccine program - has allowed the mpox virus to mutate. Now, a dangerous new strain has been detected in at least six African countries - and the world is watching.
Archive: The World Health Organization declares an Mpox outbreak in Africa a global health emergency, as it seeks to contain the potentially deadly virus.
Holder: Vaccinations are part of the key to getting this outbreak under control. But things are different today from when the world beat smallpox. And public health experts are saying that the worst part about mpox being back on the map is that it was entirely avoidable.
Archive: This is something that should concern us all.
Holder: Today on the show: missed warnings, $100 vaccines and red tape - why the latest mpox outbreak didn't have to happen like this - and what it will now cost to beat it. I'm Sarah Holder and this is the Big Take from Bloomberg News.
Furlong: So the epicentre of where we're seeing the spread is in the Democratic Republic of the Congo. We're seeing it in neighbouring countries as well. And then we're seeing a couple of cases in European countries. We saw one in Sweden and then we also saw one outside of Africa in Thailand.
Holder: Bloomberg's Ashleigh Furlong says the epicentre of this current mpox outbreak is in the country where the virus was first spotted: Congo. And one thing that's notable about this particular outbreak is how mpox is spreading.
Furlong: So what we've been seeing at the moment is that it's being transmitted often through sexual contact. But it could be through, you know, just touching a friend or, you know, sharing bed sheets with someone who has been infected by the virus.
Holder: And what does a mpox case look like? What does it do to the body?
Furlong: A lot of the symptoms are kind of like any old virus that you might get and could be confused with another virus. But I think what is quite significant about mpox are these lesions that you get, sort of small sores, kind of like chicken pox. And we've seen a few cases where actually they thought it could be mpox, but it turned out to be chickenpox. So I think that the little round lesions that you see on people with mpox - that's sort of a strong attribute of mpox - but otherwise, it can cause people to sort of feel unwell, tired, things that you might get with another kind of virus.
Holder: Historically, mpox has shown a limited ability to spread. The virus has mostly been transmitted from animals to humans - like from eating bush meat - and amongst humans in very close proximity, like those who live in the same household or share the same bed sheets. But that's changed with this latest outbreak, which began in December with the emergence of a new strain, called clade Ib.
Furlong: Now what we're seeing is sort of a change in transmission and it's spreading from human to human in these long chains of transmission. And that's what's got scientists really quite worried.
Holder: Can it be fatal?
Furlong: It can.
Holder: The key thing to know about this outbreak is that it's different from the one that happened in 2022. That year saw the first-ever global outbreak of the virus. And fresh off the heels of the COVID-19 crisis, the US and western Europe acted fast.
Furlong: We saw vaccines rolled out to at-risk communities, which at that time was mainly men who have sex with men, and we were seeing the transmission within those communities. There was a lot of public health messaging as well around safe sex practices, about how mpox is transmitted, how to stop it being transmitted.
Holder: That messaging and those resources seemed to work in some places, particularly in the US, which had stockpiled vaccines.
Furlong: The US has always been really worried about a smallpox outbreak, potentially. And this vaccine is effective against smallpox. So that's why they had those contracts and why they had those stockpiles.
Holder: But Ashleigh says in Congo and other African countries, where mpox is endemic, the response was different.
Furlong: In many African countries, mpox cases continue to appear and vaccines never arrived there. Public health messaging around stopping mpox- there might've been that messaging, but there's obviously many other priorities when you're a country, like the DRC, like Congo, where measles kills way more people than mpox does. So there's obviously different priorities that governments have when handling health crises.
Holder: Another factor governments have to contend with is the price of the mpox vaccine.
Holder: How much do those shots cost?
Furlong: So there's several vaccine developers who have mpox vaccines, and the one that is approved in the US and in Europe is from Bavarian Nordic. And we don't have an exact price because the company hasn't actually revealed how much they're charging for their shot. But the Africa CDC estimates that it's about $100 a dose. You need two doses to be fully vaccinated against the virus. So that's quite pricey. Vaccines are normally quite cheap.
Holder: In mid-2020, the US government was able to buy COVID-19 vaccines for about $20 a dose. So I asked Ashleigh what makes the mpox vaccine five times as expensive. She said there was one main reason.
Furlong: There's not a huge market for them. You know, mpox we might see - there's obviously quite a few cases, and there's currently a global health emergency around it - but it's still quite small. So if you're a vaccine developer figuring out how to price your vaccine, you need to make considerations about, you know, you're only producing maybe several million doses of this vaccine. So you need to still make a profit. And that's what Bavarian Nordic has said, basically, is that to be viable they have to charge the price that they have set, and they don't have that much flexibility. You know, when you're distributing a measles vaccine, for example - most childhood immunization campaigns will include a measles vaccine - so that's a massive, massive market compared to the mpox vaccines.
Holder: While fewer people might have needed an mpox vaccine, Ashleigh's sources told her that making sure the vaccine was available to the people who did need it could have changed the course of this current outbreak.
Furlong: When I spoke to scientists last week, they were really saying that if vaccines had gotten to the DRC, for example, to Congo in January, we wouldn't be in the situation.
Holder: But this is the situation we're in. So what will it take to get the outbreak under control - and what's at stake if the world fails to act. That's next.
Holder: The Africa Centres for Disease Control and Prevention reported Sunday that mpox has killed 575 people in the Democratic Republic of Congo since the start of this year - and it's infected 30 times more. And new cases are now being found in Asia and in Europe. I asked Bloomberg's Ashleigh Furlong where efforts to combat the outbreak currently stand.
Holder: So are vaccines available now for the folks around the world who are at most risk?
Furlong: No. So, Congo doesn't have any doses at the moment, they said, for the next couple days, but there's no clear timeline yet.
Holder: How many vaccines are needed?
Furlong: The Africa CDC says that about 10 million are needed for the African continent. That's quite small. In the DRC and in Congo, the population is nearly a hundred million. So we're talking about a tiny amount of vaccines really that are needed potentially to control the outbreak. Obviously, we would have needed probably less if we were talking about this several months ago.
Holder: The US is planning to donate 50,000 doses, but it has millions more in its stockpiles. Germany will donate 100,000 doses of its 117,000-dose reserve. Almost none of these donations are expected to get to Congo until September at the earliest.
Furlong: That won't get us up to the 10 million, so the rest will probably need to be bought. And countries like Congo don't have the budgets to buy those vaccines. So, we're going to be looking at who's going to help pay for those. There's some money being pledged by several aid organizations and organizations that might administer and roll out these vaccines. But at the moment, it doesn't look like we have the full amount that's needed.
Holder: But Ashleigh says containing the outbreak is not just a matter of getting enough vaccines.
Furlong: Rolling it out is going to also require quite a lot of resources. Healthcare workers, campaigns about educating people about getting the vaccine - because just because you have a vaccine on the ground, as we saw during COVID doesn't mean people will want to take it. And also, in some of these communities, there might be quite a lot of stigma around mpox vaccines. There might be concern that, oh, if I get an mpox vaccine, everyone's going to know that I might be at risk of mpox through my sexual network or through my sexual contacts. So we're going to have to see how that plays out on the ground.
Holder: Given all these challenges, how likely is it that mpox will be contained?
Furlong: We are seeing quite a strong finally, you know, response from sort of the global players in a sense from the US, from countries like Germany, et cetera. So we are seeing that reaction. It might have been a little bit delayed. I think there's a sense that this is not going to be the next pandemic. And that there's a strong desire to stop the outbreak and we're seeing from the WHO, from the Africa CDC, a really strong message that this needs to be stopped now. I suppose it'll depend on when that point's reached where it's no longer a global threat, then what happens? Are we going to go back to what happened last year when the global threat ended, the world health organization said this is no longer a global emergency, and then things kind of went back to the status quo where, which basically meant nothing really happened to stop the spread of mpox?
Holder: So there's a risk that there could be a false sense of complacency, and that could snowball into a much bigger problem.
Furlong: Exactly. But I think that we've seen what that risk has done now. So hopefully some of those lessons might be learned. But this is a disease that, as we've spoken about, has been spreading for a very long time. But there's been a push to end measles for years and we still haven't reached that, and we're seeing more spread of measles in high-income countries as well. So, I think global health experts don't get their hopes up too much.
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)
Egide Irambona, who thinks he contracted mpox from a friend, may have passed it on to his wife
Egide Irambona, 40, sits bare-chested on his hospital bed, next to the window, in a treatment room that he shares with two other men.
The rays of the evening sun shining above Burundis main city, Bujumbura, filter in. His face, bathed in a soft light, is covered in blisters. His chest too, and his arms.
I had swollen lymph nodes in my throat. It was so painful I couldnt sleep. Then the pain subsided there and it moved to my legs, he tells the BBC.
Mr Irambona has mpox.
He is one of the more than 170 confirmed cases recorded since last month in Burundi. One of the poorest countries in the world, it borders the Democratic Republic of Congo, the epicentre of several recent mpox outbreaks, which have led to at least 450 deaths and 14,000 suspected cases so far this year.
In Burundi, there have been no recorded deaths and it is not yet clear how deadly the current outbreak - of a new strain called Clade 1b - is because there is not enough capacity to carry out testing in the affected areas.
However, it has been declared a global health emergency because of fears it could spread quickly to previously unaffected countries and regions.
This is Mr Irambonas ninth day of treatment at the King Khaled University Hospital. One way that the virus is spread is through close contact with someone infected and it seems that he passed it on to his wife.
She is also being looked after at the same facility.
I had a friend who had blisters. I think I got it from him. I did not know it was mpox. Thankfully our seven children have not shown any signs of having it, Mr Irambona says, his voice trailing off.
This hospital in Bujumbura is home to one of three mpox treatment centres in the city.
Fifty-nine of the 61 available beds are occupied by infected patients a third are under the age of 15 and, according to the World health Organization, children are the worst-affected age group here.
Odette Nsavyimana is the doctor in charge at the hospital and says the number of patients is increasing.
We are now setting up tents outside. There are three so far one for triage, one to hold suspected cases and one to take confirmed cases before they can be transferred to the wards.
"It is tough, especially when the babies come. They cannot stay alone, so I have to keep their mothers here as well. Even if they have no symptoms It is such a tough situation, Dr Nsavyimana says, her voice muffled by her protective face mask.
Burundi is now seeing a surge in mpox cases.
"I am worried about the numbers. If they keep increasing, there is no capacity for us to handle that.
A lot of effort is made to isolate those infected from the rest of the hospitals population. There is red tape everywhere, and visitors, who are required to wear protective equipment, are physically distanced from those infected.
Medical officials are worried about limited resources. There is only one laboratory in the country where blood samples can be tested for the virus, there are insufficient testing kits and no vaccines.
Maintaining hygienic conditions across Bujumbura is also hard as access to basic resources like water is limited in the city. There is a shortage of running water and people can be seen queuing up at public taps.
Dr Liliane Nkengurutse, national director for the Centre for Public Health Emergency Operations, says she is really concerned about the coming days.
This is a real challenge. The fact that diagnosis is only done in one place delays detecting new cases.
Health centres are calling the laboratory saying they have suspected cases, but it takes time for teams from the lab to deploy to where the suspected cases are to take samples.
And it takes much more time to release the test results. We need about $14m (10.7m) to be able to at least take our response to the next level, she says.
Despite talk of vaccines reaching DR Congo as early as next week, there are no reports of a similar move for Burundi.
Public awareness about mpox is limited.
Bujumbura is just 20 minutes from the border with DR Congo and is a hub for cross-border travel and trade. But there is no sense of the possible risks of an outbreak.
The city is abuzz with activity. People are still buying and selling goods as usual. Handshakes, hugs and very close contact are the norm. There are long queues at the bus stations, with people scrambling to get onto already crammed public service vehicles.
Many people do not understand the gravity of this issue. Even where there have been cases, people still just mingle, Dr Nkengurutse says.
The BBC spoke to several people in Bujumbura and the majority did not know what mpox was. And those that did were not aware that it was spreading in their country.
I have heard about this disease, but I have never seen someone who suffers from it. I have only seen it on social media, one person said.
I know it affects babies and young people. I am scared of it, but that does not mean I will just stay at home. I have to work. My family has to eat, said another.
Health workers know that persuading people to take more care may be hard among a sceptical population that is facing a host of economic challenges.
But they will continue to treat patients, make sure they get better and try and trace those that they have been in contact with in efforts to contain the spread of the virus.
At the Katako referral health center in Maniema province, eastern Democratic Republic of Congo, in November 2023. GUERCHOM NDEBO/ALIMA
In the Democratic Republic of Congo (DRC), the epicenter of the mpox outbreak, authorities are updating their response. Libreville health authorities confirmed the first case of the new Clade 1b virus strain in Gabon on Thursday, specifying that it concerned a young man returning from a trip to Uganda.
On Monday, the Congolese Ministry of Health held a meeting with the African Union's public health agency, CDC Africa, to adapt its plan to combat mpox, less than a week after the pan-African institution declared its maximum continental alert level. This was followed the next day by the World Health Organization (WHO), which extended the alert internationally (as a public health emergency of international concern, PHEIC) after a case of new-variant mpox was announced in Sweden, then in Thailand.
In the DRC, according to CDC Africa, the latest figures for Friday, August 23 were 17,342 suspected cases and 3,167 laboratory-confirmed cases of mpox by the National Institute of Public Health, as well as 582 deaths.
"That's more than all the cases in the whole of 2023," warned Dr. Louis Albert Massing, Doctors Without Borders' (MSF) medical coordinator for the whole country. The French NGO is a major partner of the Congolese health authorities, who report that all 26 of the country's provinces have reported at least some cases.
Kinshasa can count on receiving its first vaccine donations in the week of September 26, Health Minister Samuel Roger Kamba announced on Monday, pointing out that this is now a "continental emergency." While the US has pledged up to 75,000 doses, the European Union 215,000 and France 100,000, Japan is currently the most generous, having announced that it will send 3.5 million doses from its stocks.
This international solidarity is sorely needed, given the scale of the epidemic and the prohibitive cost of the vaccine (100 per dose) for a country like the DRC. Kinshasa had actually planned to roll out a vaccination program in the east of the country as early as October, targeting between 70,000 and 100,000 people. However, in view of the rapidly deteriorating situation, it needs to be able to collect 10 million doses by 2025.
More transmissible than the variant that was rife until September 2023 in the DRC, where mpox has been endemic since the 1970s, Clade 1b is extending its grip on its neighbors: 171 cases have been reported in Burundi, which has not yet suffered any deaths, but is experiencing the week's biggest increase. This strain is spreading in Uganda, Rwanda and the Central African Republic. Further afield in Gabon and Kenya, on Thursday, Nairobi and Kampala announced the reinforcement of health surveillance at their air and land borders.
You have 62.99% of this article left to read. The rest is for subscribers only.
