EDITORIAL: Has nothing been learnt from Covid-19?

A new and potentially deadly disease rears its head in SA. Vaccines have been developed to counter the threat, but none are on hand because the world’s wealthiest nations quickly snapped up limited supplies and hoarded them for their own citizens.

Sound familiar? It should. Only this time it’s not Covid-19 but mpox, a virus that causes flu-like symptoms and painful pus-filled lesions. While mpox, formerly known as monkeypox, is generally mild, it can cause much more serious illness in people with a compromised immune system: in SA, where many people living with HIV are diagnosed late or not on treatment, the disease poses a grave risk.

Almost a month after announcing SA’s second outbreak of mpox (the first was in 2022), the health department is still trying to make good on its promise to secure donations of mpox vaccines from Western nations, who are now apparently happy to hand over soon-to-expire shots they no longer need.

SA’s current outbreak stands at 20 laboratory-confirmed cases, three of them fatal, but the true number of patients is likely much higher. Unlike the generalised outbreak in the Democratic Republic of Congo (DRC), SA’s reported mpox cases are so far confined to men who have sex with men.

There is some good news here: the fact that the outbreak remains confined to a specific group of people should make it easier to contain, and SA’s world-class genomic sequencing capacity means local scientists quickly confirmed that the strain of mpox circulating in SA is clade IIb — the strain responsible for the multi-country outbreak in 2022.

This is important, because it means it is susceptible to the two vaccines on the market: Emergent BioSolutions’ weakened smallpox jab ACAM2000 and Bavarian Nordic’s attenuated vaccinia shot Jynneos. The bad news is since neither are available in SA, efforts to contain the outbreak rest on testing the contacts of people known to have mpox and isolating those who are infected. The disease is primarily spread through touch, so friends, family and healthcare workers caring for mpox patients face an entirely unnecessary risk.

This miserable situation is a stark reminder that no matter the political will of African leaders or the aspirations of the continent’s pharmaceutical manufacturers, improving vaccine security to the point where Africans no longer depend on the largesse of wealthier nations is still years away.

At the start of the Covid-19 pandemic in 2020, Africa imported 99% of its vaccines. Today the picture has barely changed, as the AU’s determined push for vaccine sovereignty, which culminated in June in the launch the African Vaccine Manufacturing Accelerator, has yet to bear fruit.

The scheme, designed by the vaccine alliance Gavi, will provide $1.2bn in financial incentives over the next 10 years to promote vaccine manufacturing in Africa. While it will certainly boost the AU’s campaign for Africa to manufacture 60% of the vaccines it uses by 2040, the project is cold comfort for those people who need vaccines today.

Mpox is endemic to several countries in Central and West Africa, including DRC, Gabon and Nigeria. If vaccines had been readily available, it is quite possible that the global outbreak would never have happened and SA would not be scrambling to protect people from an entirely preventable disease.