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Africa fears monkeypox vaccine side-lining as disease spreads

While monkeypox has spread to around 16,000 people in more than 70 countries, with the first deaths reported in Spain and India, and been declared a public health emergency of international concern by the World Health Organisation (WHO), Africa is yet to receive any vaccines for the disease.

The Africa Centres for Disease Control and Prevention (CDC) deputy director Ahmed Ogwell Ouma said last wee that Africa has not received any doses of the inoculation, reports TimesLIVE, despite the disease being endemic to the continent.

Last month, Ouma said Africa should be first in line for monkeypox vaccines, to avoid a repeat of the coronavirus pandemic that left the continent far behind wealthier nations.

Africa CDC is in talks with developers to get shots “as soon as possible” for monkeypox and smallpox, he said. Vaccines for the latter can also be used against monkeypox.

His sentiments echo those from earlier this month, when the WHO’s regional director for Africa Dr Matshidiso Moeti said history could repeat itself, with African countries being left behind in the fight against monkeypox, just like at the onset of the COVID-19 vaccine roll-out.

News24 said he pleaded for this trend to be stopped. “What happened in the early days of the COVID vaccine roll-out when Africa watched on the sidelines as other countries snapped up limited supplies must not be allowed to recur. There are some signs that this is already happening.”

So far, second and third-generation smallpox vaccines are used to treat monkeypox. A vaccine consisting of modified vaccinia Ankara-Bavarian Nordic was approved for the prevention of monkeypox but it is in short supply globally.

For a roll-out in Africa, member states should agree on a universal framework.

“WHO is working closely with the member states and partners to define what type of co-ordination mechanism could be put in place to ensure fair access to vaccines. There are many regulatory, legal, operational, technical, and other issues to clarify before an allocation mechanism is fully operational,” said Moeti.

After the number of cases exploded last month in countries such as Portugal, Spain and the United Kingdom – where outbreaks don’t usually occur – a rapid, global response followed, including the distribution of vaccines in some countries.

But monkeypox outbreaks have been occurring in parts of Central and West Africa for years, leaving African researchers there disheartened that such resources have not been made available in their countries, where the disease’s toll has been highest. They point out that they have long been warning of the potential for the monkeypox virus, which has been behaving in new ways, to spread more widely.

Nature Briefing reports that so far this year, there have been more than 3,000 confirmed monkeypox cases in countries beyond Central and West Africa.

In Africa, health officials have reported more than 70 deaths that they suspect were caused by monkeypox. This is probably an undercount because of limited testing and surveillance capacity, says Dimie Ogoina, an infectious-disease physician at Niger Delta University in Amassoma, Nigeria.

Although he is frustrated by monkeypox having been largely ignored by Western nations until now, Ogoina worries that the current global outbreaks still won’t improve the situation for Africa.

“If we don’t draw the attention of the world for this, a lot of the solutions will address the problem in Europe, but not in Africa,” he says.

In recent weeks, the WHO has recognised the inequity in the global attention that monkeypox is receiving. On 17 June, the agency announced it would no longer report monkeypox cases and deaths for sub-Saharan Africa and the rest of the world separately, reflecting the “unified response that is needed”.

Yet even if sub-Saharan African nations procure vaccines, inoculation alone will not eradicate monkeypox, says Oyewale Tomori, an independent virologist in Ibadan, Nigeria. He cautions that vaccination is only effective if health officials understand the local epidemiology of the pathogen – and there are still many questions about how isolated cases of the disease have continued to pop up all over the affected countries in sub-Saharan Africa.

He recommends supporting research to investigate the animal reservoir of monkeypox so that health officials can devise more precise measures to curb the spread of the virus. “Without addressing the fundamental issues, you’ll end up using all your vaccines toward monkeypox,” he says, instead of dealing with the source of the problem — contact between wildlife and humans.”

Equally important are strategies to speed up testing for monkeypox, because the faster a case can be confirmed, the sooner that public-health officials can begin containment countermeasures, Ogoina adds. These advances can’t come soon enough for sub-Saharan Africa, he said.

“Isolated solutions that fix the problem for developed countries alone and leave out developing countries will lead us through the same cycle again,” he warns, pointing to past outbreaks where a pathogen continues to re-emerge. “It’s just a matter of time.”

The National Institute for Communicable Diseases (NICD) said there have been three confirmed monkeypox cases reported in South Africa, with zero deaths reported since May.

The three cases, which are not linked, were reported in Gauteng, Western Cape and Limpopo and are males aged 30, 32, and 42 years.

No secondary cases have been linked to the three cases and no new laboratory-confirmed case has been reported since the last case on 10 July, reports SABC News.

Meanwhile, reports the Cape Argus, the LGBTQIA+ community has warned against stigmatising certain groups, saying it should rather be associated with testing and vaccination, as opposed to the monkeypox virus.

Reports by health bodies have linked the virus to gay men or men who have sex with men (MSM), leading to stigmatisation and homophobia, and QueerLivesMatter activist Kamva Gwana stressed the damaging effects of the stigma being associated with gay men or MSM. This was further highlighted by several LGBTQIA+ advocacy organisations OUT LGBT in South Africa and further abroad.

“It is particularly troubling for these narratives to be allowed to continue in South Africa when we know far too well as a country the dangers of stigmatisation when it comes to viruses and disease we face through the HIV/Aids pandemic here," said Gwana. "More work should be done to dispel these misconceptions and the associated stigma, and more careful consideration given to how information about the virus is shared.”

Gwana said the LGBTQIA+ community was one that frequently tested for HIV and STIs, and took up available treatments such as PrEP and PEP.

“We’ve been seeing worldwide that a lot of people are contracting the virus, but saying: ‘It doesn’t affect us, it only affects MSM people, therefore I don’t have to isolate, I don’t have to manage it properly’, or people are not getting tested or able to isolate and treat the virus effectively,” he said.

Triangle Project communications officer Ling Sheperd said: “Stigmatising the LGBTQIA+ community will not help anyone. Framing monkeypox as a ‘gay disease’ is harmful and fuels the damaging stereotypes of gay men and MSM that is already out there. This is reminiscent of the narratives regarding HIV/Aids decades ago. It was harmful, and we are still seeing and feeling the effects today.”

However, WHO has made it clear that to reduce their risk of contracting monkeypox, men who have sex with men should consider limiting the number of their sexual partners.

The WHO’s Ghebreyesus said the outbreak can be halted, but that people in the community where most transmission is occurring – gay and bisexual men, and other men who have sex with men – should take the risk seriously and take steps to help stop the spread, reports STAT News.

“For the moment, this would include reducing your number of sexual partners, reconsidering sex with new partners, and exchanging contact details with any new partners to enable follow-up if needed,” Tedros said.

Previously public health messaging, including the WHO’s, has focused on the importance of not stigmatising gay men in this outbreak, rather than on the role the community could play in helping to stop the spread. Initially, in fact, much of the public health messaging was so vague about who was most at risk that some advocates in the community stressed the need for communications that made clear to men who have sex with men that they were at risk.

The unprecedented outbreak is primarily transmitted among men who have sex with men, especially among those who have multiple sex partners or anonymous sex.

That has made some of the tools normally used to control an infectious disease – contact tracing and targeted vaccination – potentially less effective, as a number of the confirmed cases couldn’t give contact tracers the names of all of their sexual partners, for instance.

Keletso Makofane, a social network epidemiologist at Harvard’s FXB Centre for Health and Human Rights, said as a temporary measure, limiting certain sex practices “is one tool, among many tools, people can use to manage risk – to protect themselves and their communities”.

Makofane is one of the investigators involved with RESPND-MI, an LGBTQ+ community-led survey that’s studying monkeypox cases and providing information about the outbreak and access to treatments and vaccines. The group has also issued guidance for having safer sex during the outbreak, which includes reducing group sex and sex in higher-risk spaces, adds STAT News.


TimesLIVE article – Africa, where monkeypox is endemic, gets no vaccines yet (Open access)


Nature article – Monkeypox in Africa: the science the world ignored (Open access)


SABC News article – Three confirmed monkeypox cases reported in SA, last on 10 July: NICD (Open access)


News24 article – Signs of Africa being sidelined in monkeypox fight, says WHO (Open access)


Cape Argus PressReader article – Warning of monkeypox stigmatising (Open access)


STAT News article – WHO recommends men who have sex with men reduce sex partners to limit monkeypox risk (Open access)


See more from MedicalBrief archives:


WHO declares monkeypox a global health emergency


Scientists warn of more zoonotic disease


Monkeypox: forecasters predict the global outlook for 2022




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