Already more than 1000 dead – Mpox is still not under control in Africa

Jean Kaseya, director of the African health authority CDC Africa, repeats weekly in his situation reports: “Mpox in Africa is not under control”. For him and other health experts, the situation has something of a sense of déjà vu.

As during the Covid pandemic, the weaknesses of the continent’s healthcare infrastructure are becoming clear: too little laboratory and testing capacity, but above all too little internal vaccine production. Health authorities on the continent are depending on rich countries to supply vaccines from their stockpiles to protect against the virus.

Outbreaks in now 20 countries
According to the CDC and the World Health Organization (WHO), there are currently cases of Mpox in twenty African countries; the first case occurred last week in Angola. Since the start of the year, the number of cases has risen to almost 60,000, and 1,164 deaths from Mpox have been reported so far this year.

Mpox, formerly known as monkeypox, is recurrent in Central Africa and is mainly transmitted from rodents to humans. The fact that major outbreaks never occurred for decades is partly due to the previously common smallpox vaccination. It also protects against the closely related Mpox viruses. Smallpox has been considered eradicated since 1980 and therefore vaccinations have been discontinued.

Global Mpox alert declared
In mid-August, CDC Africa and the WHO declared the highest alert level due to the Mpox outbreaks in Africa and the new, possibly more dangerous Ib variant. The aim is to encourage authorities around the world to be more vigilant. It was also necessary to develop a common strategy on the continent as cases spread from the particularly affected Democratic Republic of Congo (DRC) to more and more countries outside Central Africa.

However, in Central Africa, more than 90 percent of cases are still recorded. 95.5 percent of last week’s 2,680 new cases were also in Congo, Uganda and Burundi.

Delays in vaccination campaigns
In the first half of November, the DRC, Rwanda and Nigeria received a total of 280,000 vaccine doses. But vaccinations started with delays in Congo and Nigeria. Poor infrastructure in large areas, a lack of refrigeration options and electricity bottlenecks make vaccine distribution even more difficult, especially in rural areas.

Moreover, the vaccine doses administered so far are ultimately just a drop in the ocean: when the alarm was declared, Kaseya had already spoken of at least ten million vaccine doses being needed on the continent to stop the outbreak.

There is no vaccination solution for children yet
Furthermore, the groups that are particularly affected include children and young people under the age of 15. Their share of cases of illness is between 40 and more than 50 percent in individual countries. However, because not all countries separately register cases of illness in children, there are no figures for all affected countries.

But the existing vaccines against Mpox have not yet been approved for children. There is hope now, Ngashi Ngongo, CDC Africa’s Mpox manager, said in the latest assessment on Thursday. Japan has promised the Democratic Republic of Congo three million doses of a vaccine that is also suitable for children aged one year and older. However, the approval process in the African country is still pending.

Hygiene measures have only a limited effect
Distance and hygiene measures, which were already attempted to minimize infections during the corona pandemic, can only have a limited effect – especially in the hard-hit eastern Congo. In total, around seven million people live in extremely cramped conditions in refugee camps here, after fleeing armed fighting in the conflict-affected area.

“You can’t even think about isolating all the suspected cases because there is a huge population and there is no space or facilities for it,” Agnese Commelli, a doctor with the aid group Doctors Without Borders in Goma, eastern Congo, told the German news agency.

Many sick people wait
Many people do not seek health care until the disease is in an advanced stage, Commelli explains. “They don’t walk four kilometers or more to the nearest health post just because they have a fever. They come when they feel worse and the rash has already worsened.” The doctor also noted that the fear of an Mpox infection was not particularly pronounced: “It is not Ebola.”

Family members and neighbors are often infected by the time they go to the doctor, especially if people live close together. In addition to the characteristic rash, typical symptoms include chills, fever, headache, muscle aches and back pain.

Fatal cases mainly occur in regions with limited access to medical care. They often affect children, especially those suffering from malnutrition, and people with weakened immune systems. After suffering from Mpox disease, you develop an immunity to reinfection that lasts for years. People who are already ill do not initially need a vaccination.