Expert: There is potential for many new epidemics

“It is absolutely unacceptable in the 21st century that people are dying from cholera,” said Marcus Bachmann of Doctors Without Borders Austria, who has criticized the lack of aid.

In the case of Mpox (formerly monkeypox), the World Health Organization (WHO) declared the highest alert level of a “health emergency of international concern”, as had long been the case with Corona, and extended it on November 22. Even though we don’t hear much about the news, it remains an epidemic with major consequences for those affected, Bachmann emphasizes. According to the WHO, a total of more than 15,600 Mpox cases have been registered in twenty African countries since the beginning of last year, mainly in the Democratic Republic of Congo. The number of unreported cases is high due to limited diagnostic options.

Mpox vaccines limited
It is still the case that a significant number of people become ill and some die. “In this context, it is particularly regrettable that preventive measures such as vaccines are not sufficiently available,” Bachmann emphasized. “This is a reflection, an echo of what we know from the Covid-19 pandemic, with its great distributive injustice.”

Production of Mpox vaccines is limited. There is little interest in factories in the Global North creating additional capacity by relocating production. In addition, wealthy countries have ordered and stockpiled larger quantities of the vaccine. As with the Covid vaccines, with Mpox “the doses are running out in the north of the world and are being destroyed”, emphasized the humanitarian advisor of Médecins Sans Frontières Austria with professional experience in the pharmaceutical industry.

Marburg virus
In contrast, the response to this year’s Marburg virus outbreak in Rwanda can be seen as an example of what is possible ‘if there is no lack of political will and prioritization’. The hemorrhagic fever disease similar to the Ebola virus was combated with an internationally coordinated approach, Bachmann reported. A candidate vaccine and a drug were used on a trial basis “so that the outbreak could be controlled”. Of the 66 documented cases, 15 people have died. This is the lowest death rate in the history of Marburg outbreaks.

The Marburg virus, with previous mortality rates of 25 to more than 90 percent per outbreak, is assessed differently in terms of threat potential than Mpox, Bachmann said, explaining the reason for the different international responses. On the other hand, if Mpox breaks out in the global north, with health care there, it is a disease with no long-term consequences.

Huge vaccination gaps
In addition, “unfortunately this year, essentially vaccine-preventable diseases,” such as measles, diphtheria and whooping cough, occurred in Africa, Bachmann reported. “It is not only, but also as a result of the Covid-19 pandemic, that a huge vaccination gap has emerged worldwide, but also in the global south, preventive measures such as vaccinations have no longer been prioritized.” The MSF expert was in Niger at the beginning of this year when diphtheria epidemics occurred there with a mortality rate of ten percent. “We haven’t seen outbreaks of diphtheria and whooping cough of this magnitude in decades,” he said.

Moreover, cholera is also the largest epidemic of the disease in decades, Bachmann reported. The flow of refugees from the conflict in Sudan to South Sudan led to a massive outbreak with a high mortality rate. There are not enough vaccines against bacterial intestinal disease. One of the two manufacturers stopped production this year. Although optimal protection comes from two partial vaccinations, only one vaccination is now given to reach more people. But even with this vaccination schedule, not everyone who needs to be vaccinated can be vaccinated, Bachmann said. “It is actually unacceptable that we have to manage shortages here.”

Zoonoses are becoming increasingly likely
People in countries in the Global South are also affected by epidemics outside Africa. Bachmann was referring to India or Bangladesh, where about 900,000 Rohingya are being held in prison-like conditions at the Cox’s Bazar refugee camp. The sanitary and hygienic situation is catastrophic, making living conditions “virtually ideal for disease outbreaks.” About 40 percent suffered from scabies or the scabies mite before the outbreak was controlled through targeted mass treatment. There is also an “extremely high prevalence of hepatitis C in these camps” of 20 percent.

“The reservoir of known pathogens is large,” Bachmann emphasized. Given the “dramatically widening vaccination gap,” there is great potential for further epidemics. There are also areas such as the Congo Basin and the Central African rainforests that are particularly susceptible to zoonoses, i.e. diseases that can be transmitted from vertebrates to humans. “We humans are invading these habitats more and more deeply, mobility patterns are changing and urbanization is also progressing in Africa,” says Bachmann. This makes zoonoses more likely.

People in sub-Saharan Africa are already being hit by multiple epidemics, the MSF humanitarian expert has warned. “This creates an extreme bottleneck when it comes to people’s health care.”