Africa has been particularly affected by the ongoing Mpox outbreak. As of 28 July, 14 250 cases had been reported in ten African countries. Despite progress in pandemic preparedness and outbreak response on the continent, significant challenges remain.
First, research and development of medical countermeasures for Mpox and other diseases endemic to African countries is mainly conducted outside the continent. There is therefore a need for Africans to prioritise research on the continent to better understand the epidemiology, prevention and treatment of such diseases. While collaboration is needed to advance science and build on the existing body of knowledge, it should be African-led and produce results that benefit Africans. For now, our efforts look more like parachute science. Our governments have a critical role to play in enabling and contributing to public health research. They must step up to the task.
Second, Africa’s preparedness for epidemics and pandemics needs to go beyond disease surveillance and declaring health emergencies. It needs to be more intentional about investing in vaccine production. Ensuring easy access to vaccines for our people is a matter of continental health security and self-reliance.
Currently, in addition to limited research and development on the continent, we have a nascent manufacturing industry, with only 1% of the total vaccine doses needed in Africa produced locally. To address this, the African Union has established the Partnerships for African Vaccine Manufacturing (PAVM) to enable the African vaccine manufacturing industry to develop, produce and supply at least 60% of the continent’s vaccine requirements by 2040. It is important that our governments maintain the political will to implement the PAVM Framework for Action and invest in local production of medical products, especially now that pharmaceutical companies are scaling back their operations or leaving certain African countries. Of note, COVID-19 vaccine manufacturer Moderna has abandoned its plans to build an mRNA manufacturing facility in Kenya due to reduced demand for COVID-19 vaccine in Africa, making the business unviable. It is clear that additional manufacturing facilities would improve access to vaccines on the continent, particularly in the event of an epidemic or pandemic.
It’s no surprise that the Mpox vaccines available for use are produced by Bavarian Nordic, a Danish biotech company, and KM Biologics, a Japanese company. No African company is producing the vaccine, and once again we are relying on actors outside the continent to help us respond to the outbreak. The United States government has offered to donate 50,000 doses from its stockpile, and the European Health Emergency Preparedness and Response Authority has donated 175,420 doses. Bavarian Nordic has also donated 40,000 doses of its vaccine. While these donations are welcome, they are nowhere near enough to meet the potential needs in 13 African countries.
The vaccines are also prohibitively expensive at around $100 per dose and require two doses to be administered. In this regard, Bavarian Nordic’s Vice President of Investor Relations believes that it is highly unlikely that any country in Africa will ever be able to purchase vaccines, and that vaccines will be received through donations from organisations and other countries. Meanwhile, Mpox is spreading and has been detected in a European country. If it spreads across the European continent, Africa will find itself in a situation where vaccines go to European countries before Africa.
Finally, Africa lacks a continental regulatory authority. Yet such an institution is critical now for the review of Mpox vaccine candidates in development and on the market. Furthermore, research, development and production of medical countermeasures in Africa needs to be accompanied by strengthening regulatory systems and building capacity. Steady progress is being made in the operationalisation of the African Medicines Agency (AMA), a continental regulatory body with a vision to ensure that all Africans have access to quality assured, safe, effective and affordable medical products that meet internationally recognised standards for priority diseases. However, the AMA’s Director General has yet to be appointed and its headquarters in Rwanda has yet to open its doors.
Yesterday it was COVID-19, today it is Mpox, tomorrow it will be disease X. It is inevitable and we have no control over it. What we do have control over is our preparedness for and response to public health emergencies. We need to take responsibility for this and not delegate it to third parties.
