The World Health Organization (WHO) will decide on whether to issue an emergency use listing (EUL) for an mpox vaccine within three weeks after its manufacturer supplied the global body with all the required information last Friday, Director-General Dr Tedros Adhanom Ghebreyesus told the opening of the WHO Africa regional conference on Monday.

The WHO has been criticised for being too slow to evaluate potential mpox vaccines already approved by the US and Europe, thus leaving Africa dependent on donated vaccines.

Africa’s biggest vaccine procurers, Gavi and UNICEF, are unable to buy vaccines without either EUL or full WHO approval.

The EUL procedure fast-tracks unlicensed medical products in public health emergencies, and Bavarian Nordic’s Jynneos (also called MVA) and Emergent BioSolutions’s ACAM2000 vaccines have both been recommended for consideration by independent health experts. 

Continent needs $135 million for mpox

Tedros added that it will take around $135 million to bring the current mpox outbreaks in Africa under control, requiring “a complex, comprehensive and coordinated international response”. 

The WHO also published a Global Strategic Preparedness and Response Plan for mpox on Monday setting out steps to address the outbreak. 

“So far this year, more than 18,000 suspected cases of mpox, with 615 deaths have been reported in the Democratic Republic of Congo alone, already exceeding last year’s total, which was itself a record,” Tedros told the meeting, which is being held over five days in the Republic of Congo (Brazzaville).

“Of particular concern is the rapid spread of a new strain of the virus that causes mpox called clade 1b in the countries. In the past month, more than 220 cases of clade 1b have also been confirmed in four countries neighbouring DRC, which had not reported mpox before, Burundi, Kenya, Rwanda and Uganda.”

Tedros also commended the WHO Africa region for improvements in primary healthcare across the continent, as well as a 50% increase in funding for the WHO provided by member states.

“District Health Systems have been strengthened. Access to essential medicines is improving. The capacity of the health workforce is increasing, and community health communities are functioning effectively,” said Tedros.

Conference praises outgoing director

Botswana’s Dr Matshidiso Moeti, the outgoing WHO Africa regional director, told the conference that “economic difficulties, which include debt servicing, growing wealth inequalities and conflicts, are slowing down investment in priority health programmes”.

Poorer African countries are experiencing “deteriorating conditions below 2019, pre-pandemic levels”, making it “even more difficult to achieve the sustainable development goals health targets”.

“As a region, we must unite and encourage the rest of the world to join forces against the major threats of the 21st century, especially climate change, the next pandemic and non-communicable diseases,” Moeti urged.

“These threats, demand, international collaboration. They require government leadership and the public and private sectors to work together with fairness.”

Moeti added that the WHO country teams are “working on the frontline to help reinforce measures to spread to to curb the spread of mpox”, and in partnership with the African Union, “we continue to advocate for the necessary diagnostic therapeutic tools and vaccines”.

Moeti also raised the emigration of African health workers, and called for the implementation of the Africa Health Workforce Investment charter which was luanched in May.

“In Uganda, the immigration of doctors increased by 16% in three years, while in Zimbabwe, during the same period, over one in five doctors has left the country in May,” Moeti noted.

Moeti, who was appointed in 2015 and served two terms so is not available for re-election. She has overseen WHO’s operations through trying circumstances, including Ebola outbreaks and the COVID-19 pandemic.

“Never before has healthy life expectancy been so high in the African region. Never before have fewer young children died each year, or fewer women died of maternal causes. Never before have we responded to emergencies in so short a time. Never before have malaria vaccines been introduced into routine child immunization schedules in Africa, and this after centuries of waiting,” said Moeti, who described her term as the “highest honour of my life”.

Tedros described Moeti as “one of the most formidable health professionals I have ever had the privilege to call my colleague”.

“She is not afraid to tell you exactly what she thinks, but she does it because she cares. She cares deeply about the people of our continent and the people of the regional and country offices. She believes that the people of Africa deserve nothing but her best, and that’s what she has given for the past 10 years,” said Tedros.

“Under the leadership of Dr Moeti, WHO Africa region has been leading a transformation agenda to ensure that the organisation is accountable, effective, and driven by results,” said Botswanan health minister Dr Edwin Dikoloti.

“In this regard, we are pleased that many countries have now undertaken reforms to improve health financing and the delivery of quality essential health services.” 

Hotly contested leadership race

On Tuesday, the conference will elect a new regional director with five males candidates contesting for the position. 

Senegalese Dr Ibrahima Socé Fall, proposed by his home country, is currently the WHO director of Global Neglected Tropical Diseases (NTD). 

Dr N’da Konan Michel Yao, proposed by his home country of Côte d’Ivoire, has been WHO Director of Strategic Health Operations since August 2020, where he coordinates the body’s response to health, natural and humanitarian disasters.

Dr Richard Mihigo, proposed by Rwanda, is currently senior director of programmatic and strategic engagement with the African Union and Africa CDC. 

Dr Boureima Hama Sambo, proposed by Niger, is WHO’s Representative to the Democratic Republic of the Congo as Head of Mission. 

Dr Faustine Engelbert Ndugulile, proposed by Tanzania, was that country’s Minister for Communication and Information Technology between December 2020 and September 2021 and has also served as a deputy minister of health.