Despite having the second biggest mpox outbreak in Africa, Burundi has no immediate plans to vaccinate those at risk.

Donated vaccine doses are available to Burundi for free but “vaccine hesitancy” might be playing a part in the government’s reluctance to vaccinate people, according to Dr Ngashi Ngongo, mpox lead for the Africa Centres for Disease Control and Prevention.

Over the past week, Burundi has registered 273 new mpox cases – an 13.8% increase over the previous week – and its first death. Overall, it has over 2,000 cases.

“The problem is not really the availability of vaccines. The problem is more on the country’s side,” Ngongo told an Africa CDC briefing on Thursday.

“During the COVID-19 time, it was a similar experience, where there was hesitancy to embrace vaccination. But toward the end of the response, the government of Burundi had accepted for vaccinations to be introduced in Burundi. We are hoping that it will be the same here.”

Ngongo confirmed that “there was really some hesitation” from the government, who wanted more information. 

“That information is being provided in order to get to the point where we can then convince the government of Burundi to move ahead with vaccines,” said Ngongo.

“The vaccines are ready. As soon as they accept, we should be able to deploy them.”

Burundi is one of the poorest countries on earth and two-thirds of the population live below the poverty line, according to the World Bank.

While 44 of the country’s 49 districts have registered mpox cases, the heart of the outbreak is in the economic capital of Bujumbura, where almost 60% of cases are, according to Ngongo.

Children under the age of 15 account for 42.9% of the country’s cases, the highest percentage on the continent. Clade 1B is dominant. 

Former President Pierre Nkurunziza failed to impose public health measures to control COVID-19. But after his death in 2020, his successor, Évariste Ndayishimiye, gave the go-ahead to vaccinations.

Misinformation campaign

However, vaccination campaigns particularly in Francophone Africa have become the target of disinformation campaigns allegedly fueled by Russia, according to The New York Times. 

Pro-Russian social media influencer Egountchi Behanzin has campaigned against malaria vaccines solely because they were developed in Western countries.

More recently, Behanzin – who has a large social media following and posts daily videos – took aim at mpox vaccines and urged Congolese people to reject them.

He claimed Western countries were involved in “health terrorism”.

ALERTE 🚨 #CONGO 🇨🇩
Les criminels impérialistes de l’union Européenne 🇪🇺 envoient 100 000 vaccins mortels avec des effets indésirables graves contre la « VARIOLE DU SINGE »🐒

Nous appelons les populations congolaises à faire preuve de la plus grande vigilance. Aujourd’hui,… pic.twitter.com/0ZUSgg3tfX

— Egountchi Behanzin (@EgountchiLdna) November 16, 2024

Steady growth of mpox

In the past week, Africa has recorded 2,680 new cases (492 have been confirmed) and 22 deaths.

Some 84% of cases are located in the Democratic Republic of Congo (DRC), which recorded 2,261 new cases. The country also recorded 21 deaths, representing 95% of the continental total. 

Burundi and Uganda account for most of the remaining cases, while there are smaller outbreaks in Cameroon, Central African Republic and Liberia.

Gabon, Guinea and South Africa have moved from “active” to controlled, with no new cases in the past six weeks.

Meanwhile, the US and Canada have recorded their first mpox cases in people who have traveled to African countries with outbreaks.

Vaccination campaigns

In contrast to Burundi, Rwanda, DRC and Nigeria have started to vaccinate people at risk. Almost 56,000 people have been vaccinated in seven provinces of the DRC.

Rwanda has already reached 44% of its initial target, and is planning a new strategy for the next phase – “cluster vaccination in hot spots”, said Ngongo.

“Given that in some of the areas, the identification of contacts has remained a challenge, I think entire households are also being considered where there’s clear evidence of proximity and increased risk to those around the confirmed case,” said Ngongo.

The Japanese LC16 has now been included in the World Health Organization’s (WHO) emergency use listing for people aged one year and above.

“Now we are just waiting for the confirmation now from the Japanese government when the three million doses going to arrive in the DRC,” Ngongo noted.

Still a public health emergency

The International Health Regulations (IHR) Emergency Committee has resolved that mpox is still an public health emergency of international concern (PHEIC), WHO Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday.

According to a statement from the emergency committee meeting held last Friday (22 November), the “observed dynamics of transmission” of mpox clade 1b in DRC “are changing over time and are diverse across affected health zones”.

Infections have “shifted from adults, where transmission was first observed and appears to have been sustained by contact within commercial sexual networks, to younger age groups, including children, and sustained by household and likely broader community transmission through close physical contact”, it notes.

“Regardless of the circulating mpox clades, adults of 50 years of age or older are less affected, likely due to the immunity conferred by prior vaccination against smallpox,” it notes.

“As we have said many times, we’re not dealing with one outbreak of one virus, but several simultaneous and overlapping outbreaks of different strains or clades of the virus affecting different groups in different places,” added Tedros.

“We still face many challenges to bring these outbreaks under control. We need stronger political commitment to scale up responses activities. We need fully resourced preparedness and response plans. We need further contributions of medical countermeasures, including diagnostics and vaccines. And we need continued transparency and collaboration between affected countries and partners.”