The Democratic Republic of Congo (DRC) is planning to launch its mpox vaccination campaign in early October, marking a critical step in the fight against the ongoing outbreak across Africa, said Dr Jean Kaseya, Director-General of the African Centres for Disease Control and Protection (Africa CDC), on Thursday. 

Kaseya spoke at a press briefing following last week’s arrival of the first 99,100 doses of Bavarian Nordic’s (MVA-BN) vaccine in DRC, the country at the epicentre of the new mpox outbreak.

The DRC’s immunization efforts are complicated by the ongoing conflict with M-23 rebels in outbreak hotspots like South Kivu Province and its embattled capital city, Goma, in the country’s east.

Meanwhile, UNHCR, the UN Refugee Agency, appealed for $21.4 million to boost health services and critical mpox response for about 10 million refugees and host communities across 35 African countries, where overcrowded shelters and limited access to resources are exacerbating the risk of mpox transmission. 

With nearly 25,000 suspected cases reported in Africa so far this year, including in dozens of communities hosting displaced populations, sustained international cooperation and financial support is more urgent than ever to prevent further spread and strengthen public health systems across the continent, said the UN agency in a special report, released Wednesday.

Outbreak has spread to 20 nations

Twenty of the African Union’s (AU) 55 member states across all five AU regions have reported at least one confirmed mpox case, according to the latest Africa CDC report on 8 September, for a total of 24,873 suspected cases, of which 5,549, were laboratory confirmed.

By Thursday, just four days later, the number had swelled to 26,543 reported cases, with nearly 6,000 laboratory confirmed, Kaseya said at the briefing, illustrating the snowballing nature of the epidemic. There have also been 724 reported deaths, for an estimated 2% fatality rate. Some 63% of those infected are men, while 47% are women, and 41% are children under the age of 15, according to the Africa CDC data.

Testing rates are woefully low

But testing rates, at 52.9% are woefully low, he added, saying, “We cannot rely solely on confirmed cases for decision-making and response.”

The current #Mpox testing rate stands at 52.9%, highlighting insufficient testing across the continent. “We cannot rely solely on confirmed cases for decision-making and response,” said @AfricaCDC Director General Dr. @JeanKaseya2.
Factors affecting testing include sample… pic.twitter.com/FYPUumujeT

— Africa CDC (@AfricaCDC) September 12, 2024

Vaccine supply and distribution efforts

Kaseya emphasized Africa CDC’s commitment to supporting the planned DRC October vaccine launch, saying that he would attend and get vaccinated himself to demonstrate the vaccine’s safety to the vaccine-hesistant Congolese and wider African public.

“We are ensuring all logistics are in place, including the training of vaccinators and the movement of vaccines to the provinces,” said Kaseya. He noted that Africa CDC teams will be on the ground at the provincial level to support the vaccination program, ensuring a smooth rollout amidst the complex logistics of such a large-scale campaign.

The DRC has received about 265,000 doses of the mpox vaccine, primarily from the European Union through a partnership with Bavarian Nordic. But the vaccines are currently being held in cold storage in the capital city of Kinshasa, and transporting them thousands of kilometres away to conflict-ridden eastern DRC is a huge logistic challenge in a country that is the size of western Europe, DRC officials say. 

“Logistic problem, these are I think the biggest challenge because we have to bring the vaccines from Kinchasa to other parts of the country, where we not only have problems with roads, but with distances that are very, very big,”  Dr Roger Kamba, DRC Health Minister, told the BBC recently, adding that there are also more than seven million internally displaced people do to the ongoing conflict with M-23 militants in eastern DRC, 

“So I think we will start maybe at the beginning of October, in two or three weeks, we will start vaccination.” 

He added that the 265,000 doses received so far are “not enough” in a country of more than 100 million people. “But we think that we will receive more doses from Japan, for example, we think it can give us maybe nearly 3 million doses.”  

Kamba was referring to a reported Japanese pledge of several million doses of its new LC-16 vaccine, which has the advantage of being a one-dose vaccine, also approved for use in children. 

Shortages of syringes and protective gear

Additional MVA-BN vaccine donations also are due to come from the United States, which recently donated 50,000 doses to the DRC, and from other international partners, including France and Germany, Kaseya said at the Africa CDC briefing.

Despite these contributions, Kaseya again highlighted that the continent faces a significant vaccine shortfall, with a total need of 10 million doses to adequately protect populations at risk.

A major challenge in the vaccination effort has been the lack of syringes accompanying vaccine donations. Africa CDC said it is working with UNICEF and regional suppliers to address this gap, ensuring that essential supplies are available when the vaccination campaign begins.

The vaccination campaign will initially focus on high-risk areas identified as hotspots for the outbreak, including South Kivu, in Eastern DRC, and Equateur province, in the north west, Kaseya said. 

Equateur is seeing longer transmission chains of the most deadly Clade 1A variant of mpox, which typically spreads from forest animals to household members through skin-to-skin contact as well as through contact with shared items like towels and bedsheets, and can have a mortality rate as high as 10%. 

South Kivu is seeing a surge in a novel strain Clade 1B mpox variant. Somewhat less lethal, it is also being transmitted through heterosexual sexual contact as well as within households and communities – unlike the original Clade 2 variant that is generally much milder, and spread internationally in 2022 and 2023, mainly among men who have sex with men.

The outbreak in these regions has been particularly severe, with children under the age of five representing a substantial proportion of cases. Kaseya stressed the importance of prioritising these vulnerable groups and ensuring adequate protection through vaccination.

Scaling up genomic surveillance

Africa CDC revealed it is also scaling up genomic sequencing efforts to better understand the virus’s spread and its genetic variations across the continent – where a mix of suspected variants are being reported, but genomic mapping remains limited. He said that the goal is to sequence a minimum of 200 samples from each affected African Union member state.

Current data, however, indicates that Clade 1B is the predominant strain affecting children in the eastern part of the DRC, while the milder Clade 2 is more commonly found in West Africa.

Kaseya underscored the need for  financial support to sustain the vaccination campaigns and broader response efforts. Africa CDC’s mpox continental preparedness and response plan is currently calling for $600 million, to not only address immediate outbreak needs but also to build stronger public health infrastructure, including enhanced laboratory and surveillance capacities.

Combatting mpox among Africa’s displaced populations

As for the UNHCR’s $21.4 million appeal, this aims to bolster health services for some 9.9 million forcibly displaced people and host communities in 35 countries across Africa in countries grappling with the spread of mpox. 

Those, most vulnerable populations, are at the highest risk of contracting the disease due to overcrowding and lack of access to basic hygiene and sanitation, warned Allen Maina, UNHCR’s public health chief. 

“For refugees and displaced communities already facing enormous challenges in accessing healthcare, these conditions place them at higher risk of falling sick and make it harder to protect themselves,” Maina stated in a news release.

Africa hosts over a third of the world’s forcibly displaced people, many of whom reside in countries experiencing mpox transmission. These communities are already contending with protracted conflict, chronic funding shortfalls, and other humanitarian crises, making them particularly susceptible to outbreaks.

UNHCR cautioned that the mpox outbreak could further stretch already overburdened humanitarian resources, disrupting critical services such as food distribution, education, and protection activities.

Maina emphasized the need for sustainable financing to strengthen health systems, water and sanitation facilities, and other services, ensuring resilience against current and future health emergencies.

“We need to support governments and partners in the mpox response to ensure that no one is left behind,” Maina said. “Sustainable financing is crucial to maintaining essential services for the most vulnerable.”

Image Credits: BBC/YouTube, Africa CDC, WHO , © UNHCR/Blaise Sanyila, UNHCR.