There is only enough funding for around half the mpox vaccine doses that Africa needs, with Sierra Leone and Uganda particularly short of vaccines, according to Dr Ngashi Ngongo, the Africa Centres for Disease Control and Prevention (Africa CDC) mpox lead.

The continent needs 6.4 million doses to address the multiple outbreaks, but money still needs to be raised to pay for 3.5 million doses, Ngongo told a media briefing on Thursday.

Sierra Leone requested 280,000 doses but has only received 50,000, while Uganda has received half of what they requested. These countries, along with the Democratic Republic of Congo (DRC), account for 86% of all Africa’s current mpox cases.

The non-profit consumer advocacy organisation Public Citizen this week urged Bavarian Nordic to lower its price for the mpox vaccine known as MVA-BN to help alleviate the shortage.

“MVA-BN’s high price of $65 per dose threatens to further strain budgets and impede the response in Africa,” wrote Public Citizen’s Peter Maybarduk in an open letter to Bavarian Nordic CEO Paul Chaplin.

The US paid around $55.35 for the MVA-BN – almost $10 less per dose less than UNICEF – according to a Public Citizen report on the mpox vaccine shortfall published this week. 

Since 2022, when the World Health Organization (WHO) declared an mpox emergency and 2024, Bavarian Nordic has seen “a 523% increase in cumulative revenue from MVA-BN compared to the previous three years,” the report notes.

“Increased sales and long-term stockpiling agreements with high-income countries should give Bavarian Nordic more flexibility to lower MVA-BN’s price.”

In his letter, Maybarduk noted that “even the remaining doses ‘available’ under UNICEF and Bavarian Nordic’s one million dose supply agreement require additional funding before they can be deployed”.

UNICEF, the United Nations Children’s Fund and the world’s biggest source of vaccinations, facing a funding crunch of its own, is unable to cover the cost of roughly 350,000 doses remaining from its one million dose supply agreement with Bavarian Nordic.

UNICEF executive director Catherine Russell told the body’s board meeting on Tuesday that it projects a 20% reduction in total income in comparison to 2024 levels, with a 26% drop from the public sector to $250 million, “the lowest figure in more than a decade”.

US deals blow to global vaccination

The loss of United States’ contribution a particular blow to global vaccination efforts.

“The sudden interruption of funding and other critical support from the US underscores the need for renewed, public health-oriented commitments from all actors involved in the mpox response,” said Public Citizen.

The Trump administration’s dismantling of the US Agency for International Development and defunding of the WHO has made the delivery of mpox vaccines, including 695,000 US-pledged doses “uncertain” and has “prompted a concurrent crisis of disrupted care and severe funding shortfalls across a range of disease areas and health services”, notes the Public Citizen report.

While mpox cases appear to be declining on the continent, with a 30% drop in the past week, Ngongo warned that a drop in testing in the DRC may be behind the decline.

“The testing rate in the DRC has declined by almost half… and now stands at 13%,” warned Ngongo, who added that the DRC’s cases appeared to have dropped by 42%.

In the past week, Sierra Leone accounted for 63% of new confirmed cases, and currently has 958 active cases. Ghana has had a new resurgence of mpox cases, albeit still small, while Liberia and Malawi also have outbreaks.

Cholera continues to surge

Cholera is affecting 21 member states, and there have been almost 150,000 cases this year alone, Ngongo told the Africa CDC media briefing.

Angola, which has been the epicentre of cholera, reported a 46% reduction in cases over the past week from 1,782 to 956 cases.

Meanwhile, the WHO started a 10-day oral cholera vaccination campaign this week, aiming to reach more than 2.6 million people.

“Since May, there has been a rapid increase in cholera cases in Khartoum State, with over 16 000 cumulative cases and 239 deaths reported across the state’s seven localities,” according to the WHO.

“A conflict hotspot since April 2023, Khartoum State is facing an infrastructure breakdown and severe access constraints. The cholera outbreak has been fueled by poor water, sanitation and hygiene, caused by a shortage of safe water following attacks on major power plants and water sources, and compounded by displacement and the breakdown of the health system.”

Image Credits: Africa CDC.