Mpox: vaccine drive critical as Pakistan and Sweden confirm cases

Call for international response to contain rapidly evolving health emergency

Patients wait to be seen by a doctor at the mpox treatment centre at Nyiragongo General Referral Hospital, north of Goma. AFP

The first recorded case of a deadlier strain of the mpox virus outside of Africa has underlined the need for the international community to be on high alert over the threat posed by the outbreak.

Sweden reported its first case of mpox clade 1 variant on Thursday, considered a more dangerous type of virus that is passed on via human contact, rather than primarily sexual transmission in previous outbreaks.

Pakistan's Health Ministry on Friday confirmed one patient had contracted the virus, but they did not yet know the strain of the virus.

So far, more than 550 people have died from mpox in Democratic Republic of the Congo, where the outbreak was initially reported, but has since spread to other areas of Central and East Africa.

Sylvie Jonckheere, a Brussels-based emerging infectious diseases adviser for Medecins Sans Frontieres, has been working in impacted communities in DRC and Burundi.

“The situation is diverse as mpox is a known entity in many parts of DRC, the problem is the sheer number of cases that have increased dramatically this year, which is beyond anything we have seen before,” Ms Jonckheere told The National.

“Teams there are overwhelmed by the number of patients they need to care for, while in Goma [in DRC] and Burundi it is a new entity, so these areas are more vulnerable.

“We don’t really have a playbook for those regions, so we don’t know what is going to happen. Access to vaccines is paramount to control this outbreak, and that is very slow.”

Fear and mistrust

Ms Jonckheere said fear and mistrust in areas previously untouched by mpox was proving a barrier to providing effective health advice.

Meanwhile, China has began monitoring people entering the country from areas impacted by the outbreak, its customs administration said.

For the next six months, all goods and passengers will be checked, with vehicles and containers arriving from areas with mpox sanitised.

Dr Javier Guzman, director of global health policy and senior policy fellow at the Centre for Global Development think tank in Washington, urged caution against imposing blanket travel restrictions.

“The declaration of an international emergency is a signal for all countries to report their own cases of mpox, through monitoring and surveillance systems,” he said.

“Case definitions should be updated and harmonised as new data emerge, with heightened surveillance, case detection, and contact tracing.

“Travel restrictions should be limited to individuals showing signs and symptoms of mpox, those who are suspected, probable, or confirmed cases, or those identified as contacts of a Mpox case under health monitoring.

“It's crucial to avoid blanket international travel measures that could discourage countries from transparently reporting new cases.”

Deadlier strain

The current outbreak of mpox has several key differences from previous incidents, including the 2022 outbreak, which was also categorised as a public health emergency of international concern.

In 2024, a new, deadlier strain of the mpox virus has become more adept at human-to-human transmission and is not confined to a specific segment of the population and is spreading rapidly beyond the DRC.

While recent public health emergencies, including Covid-19, taught multiple lessons in how to respond to viral outbreaks, challenges remain.

“African countries are struggling to mobilise the necessary funds to deploy medical countermeasures, including vaccines,” Dr Guzman said.

“Gavi, the Vaccine Alliance’s US$500 million First Response Fund is available, but remains non-operational because it requires WHO emergency use listing for mpox vaccines, despite these vaccines already being approved by well-resourced regulatory authorities. This process needs to be updated.

“Despite advancements in pandemic prevention, preparedness, and response, African countries affected by the outbreak still require additional resources and support to contain it effectively.”

In a landmark step, the Africa Centres for Disease Control and Prevention agency declared a public health emergency of continental security, a sign that African institutions would lead and co-ordinate the response.

Two vaccines have been approved for emergency use by the WHO.

MBABN, is a two-dose regimen with a US FDA approval recommended in adults; and LC16 produced in Japan has local regulatory approval recommended for both adults and children.

To date, about 200,000 vaccine doses have been made available, well short of the 10 million required.

Further resources are urgently needed to enhance surveillance, laboratory testing, and contact tracing efforts in affected countries, experts said.

The new clade 1b mpox strain results in whole body rashes as well as genital lesions in some cases, with about five per cent mortality in adults, and 10 per cent in children.

Vulnerable nations

Due to poor infrastructure, poverty and high migration there are huge challenges in containing the disease along the DRC border with Rwanda, Burundi and Uganda.

On July 24 2024 the Uganda Virus Research lnstitute confirmed two cases of mpox from six samples received from Bwera Hospital, Kasese District.

The two cases were a 37-year-old female market vendor, who also operated a hair saloon at Mpondwe border point and is married to a Congolese man, and a 22-year-old Congolese pregnant woman from Bunywisa, who was seeking antenatal care in Bwera hospital.

Both women have recovered and been discharged without complications.

Uganda has 17 districts that share a border with DRC, where the majority of mpox cases have been reported.

Uganda’s Health Minister Dr Jane Ruth Ocero called on cross-border collaboration with neighbouring countries to ramp-up health surveillance.

“Long-distance truck drivers plying the region in the interconnected routes and resting areas within East Africa are among the most at risk and could act as a quick way of transmitting the virus,” she said.

“This is the first time mpox has been confirmed in Uganda. Since then, no new cases linked to the two cases have been confirmed.

“To date, a total of 42 samples have been collected from suspect cases, and all tested negative by PCR.

“Mpox transmission in Eastern DRC is expanding rapidly due to regular cross-border human interactions between our two countries for trade, culture and social reasons.

“This means the risk of importation into Uganda remains high.”

Danish drugmaker Bavarian Nordic hopes European approval for its mpox vaccine for children aged 12 to 17 can help curb new mpox infections that cause skin lesions, fever and aches after physical contact between humans.

The vaccine is currently only approved for adults over 18.

International response

Dr Richard Lessells, an infectious diseases specialist at the KwaZulu-Natal Research Innovation and Sequencing Platform at the University of KwaZulu-Natal, in Durban, South Africa, said vaccines are just part of the containment solution.

“The reality is we just don't have any certainty about this phenotype, whether the virus itself is more transmissible, or whether it's just that the mode of transmission has changed,” Dr Lessells told The National.

“We don't even have good data on how effective the vaccine is against the clade 1 virus.

“This has been a public health emergency for a long period of time in Central Africa.

“It's fairly predictable what is happening as we've got a huge population of susceptible people under 40 unvaccinated against smallpox.”

The Red Cross and Red Crescent humanitarian network said far more diagnostic kits, treatments and vaccines need to be shipped to Africa to respond adequately to the outbreak.

Failing to control the virus at source risks worsening the global problem, Dr Lessells said.

“If you don't control the problem at its source, then it becomes of international concern,” he said. “By allowing things to progress, it is now a much bigger challenge to control.

“This is a test not only for the international sphere but specifically for African countries and African governments to commit funding and resources to to deal with this outbreak.”