A critical challenge has emerged in the response to Africa’s mpox outbreak: More than two-thirds of new cases are appearing in people health workers haven’t been monitoring and who aren’t known to have been in contact with existing patients.
“That shows that your surveillance is not working, which is the reality in most of these countries,” says Dr. Ngashi Ngongo, Africa Centres for Disease Control and Prevention’s lead on coordination of the continent’s mpox response.
There have been over 32,400 suspected and confirmed mpox cases already this year on the African continent, and at least 840 deaths. The majority of both have been in the Democratic Republic of Congo. The critical first step to getting the outbreak under control is understanding how the disease is moving through communities. But that’s not yet happening.
There are several reasons for this, including insufficient testing. Fewer than half of all suspected cases are getting tested. Then there is the problem that health workers don’t have access to rapid tests that would facilitate quick results. Instead, tests often go to laboratories, and it can take days for patients to learn if they are infected. This has left many health workers to diagnose people based on symptoms.
And there are still a lot of unanswered questions about the disease, including why so many children have contracted it during this outbreak.
In another blow to the mpox response, Public Citizen revealed this week that UNICEF has been overpaying for the mpox vaccine. The agency announced that it had negotiated the lowest market price from the manufacturer Bavarian Nordic on behalf of low-income countries, at $65 per dose. But Public Citizen reports that the U.S. government is paying $10 less per dose.
A Bavarian Nordic spokesperson tells Devex the report was incorrect and that UNICEF received the lowest available price for the vaccine, but did not provide any additional details.
UNICEF was responsible for an emergency tender to secure vaccines for the countries hardest hit by the outbreak.
Read: The majority of mpox cases can’t be tracked
ICYMI: What you need to know about mpox vaccines (Pro)
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Nigeria is set to become sub-Saharan Africa’s hub for next-generation mosquito nets. The new models are deemed more effective than standard nets that are infused only with pyrethroid when it comes to mosquitoes that have developed resistance to the insecticide.
The Nigerian government last week signed an agreement with Vestergaard so it can enter in a joint venture with a local company to manufacture a new kind of net that contains two different insecticides. This approach kills the mosquitoes that have already developed resistance, while helping fight off future mutations.
Once everything is operational, Vestergaard anticipates the Nigerian facility will produce 10 million nets annually. Officials expect the first nets to be available in about a year.
Support from development financing institutions will be critical for the initiative to succeed. The project hopes to draw funds from the U.S. International Development Finance Corporation and MedAccess, a U.K. social finance company. Vestergaard said this financing will be essential to mitigate the social and economic risks of operating in sub-Saharan Africa.
Insecticide resistance is not the only problem facing malaria control efforts. At a Devex side event during the recent United Nations General Assembly, U.S. Global Malaria Coordinator David Walton pointed to the challenges being created by climate change.
People don’t have time to worry about nets when weather has destroyed their homes, he pointed out. And prolonged rainy seasons mean mosquitoes are sticking around longer than usual, which demands more resources, including more nets, for malaria prevention.
Read: Africa to get first manufacturing hub for next generation malaria nets
Read more: US malaria initiative ‘having to invest much more’ with climate change
On Friday, Rwanda declared its first outbreak of Marburg — a viral hemorrhagic fever that the Coalition for Epidemic Preparedness Innovations calls "an extremely deadly cousin of Ebola." Marburg has a fatality rate of up to 88%. There have been 27 confirmed cases, who are now in isolation, and nine deaths reported. Most of the cases have been among health workers. Over 297 contacts of these people are being monitored.
A key difference between Ebola and Marburg is that there are World Health Organization-approved vaccines and treatments for Ebola, whereas there's no vaccine nor specific treatment for Marburg.
The virus is usually transmitted to humans from fruit bats, and can then spread between humans through contact with bodily fluids or contaminated surfaces and materials. Cases of the virus have been reported in seven of the country’s 30 districts. Most are in and around the capital city of Kigali. The most recent outbreaks occurred last year in Equatorial Guinea and Tanzania — in an area that borders Rwanda.
Background reading: New Marburg outbreak sparks race to test vaccines
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During UNGA, Devex worked to keep global health issues on the agenda. Here’s a roundup of some of our key events:
Ankur Vora, Bill Gates’ top strategy adviser at his foundation, offered some behind-the-scenes details about his job, including how he is addressing new challenges related to maternal and child mortality that emerged during the COVID-19 pandemic.
Read: Bill Gates' strategist on global health and local innovation
Policymakers looking to expand access to health services and products would do well to read up on some history. That was the message from Angeli Achrekar, deputy executive director of programs at UNAIDS, who pointed to lessons from the decades-long AIDS response that can inform ongoing crises. Among those lessons is the importance of a multisectoral response that puts patients at the forefront.
Read: What the HIV response can teach on expanding medicines access
Looking for your next great read? At UNGA, Devex sat down with Vivianne and Chikwe Ihekweazu, authors of “An Imperfect Storm: A Pandemic and the Coming of Age of a Nigerian Institution.” The book charts the development of the Nigeria Centre for Disease Control and Prevention, where Chikwe previously served as the inaugural assistant director-general. Among other things, the couple writes about the challenges the institution faced guiding the country through the COVID-19 pandemic.
Read: Global health's ‘power couple’ documents Nigeria CDC's coming of age
The U.S. Food and Drug Administration has approved a new schizophrenia treatment for the first time in decades. The new pill may have fewer side effects than existing treatments. [NPR]
Gavi, the Vaccine Alliance, secured a number of commitments during UNGA, including more than $287 million in new funding from the European Commission. [ReliefWeb]
Breast cancer rates in young American women continue to rise, though death rates from the disease are falling. [The New York Times]
Sara Jerving contributed to this edition of Devex CheckUp.