Responders outline the complexities of controlling mpox in Africa

The African continent is experiencing a widespread mpox outbreak with over 34,000 suspected and confirmed cases reported this year. Over 860 people have died. Health responders have faced significant challenges, including slow access to vaccines and no rapid tests or specific treatments. The majority of cases are in the Democratic Republic of Congo, which is logistically challenging. The country has long been riddled with conflict, which has led to a humanitarian crisis. Mpox cases are present in internal displacement camps — a setting where it's difficult to isolate patients. In a Devex Pro event on Thursday, experts gave insights on both the continental response and the work happening on the front lines. “The magnitude at which we are seeing this outbreak. It's really a challenge,” said Dr. Rashidatu Kamara, who is co-leading case management of mpox for the continental response plan on behalf of the World Health Organization. “We are trying, we are scaling, but it's a bit complex.” Experts also spoke about the limited testing capacity. Instead of using rapid tests, samples are sent to laboratories and it can take more than a week to get results. But it's impractical to keep a patient isolated in the meantime while waiting for results. “This is a very big issue for us,” said Dr. David Munganga, medical manager at the Alliance for International Medical Action’s emergency and opening services, which is operating in DRC. Dr. Abdou Salam Gueye, regional emergency director at WHO’s regional office for Africa and one of the authors of the continental response plan, said that scaling up testing capacity is a serious issue that his teams at WHO and its partners are working to resolve. This includes providing countries with GeneXpert machines, which are easier to install than PCR machines, he said. But there is only one manufacturer, so WHO is working with the manufacturer to ensure there’s an adequate supply. They are also working to increase PCR capacity at the provincial level. He also spoke about the shortage of mpox vaccines on the continent — and said only DRC, Nigeria, and Rwanda have received doses. “Currently, there are less than 500,000 doses that are available in Africa,” he said, adding that about 4 million have been pledged to eventually come to the continent. The Africa Centres for Disease Control and Prevention has previously estimated that some 10 million doses are needed on the continent. Under this supply-constrained environment, there are efforts to ensure vaccines are used optimally, he said. For example, if cases are found in a community of less than 1,000 people, it’s better to vaccinate everyone, whereas in a larger community, it's better to vaccinate those most at risk. Gueye said this was an effective strategy during the North Kivu Ebola outbreak, where health workers were able to control Ebola in one of the country’s health zones with about 300,000 doses. “We can control this outbreak with the vaccine,” he said. And while the Bavarian Nordic vaccine is recommended for two doses, WHO has said in supply-constrained settings, one dose can be used. “One dose combined with other interventions can help stop the outbreak,” Gueye said. But he also stressed that the vaccine is not the only way to stop this outbreak. Other efforts like risk communication, community engagement, strong surveillance, contact tracing, putting patients in isolation, and protecting health workers can also end this outbreak. “I do believe that this outbreak can be controlled. We have the resources, the commitment of the international organization to stop it,” Gueye said. “It is good to have vaccines, and the vaccine is a powerful tool to stop outbreaks, but we have stopped outbreaks that did not have vaccines.”