Mpox outbreaks in Africa—we must avert another failure of global solidarity

Will we repeat the same mistakes?

Having observed covid-19 and previous epidemics, we have every reason to worry that high income nations will make the same mistakes again—from vaccine hoarding to unfair travel bans and anti-Black racism.456 We are concerned that the rest of the world will once again resort to performative charity, and fail to act in authentic solidarity with Africa. The region is always last in line for access to lifesaving tools, as we saw with HIV/AIDS, Ebola in West Africa, covid-19, and the mpox outbreak in 2022.4

Whenever outbreaks have appeared to be limited to Africa, we have seen the world do little, and take action only when high income nations are directly affected.5 Until Ebola affected people in the US and Europe, it barely registered as a problem for leaders and funders in the Global North,7 and this was replayed in 2022 when mpox clade IIb was declared a PHEIC.8 Once these diseases affected people in rich nations, millions of dollars were poured into finding cures and vaccines.8 We simply cannot do this again with the ongoing mpox crisis in Africa.

Vaccine inequity is already evident, with Africa CDC reporting a need for approximately 10 million vaccine doses to control the outbreak, of which only about 280 000 are available,19 ie, less than 3% of the estimated need, even as wealthy countries hoard, stockpile, and refuse to share vaccines.10 These same countries hoarded covid-19 vaccines, actively blocked or delayed the patent waiver that could have enabled Global South countries to manufacture covid-19 vaccines during the pandemic, and eroded the equity clauses in the draft pandemic accord after lobbying by big pharmaceutical companies.3111213

Consequently, this year’s World Health Assembly failed to yield agreement on the pandemic accord, with key articles in the draft text still unresolved, including the strategy for equitable sharing of vaccines and medicines during emergencies. If a pandemic accord had been reached, it could have helped Africa during the current mpox crisis.

Following WHO’s declaration of this mpox outbreak as a PHEIC, rich nations may resort to travel bans against the affected African nations, rather than offer genuine support. The unjust, racist travel bans that were imposed on some African nations during the SARS-CoV-2 omicron wave are stark evidence.14 We worry about a resurgence of stigma and racism aimed at African nations, as we saw during the omicron wave and the 2022 mpox outbreak.15

What would authentic solidarity look like?

In declaring the PHEIC, Tedros Adhanom Ghebreyesus, WHO director general, stated that “a coordinated international response is needed to stop these outbreaks and save lives.” That is exactly the need of the hour. In fact, if we had learnt the lessons of HIV, Ebola, covid-19, and the earlier mpox outbreak, we would have already acted to support African countries with speed and cohesion to avert the present crisis.

In the immediate term, we must ensure that Africa CDC has adequate funding, as well as the full supply of mpox vaccines required to control the outbreak, along with diagnostics and medicines. We need more affordable vaccines and many more manufacturers engaged. Africa CDC’s response plan needs the full support of the international community.1 African nations must work together and mobilise domestic funding and resources to widen public health surveillance, contact tracing, and implement other public health measures critical to containing further spread.

In the longer term, the African region must invest in its own vision for a New Public Health Order for Africa, which has five strategic pillars: strengthened public health institutions; strengthened public health workforce; expanded manufacturing of vaccines, diagnostics, and therapeutics; increased domestic resources for health security, and respectful and action oriented partnerships within Africa and globally.16 This framework will enable Africa to shift from the current global health model based on aid and charity to a paradigm that is rooted in autonomy and self-sufficiency. In particular, the African region must manufacture tests, medicines, and vaccines, and must have full access to modern technologies like the mRNA platform.

Finally, the latest mpox crisis is another reminder that the world desperately needs a strong pandemic accord with equity and accountability.13 Otherwise, history shows that repeated failures of equity are the norm in global health, not the exception.