None of the African countries affected by the outbreak of a new variant of mpox have received any of the promised vaccine, pushing back a rollout that had been planned for last week.
The Democratic Republic of the Congo (DRC) has been at the centre of an outbreak of the new clade 1b variant, with 18,000 suspected cases and 629 deaths this year, according to the World Health Organization (WHO).
The variant has also been found in Burundi, Uganda, Rwanda, Kenya, Sweden and Thailand.
WHO chief Tedros Adhanom Ghebreyesus said on Friday that the first doses should arrive in the DRC “within days” but similar statements were recently made regarding donated shots from the US, which did not materialise on time.
There has been no coordinated response, with Spain pledging as many as 500,000 doses while France and Germany have promised 100,000 each and the US said it will donate 50,000. None of the pledges have so far been delivered.
The Africa Centres for Disease Control and Prevention (Africa CDC) said on Wednesday that the $245m (£187m) it had requested to tackle the outbreak was only 10% funded.
Despite mpox being first identified in humans in the DRC in 1970, African nations vulnerable to its spread are reliant on donations of vaccines from the stockpiles of richer nations.
Dr Dimie Ogoina, an infectious disease physician at the Niger Delta University teaching hospital, said neglect both internationally and by African governments meant that, decades after mpox was first identified, there were still not enough vaccines or even treatments available to the affected countries.
He said it was only during the global outbreak in 2022, which saw the virus spread to Europe and North America, that there was a wider international reaction to the disease.
Ogoina said it was important for African countries themselves to invest in protecting against diseases such as mpox to ensure they are not reliant on donors.
“The manufacturers are not based in Africa,” he said. “They tend to favour, knowingly or unknowingly, the global north. So if there’s a list of people to procure, Africa is always last in the list, and we are always the last to get supplies.”
The WHO declared a public health emergency in mid-August in response to the spread of clade 1b, a recently identified variant that spreads through close physical contact, including sexual contact but also within households.
Concern has been raised about high numbers of children dying, with a mortality rate of up to 8% for under-15s, according to the WHO. The latest update from Africa CDC on Tuesday showed a sharp rise in cases of almost 4,000, compared with 1,200 the previous week.
Last week, civil society groups published a letter to Gavi, the global vaccine alliance, urging it to push for lower pricing of the vaccine produced by pharmaceutical company Bavarian Nordic, which currently costs between $50 and $75 a dose.
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“The continuously unfolding injustice of mpox owes to long indifference and inequity, stigma, slowness, anaemic use of public power and yes, greed,” said Peter Maybarduk, access-to-medicines director at US-based campaign group Public Citizen, which signed the letter.
He said that while the US government had invested in the development of the Jynneos vaccine used against mpox, the production and “outrageously high” prices were now being controlled by Bavarian Nordic.
Victorine de Milliano, policy adviser at Médecins Sans Frontières’s wing for campaigning for fair medical treatment, MSF Access, said there was a “systematic issue” that meant that lower-income countries struggle to access medical tools in public health emergencies, which was highlighted during the Covid pandemic, when richer countries were able to stockpile vaccines, tests and treatments.
“It’s a real feeling of deja vu. You would have thought that we would draw some lessons from the Covid-19 pandemic, but we see the same patterns again,” she said. “Low- and middle-income countries are also now reliant on those donations from high-income countries who do have access to the vaccines. And we also see a vaccine monopoly, [where they are] sold to the highest bidder.”
Bavarian Nordic has told Africa CDC that it can provide 2m doses this year if it gets approval for orders, allowing it to reallocate resources from other production lines.
A spokesperson for the company told the Guardian it had donated 55,000 doses and would provide an update when an agreement was made to start delivering more widely.
The company also said it was open to using tiered pricing so that countries with smaller economies would be charged less as well as those who were able to order more vaccines and over longer periods of time.
Ogoina said there were promising signs of political leaders in Africa showing vigilance in response to the public health emergency and discussing how they can invest in tackling it, as well as pledges of support from outside the continent, but it would have to be sustained.
“[There have been] a lot of commitments, pronouncements, promises, but what happens after three months? What happens after six months? What happens after one year? Will people still be interested, or will they lose interest?” he asked.