Mpox vaccines arrive in Congo, but not fast enough as the disease spreads and deaths mount fast

Johannesburg — Health officials in the Democratic Republic of Congo said Thursday they would start administering mpox vaccinations on Oct. 2, about a week sooner than initially planned, in a bid to counter the sharp rise of cases in the central African nation. The World Health Organization, meanwhile, granted pre-authorization Friday to the mpox vaccine already widely in use around the world, which should make it easier for African nations to obtain doses — if the developed world provides the necessary funding.

"This first prequalification of a vaccine against mpox is an important step in our fight against the disease, both in the context of the current outbreaks in Africa, and in future," WHO Director-General Dr. Tedros Adhanom Ghebreyesus said.

Congo authorities approved two mpox vaccines for use in adults in the country in late June as they raced to contain a growing outbreak. Without the WHO pre-authorization, however, Gavi, the global vaccine alliance that funds the purchase of vaccines for low-income countries, could only accept donations from other nations. The Friday announcement paves the way for Gavi to directly purchase vaccines from pharmaceutical companies to ship to affected countries.

Race to roll out first mpox vaccinations in hard-hit Congo

An initial 10-day vaccination drive, using vaccines donated by the U.S. and Europe, is to launch simultaneously in several of Congo's most affected regions, targeting only adults who work in health care, sex work and other front-line community jobs, according to Cris Kacita Osako, coordinator of the country's Monkeypox Response Committee.

U.S. Ambassador Lucy Tamlyn announced in a Tuesday social media post the arrival of 50,000 mpox vaccine doses in Congo donated by the U.S. government, adding to the 200,000 doses received late last week from the European Union.

Dr. Jean Kaseya, director general of the Africa Centers for Disease Control and Prevention, welcomed the vaccine deliveries, adding a call for the U.S. to provide "continued support as we need to vaccinate 10 million people in Africa in the next 6 months."

Kaseya said the Africa CDC was seeking an additional $599 million from the U.S. to support "the continental response to the outbreak." Such funding would help Congo and other poor nations obtain significantly more vaccines through the Gavi alliance.

The mpox vaccine, manufactured by Denmark-based Bavarian Nordic, has been approved for adult use and distributed globally. The company recently filed an application with the European Medicines Agency to extend the approval to children from the age of 12. Regulators could authorize the vaccination for that age group by the end of the month.

Mpox cases spreading fast in Congo and beyond

Mpox, previously known as monkeypox, has continued to evolve and spread quickly in Congo, with new strains or clades of the virus causing multiple outbreaks with distinct epicenters in the country, putting different groups at risk. The newly arrived vaccines are known to be effective against the older clade 2 variant, but it's not yet clear how well they will work against the newer, more lethal clade 1 strain.

Congo health officials have confirmed more than 22,000 mpox cases in the country and more than 716 deaths from the disease this year. But experts believe very low testing rates and under-reporting of cases mean the real mpox caseload in Congo and surrounding nations is likely much higher.

The virus has spread to 22 of Congo's 26 provinces and 13 of its neighboring African nations. It has been declared a public health emergency by both the WHO and the Africa CDC, which have crafted a six-month, $600 million response plan.

Mpox infections have reached as far abroad as Sweden, Thailand and India, with most cases linked to recent travel to affected regions.

Morocco reported its first case this week — a 32 year old man who tested positive in Marrakech. In a statement, the Health Ministry said he was receiving treatment and was in a stable condition, and that none one he'd come into contact with was showing symptoms.  

South Africa recorded its 25th case last week, a 38-year-old Cape Town man who had not traveled nor had contact with any suspected or confirmed other cases. In a statement, the South African Health Department said it had deployed a provincial outbreak response team to identify possible contacts, adding the protocol was for positive cases to be isolated at home.

The National Institute for Communicable Disease in South Africa says there are currently no mpox vaccines available in the country. That's a significant concern for health officials in the country, which has a highly immunocompromised population, with close to 9 million people infected with HIV.

"We need to stop this outbreak now to ensure we don't get a new mutation," the Africa CDC's Kaseya told journalists during a virtual news conference on Thursday. 

More than 70% of mpox cases in Congo are currently in children, and the Africa CDC says four of every five deaths recorded are minors. Health officials say children are more vulnerable to mpox, a virus with similarities to smallpox. Experts believe older generations could still have some immunity to mpox from previous smallpox vaccinations.

Other diseases complicate mpox response in Congo

Eastern DRC is racked by conflict, largely between the army and militias, including the Rwandan-backed M23 group. The clashes have caused mass displacement of the population and made vaccination campaigns, for all diseases, far more complicated.  

Even before the mpox outbreaks, Congo was facing one of the biggest human displacement crises in the world. According to the U.N. children's charity, some 7 million people in the east of the country have fled their homes and more than 25 million people are in need of humanitarian assistance to survive, including almost 15 million children.

"Things are really moving fast — we are seeing cases going up in the whole province," Marietta Nagtzaam, Congo country coordinator for the Doctors Without Borders charity, who is based in the hard-hit South Kivu region, told CBS News. "There is a lot of underreporting in an overburdened health system." 

South Kivu is divided into 34 health zones. In the Uvira zone, Nagtzaam said her organization, which goes by the French acronym MSF, had treated more than 850 patients over the last three months alone. A handful of those who made it to the medics still died with the disease.

"This clade of mpox [clade 1] is so new, we just don't know enough, and the population is easily confused between measles and mpox, with similar looking lesions," Nagtzaam said of the challenges facing her team.

MSF also works in the Fizi health zone, at two hospitals with isolation centers where medics are having to treat measles and mpox cases simultaneously, requiring separate isolation areas.

Diagnosing a sick child with very limited supplies, in an area with endemic measles, cholera, poor sanitation and little access to proper nutrition or clean water, has proven an immense challenge for the overburdened health workers.

"Fluid needs to be collected from the lesions by a health worker with protective gear, transported in a cool box on often non-existent or flooded roads to the capital of Bukavu to the testing lab. This alone is very difficult, then we need stock of the expensive PCR cartridges to test for mpox," she explained, highlighting the logistical challenges.   

"We would love to do contact tracing," Nagtzaam added, "but the money isn't there to test close contacts."

A vast shortage of mpox vaccines in Africa 

The Africa CDC said last month that it had started talks with Bavarian Nordic about manufacturing its mpox vaccine in Africa. The CDC's Kaseya said transferring the technology required to do that to Africa would cut the cost of the vaccine by 80-90% on the continent.

The 250,000 vaccine doses now in Congo are far short of the 3.5 million the country's Health Minister Samuel-Roger Kamba has said are needed urgently to stem the spread of the virus.  

The WHO's designation last month of mpox as a "public health emergency of international concern" was partly intended to spur nations around the world to assist in the response in Congo and other poor nations, as well as to prepare their own contingency measures.

Germany, Belgium and France have said they will donate 100,000 vaccines each, according to Kaseya. On Wednesday, the Reuters news agency quoted a Canadian government spokesperson as saying the country would send 200,000 doses. 

The pledges of help come after criticism leveled at the developed world as African countries grappled with the last mpox outbreak in 2022, when they had no vaccines.

African health officials have told CBS News that some countries still have not been transparent about the number of vaccine doses they have in stock.

In:
• Democratic Republic of Congo
• Centers for Disease Control and Prevention
• Vaccine
• Africa
• Mpox