(Aug 19): A mutated form of mpox has been circulating in the Democratic Republic of Congo for months. Now the response to what has become a global health emergency faces a key obstacle: The country still doesn’t have a single vaccine.

The absence of shots and challenges in understanding the spread of the disease in the central African country underscore how hold-ups on the ground, a lack of international coordination and funding problems have hampered a swift response. 

The chain of delayed reactions to the crisis began during the last mpox emergency that ended in 2023, with the Africa Centers for Disease Control and Prevention saying the continent didn’t get the appropriate support. 

Even as the threat from mpox returned and the organisation responsible for global vaccine distribution expressed its concern, Congo held off formally requesting vaccine donations. Drug regulators in the country only approved emergency use for the shots in June.

Meanwhile, multiple countries, organisations and potential donors are trying to help, but are only just starting to coordinate a joint response. 

“I don’t think the world has learned that it didn’t make sense to stop the World Health Organization (WHO) emergency last year,” said Tulio De Oliveira, a director of the Stellenbosch University’s Centre for Epidemic Response and Innovation, in an interview. “If we had learned, we would have focused on stopping the outbreak.” Some experts disagree that the emergency declaration should have been continued.

The world’s focus has been elsewhere, according to Peter Sands, the head of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Mpox has been in Congo for a long time and “it didn’t receive much attention”, Sands said in an interview. 

War and other threats have demanded the attention of governments since the end of the Covid-19 pandemic. But the mpox outbreak should be a reminder that if disease surveillance and basic primary care are neglected, “that can come back and bite us”, said Sands.

The situation in Congo has been complicated by multiple other health threats, including measles outbreaks and a humanitarian crisis, with 1.7 million internally displaced people in the province where the outbreak arose. There are about 15,700 suspected mpox cases, but the real figure is likely much higher.

For one of the world’s poorest countries, the crisis requires a financing response that it isn’t able to meet. Roger Kamba, Congo’s public health minister, estimated that 3.5 million doses will be needed at a cost of hundreds of millions of dollars.

One of the organisations responsible for global vaccination efforts, Gavi, started holding daily meetings to discuss the Congo outbreak in May. As of last Thursday, it was still waiting for Congo to formally request vaccines. The country doesn’t have any mpox vaccines for the emergency response, but it has requested doses from the US and Japan, Samuel Boland, an mpox incident manager for the WHO in Africa, told Bloomberg.

Coordination is going to be critical to the response, said Gavi chief executive officer Sania Nishtar. “We are all talking to the same donors — and that’s very good news — but we need to coordinate, and hopefully in the coming days, there will be a coordination mechanism,” she said. 

Donations of vaccines could come from countries that already have stockpiles. The US is planning to donate 50,000 doses, but it has millions more. The UK has confirmed that it also has stockpiles, without giving more detail. Germany has 117,000 doses.

“What is sad here is that the vaccines are ready to go, and there are certain things that are impeding these countries to have access to them,” said Javier Guzman, the director of global health policy at the Center for Global Development. Without a rapid response, the disease will spread to other countries, he said.

After the initial donations, vaccines will need to be ordered through manufacturers like Bavarian Nordic A/S. When the emergency was declared, those discussions were limited, according to the Danish company’s CEO Paul Chaplin.

“Covid and also the mpox outbreak of 2022-23 should have taught everyone that you can’t just ignore an outbreak in one part of the world,” he said. 

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