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Cologne/Kinshasa/Rotterdam – Given the rapid spread of Mpox in several African countries, an expert from the Democratic Republic of Congo (DRC) has expressed concern about a lack of vaccine supplies.

Ten million vaccine doses are needed for the continent, but only 500,000 are in the pipeline so far, Placide Mbala-Kingebeni of the University of Kinshasa said in an online briefing today.

Even with these 500,000 vaccine doses, it is unclear when they might be available, stressed the head of the Department of Epidemiology and Global Health and Director of the Clinical Research Center at the National Institute for Biomedical Research.

The further spread of the disease, including to other countries, is only a matter of time. Vaccination is the best tool we have, although many questions remain unanswered.

Uncertainties surrounding the vaccines need to be communicated as vaccination is rolled out in Africa, said Dimie Ogoina, a professor of infectious diseases at Niger Delta University in Nigeria and a member of the World Health Organization’s International Health Regulations Committee regarding the current Mpox outbreak.

For example, the duration of the vaccination protection and the vaccination effectiveness for the new clade Ib are not yet known, and studies are still ongoing on the safety of the vaccination in children. A risk-based vaccination strategy is therefore advisable.

A vaccination strategy must also be based on information about the transmission dynamics and risk factors of the outbreak, Ogoina stressed. However, he is not sure whether these are yet fully understood.

Given the shortage of vaccines, Mbala-Kingebeni mentioned possible options such as vaccinating high-risk groups such as sex workers, but also ring vaccinations, i.e. vaccinating the contacts of an infected person. At present, it is thought that the focus will first be on hotspots and then on special risk groups.

The World Health Organization (WHO) declared the highest alert level two weeks ago due to the current Mpox outbreaks in Africa and the new, possibly more dangerous clade Ib. Tim Nguyen of the WHO recently said that 500,000 doses of the MVA-BN vaccine were available for purchase. Germany, among others, also announced vaccine donations. The German Medical Journal reported. This afternoon, Spain also announced that 20 percent of its own Mpox vaccine stock would be donated. This involves 100,000 ampoules, which are equivalent to 500,000 doses.

Many questions remain unanswered about the new variant

According to Marion Koopmans, head of the Institute for Virus Research at Erasmus University in Rotterdam, many questions regarding clade Ib remain unanswered. This applies both to the transmissibility of the pathogen and to the severity of these diseases.

How well a virus is transmissible always depends on where it appears: If there is a spillover event from the animal kingdom in a remote village, the starting situation for the virus is very different than if it appears, for example, in a densely populated region with sexual networks.

In addition, it is not only Mpox infections that pose a challenge, as Ogoina made clear. Co-infections with chickenpox, measles, malaria and other endemic infectious diseases must also be taken into account. Experience shows that in the case of co-infection with chickenpox or HIV, for example, the probability of a severe course of Mpox disease and death increases.

“We need to better investigate the influence of co-infections,” said Ogoina. He also pointed out the risk of confusing chickenpox and Mpox if no laboratory diagnostics are carried out. According to the experts, there are also factors such as malnutrition.

Various stigmas associated with Mpox must now also be addressed, said Mbala-Kingebeni. Locally, the disease is associated with suspicions of homosexuality as well as the alleged consumption of dead animals from the forest.

Facilitating local vaccine production is not the highest priority for experts

In response to calls to enable cheaper vaccines to be produced in Africa, Koopmans said this was not a solution to short-term needs. The pressing questions now were rather who had vaccines and where they could be used sensibly. There were also the logistical issues involved.

As important as support from countries outside Africa is, Ogoina believes that the main responsibility lies with the affected countries themselves. He criticised the situation as flying blind when, as in the DRC, only less than 40 percent of cases are tested in the laboratory. He believes that there is a significant under-reporting because the health systems are not able to identify cases. Investments in surveillance and prevention are needed, for example.

For Ogoina, the current situation is due to decades of neglect of the disease and a lack of investment, he said. There is a lack of capacity to contain outbreaks. In addition, Africa’s population is relatively young and no longer benefits from the protection provided by smallpox vaccination.

Another factor is the new virus variant Ib, which is apparently much more easily transmitted from person to person and is now spreading in the east of the DRC – and thus, in contrast to the previously known clade I, in a region that is not densely forested and where the consumption of so-called “bush meat” is therefore much less common, as Mbala-Kingebeni explained. Clade I pathogens have so far jumped to humans sporadically through the consumption of dead wild animals. Sexual transmission is now very significant.

In the conflict region in the east of the DRC, dozens of possible Mpox cases have now emerged among refugees and displaced persons. The UN refugee agency UNHCR is deeply concerned because it is difficult to reach those affected.

In addition, in the cramped conditions in which many people live, it is difficult to keep physical distance from one another in order to prevent the spread of the virus. UNHCR health officer Allen Maina spoke of a good 40 suspected cases. Hundreds of thousands of refugees and displaced persons are in the region.

Mpox (formerly known as monkeypox) is transmitted through close physical contact and can cause skin rashes and fever. According to the WHO, displaced people and refugees are particularly vulnerable to the disease.

Many are repeatedly displaced because of the conflicts in the region, have little food and rarely receive medical care. They are therefore fundamentally weakened and generally become sicker when infected than well-nourished and healthy people.

The WHO has declared Mpox a public health emergency of international concern. It does not rule out the possibility of spread beyond African countries and calls on all countries to be vigilant. © gie/ggr/dpa/aerzteblatt.de