F
rom its epicenter in the Democratic Republic of the Congo, Africa’s mpox epidemic is spreading fast, reaching a dozen other African nations so far. The single most important tool for extinguishing the fire is mpox vaccination, which prevents infection and illness. Until yesterday, not a single dose of mpox vaccine was available in Congo. Few shots are available anywhere on the continent.
Congo’s health minister Samuel-Roger Kamba says his country urgently needs 3.5 million doses to stop its outbreak, while 10 million doses are needed for the whole African continent. Without these shots, mpox will continue to spread.
And here’s the kicker. While adults and children in 13 African nations are getting infected, sick, and in some cases dying, several rich nations are sitting on large stockpiles. The U.S., for example, is believed to have stockpiled 7 million doses by mid-2023, while Spain has 2.5 million doses. If a rich country were to become affected, it could immediately launch a vaccination campaign to protect its own citizens—as we saw during the 2022 U.S. mpox outbreak, when the government mounted a robust vaccine campaign, distributing more than one million shots by the end of the year.
The return of “vaccine apartheid”
It is painful to watch history repeating itself. During the COVID-19 pandemic, we witnessed what Winnie Byanyima, executive director of the Joint United Nations Programme on HIV and AIDS, called “a global vaccine apartheid”—a profound injustice in which rich countries were the first to get vaccines and boosters, while low- and middle-income nations were left behind. Now we are witnessing mpox vaccine apartheid.
Beyond being unfair and causing preventable illness and deaths in the 13 affected nations and counting, this vaccine inequity also hurts rich nations in two important ways. First, an adage in public health is that an outbreak anywhere can become an outbreak everywhere. In other words, if the outbreak is not contained, it will continue to spread, including to rich nations.
We’re already seeing this happen. The outbreak centered in Congo is of an mpox strain targeting adults and children called clade I, which is thought to cause a more severe illness than clade II, the strain that caused a multi-country mpox outbreak in 2022-2023. Cases of clade I mpox have recently been identified as far away as Sweden and Thailand, in people who had traveled to African countries.
Second, when vaccine apartheid causes a pandemic to smolder, it hurts the entire global economy by disrupting supply chains, imports, and exports. It is not just low- and middle-income countries that suffer this economic pain. During the COVID-19 pandemic, for example, one study estimated that about half of the global economic losses caused by vaccine apartheid were borne by rich nations, mostly through suppressed exports.
Mounting an urgent mpox vaccination campaign in the countries affected in the African region is in the whole world’s interest. Why is it not yet happening? Understanding the reasons is critical—not just to control Africa’s current mpox epidemic, but to ensure we do not make the same grave mistakes again.