Why mpox vaccines, in use since 2022, are only just arriving in Africa?

The 30-year-old mother, who fled conflict to live in a displacement camp, now faces a new battle: her child's fight against mpox.

"Imagine fleeing a war and then losing your child to this illness," Furaha says, her voice tinged with worry. "We need a vaccine for this disease. It's a bad disease that weakens our children."

Next week, 10,000 mpox vaccines are due to arrive in Africa – the first doses outside clinical trials to reach the continent, where a dangerous new strain of a virus that has afflicted people for decades has caused global alarm.

It has taken so long to get vaccines to those in need like Furaha because the global system to get tests, treatments and vaccines to lower-income countries for health emergencies is not working, half a dozen public health officials and scientists involved told Reuters.

Mpox, a potentially deadly infection that causes flu-like symptoms and pus-filled lesions and spreads through close contact, was declared a global health emergency by the World Health Organization (WHO) on Aug. 14 after the new strain, known as clade Ib, began to proliferate from Democratic Republic of Congo to neighbouring countries.

Two years before that, a different strain spread globally. Smallpox vaccines were repurposed within weeks in high-income countries to protect those most at risk, and have now reached 1.2 million people in the United States alone, according to the US Centers for Disease Control and Prevention (CDC).

But this delivery highlights a critical issue: the vaccines are not going to Congo, where the vast majority of cases are occurring. Instead, they are destined for Nigeria, as a result of several years of talks between both governments. Nigeria has had 786 suspected cases this year, and no deaths.

"The issue of access is the one that globally we need to shout about, because it is really outrageous that after Covid we are going back into the same situation that the African region once again doesn't have access to vaccines easily," said Helen Rees, a member of the Africa Centres for Disease Control and Prevention (CDC)'s mpox emergency committee, and executive director of the Wits RHI Research Institute in Johannesburg, South Africa.

She called for a global system that, at the press of the button, would secure access to tests, treatments and vaccines in emergencies.

While a host of factors have held back vaccine access in Congo, including a lack of funding, competing disease outbreaks and slow progress by the authorities there, which only approved the use of a shot domestically in June and did not request help for months, there is another major factor holding back access. That is the lack of an official approval from the World Health Organization for the two main mpox vaccines, Bavarian Nordic's shot and another made by the Japanese manufacturer KM Biologics.

Without this rubber stamp, organizations like the vaccine group Gavi and Unicef cannot buy any vaccines; they can only help support donations that are reliant on complex inter-country negotiations. Lower-income countries like Congo, one of the poorest countries in the world, rely on organizations like Gavi to buy vaccines.

The WHO only this month asked vaccine manufacturers to submit the information needed for an emergency licence for mpox shots. It urged countries to donate shots until the process was finalised, in September.

"We're actually seeing some of the same responses in the narrative that we saw earlier in the last century in response to HIV, where it took a very long time before the treatments became available in poor regions of the world," said Dr Ebere Okereke, Associate Fellow at Chatham House's global health programme.

She stressed that this might not always mean vaccines: tests and better surveillance are also desperately needed in Congo and other parts of Africa, and other public health measures that are even as basic as handwashing campaigns.

Dr Pierre-Olibier Ngadjole, a medical advisor for Medair, a charity helping with treating and transporting patients to the centre where Furahana and her son are, emphasized the critical role of vaccines in the response.

"We believe that this is still the key to a successful response, to cutting off the chain of transmission, but also to preventing new transmissions," he said. "Because vaccines increase people's immunity. And once people are better immunised, they will be better able to resist catching the disease. So everyone is really looking forward to vaccines. It's really quite crucial to the response."