From COVID-19 to mpox vaccine hoarding - Has the Global North learned its global health lessons?

Abstract

During the COVID-19 pandemic many writers decried the global north's hoarding of COVID-19 vaccines. The response ranged from authors calling said hoarding tamely ‘unethical’1 or, more aggressively, labeling this conduct as ‘Vaccine Apartheid.’2 Now that we have established that at a certain point in time in a WHO declared ‘public health emergency of international concern’3 vaccine hoarding becomes ethically problematic, how are things playing out in the currently ongoing mpox outbreak on the African continent? After all, in August this year the WHO declared just that. The Africa Centres for Disease Control and Prevention declared the mpox outbreak ‘a public health emergency of continental security’.4 This clearly constitutes a call to arms, both directed at partners in the global north, as well as to African governments, to take this outbreak seriously, and to commit the resources required to address it efficiently.

Mpox was first described in the Democratic Republic of Congo (DRC) in 1970. At the time of writing this editorial, it is spreading rapidly in a number of African countries, including Burundi, Kenya, and Uganda, countries where mpox had never been reported before. Since then, it has also spread to South Africa and caused disease and death there, as well as to Sweden and Thailand. Such is the nature of global travel that an illness that is often sexually transmitted moves around quickly. At greatest risk of death are seemingly young children and people living with compromised immune systems, which undoubtedly will include many in sub-Saharan Africa who don't have reliable access to HIV medication.

At this point in time the DRC ‘remains the epicentre of disease, accounting for 96% of new cases and deaths.’ It is estimated that the currently affected African countries require about 10 million vaccine doses to get the mpox outbreak under control. Only around 2.6-3.6 million doses are available, and countries of the global north haven't donated what is needed, despite having uncontroversial ethical obligations to do so.5^,6

Of course, there will be much talk about the need for transparency, but African countries’ governments will recall what happened after they reported truthfully the discovery of the COVID-19 Omicron variant. Racist, punitive travel bans were issued, and the harms they did to African people was much worse than anything caused by Omicron. None of that travel ban grandstanding implemented in many nation states, partly in order to avoid inflaming already existing xenophobic sentiments, prevented the rapid spread of the variant across the globe. One would hope Western governments have learned relevant lessons from this.

As a result of the failure of the global north to provide COVID-19 vaccines to people in the global south in a timely fashion, the WHO's legally binding International Health Regulations (IHR) were updated to include equitable access to lifesaving countermeasures. The IHR also explicitly requires nations to abstain from unnecessary travel bans. It will be interesting to see what this will mean in Realpolitik.

Mpox is oftentimes transmitted sexually, including by men who have sex with other men. A fair number of African countries have recently introduced legislation that criminalises such sexual activities. Leaving other human rights considerations aside, such measures are counterproductive, because they will make it less likely that those at risk will consider getting vaccinated when the vaccines become available.

As Larry Gostin and colleagues noted in a recent Editorial, countries of the global north have access to large quantities of mpox vaccines, however, in response to the WHO declaration the USA donated a paltry 50,000 doses and the EU provided another 200,000 doses.7 The vaccine hoarding on display here may well turn out to be counterproductive, when the outbreaks on the African continent can't be brought under control and eventually spread across the globe. While such spread would not be anything like the COVID-19 virus, it might still affect larger numbers of people due to its sexual transmissibility. Both in North America as well as in Europe population level immunity to mpox is low, leaving people in these countries vulnerable to a global outbreak. The best solution would be to prevent a global outbreak, but currently too little is done to achieve that.

It does look as if governments of the global north have learned very little from their global health failures during the COVID-19 pandemic.