The fight against monkeybox requires a collective effort, says the WHO. African doctors are skeptical | CBC News

As an infectious disease specialist in Atlanta, Dr. Boghuma Kabisen Titanji has been on the front lines of the COVID-19 battle raging in the US for much of 2020

When a vaccine arrived in December this year, she felt some relief. But also fear.

“I had seen what COVID could do to people my parents’ age,” Titanji said.

“I was absolutely terrified because from the moment I had access to vaccinations to the moment my parents had access to vaccinations, it was eight months.”

In Cameroon, where Titanji is from, her parents only received a first coronavirus vaccination in August 2021. By this point, most Canadian and American adults were well past their second vaccination.

“It was the most nerve-wracking experience living in fear that they would get COVID,” she said.

Despite the World Health Organization’s appeals for rich countries to stop stockpiling COVID vaccines and share them with lower-income countries – particularly in Africa – global health experts agree we have failed.

Nor are they surprised, as the same unequal distribution of vaccines and treatments has been a pattern for decades.

On July 23rd, the WHO explains monkey pox a”Public health emergency of international concern‘ — and doctors fear the same pattern will repeat itself as Canada, the US and European countries rush to vaccinate vulnerable populations.

They use a vaccine originally made for smallpox that had been eradicated. It’s called Imvamune in Canada, and small amounts were stockpiled years ago in case smallpox ever returned. Imvamune is also approved to vaccinate humans against monkeypox.

However, monkeypox has been endemic in several African countries for the past 50 years. Dozens have died this year alone, Titanji said, but no vaccine has ever been made available except for targeted trials with health care workers.

Speaking about outbreaks of monkeypox in Cameroon, she said there was also no access to antivirals to treat the disease.

“When you diagnose someone with monkeypox [in Africa], provide supportive care. So basically you diagnose them and tell them to isolate and take acetaminophen for their fever… and rest and recover.

Although anyone can become infected through close contact with someone who has monkeypox or through personal items such as bedding, in countries outside Africa, males who have sex with males are currently the demographic most at risk. In Africa, in the past, it was mainly spread through contact with infected animals.

Lack of concern for disease in Africa

Unless a pandemic of the magnitude of COVID has prompted an equitable global response, Titanji said she is skeptical that the response to monkeypox — let alone future outbreaks of other diseases — will treat Africa differently.

“The problem is that healthcare in Africa is generally neglected,” said Dr. Githinji Gitahi, head of Amref Health Africa, a Toronto-based group working to improve access to health care across the continent.

“The view is that as long as health threats are limited to African communities, it’s okay for the world not to worry.”

But if rich countries want to end epidemics that are affecting their own citizens, it is in their best interest to ensure low- and middle-income nations have the resources to stop the spread of disease, Gitahi said.

“Pandemics and disease threats start in a community,” he said. “If you have a community that is not safe, the whole world is not safe in our current connectedness.”

“This needs to change, not only for monkeypox but also for other neglected diseases in low-income countries, as the world is once again reminded that health is a connected issue,” said the WHO chief.

What is the solution?

One of the things that needs to change is the monopoly rich countries have on vaccines and medicines, including antivirals, African doctors and global health experts have said.

During COVID-19, donations through the vaccine-sharing program COVAX helped, but they arrived late in African countries, Gitahi said. “People died while waiting for vaccines.”

In many cases, vaccines have been unusable because they ended up with “very low remaining shelf life”.

In addition, people who would have previously queued for vaccination had lost both a sense of urgency and confidence in the healthcare system by the time they arrived, with the perception that they were receiving vaccines that were being rejected by rich countries, Gitahi added added .

According to some experts, the way to level the playing field for low- and middle-income countries is to remove intellectual property protections for key vaccines and treatments.

Rich countries invest huge amounts of money in vaccine manufacturers during emergencies, Titanji said. That gives them the ability to condition funding on giving low- and middle-income countries an equal opportunity to buy them at a fair price, she said.

According to experts, an even better solution is to ensure Africa is able to conduct its own emergency response to epidemics, rather than being forced to wait for charities and wealthy nations to act.

“If we’re going to build a resilient system, there’s a lot, a lot, a lot more to do than just donate vaccines,” said Dr. Mary Stephen, Technical Officer for the Health Emergencies Program at the WHO Regional Office in Brazzaville, Republic of the Congo.

“Imagine … countries on the continent could make their own PPE, could make their lab reagents, make their test kits. [If] They’ve been able to make vaccines and medicines… it’s going to go a long way,” she said.

An important step in building this independence was the WHO-supported opening of the mRNA Vaccine Hub for Africa in Cape Town, South Africa. Scientists there have made their first batches of the COVID-19 mRNA vaccine.

As Africa works towards healthcare self-sufficiency, it is important for the world to remember that the continent has already made a significant contribution to global health, Titanji said.

For example, African participants in many clinical trials have enabled the development of HIV/AIDS treatments that patients in rich countries receive, she said.

Now that the world is facing monkeypox, Africa has decades of knowledge of the virus that wealthy nations rely on, Titanji said.

“It’s 50 years of research by African scientists, sometimes with incredible challenges, to make this data public,” she said of monkeypox studies, including one on Congo health workers testing the effectiveness of the Imvamune vaccine.

“We are now building on that so that in the meantime we can address outbreaks in non-endemic countries and leave behind the very people who contributed to this body of knowledge.”