The first donation of mpox vaccines arrived in Democratic Republic of the Congo on Thursday, but officials say millions more doses will be needed.
The announcement came amid warnings that the geographical spread of the virus, formerly known as monkeypox, was increasing, and swift action was needed across the continent to contain the outbreak.
Almost 100,000 doses of Bavarian Nordic’s vaccine were delivered to the DRC’s capital, Kinshasa, as part of a European Union donation programme, with another 100,000 expected on Saturday.
Dr Jean Kaseya, director general of the regional health authority, Africa Centres for Disease Control and Prevention (Africa CDC), emphasised the need to curb the spread of the disease to neighbouring countries.
“The outbreak is really moving [fast],” said Kaseya. “We really need to stop it really quickly.”
Almost 25,000 cases of mpox have been reported across Africa this year, with 5,549 confirmed by testing, and 643 deaths, according to Africa CDC. Cases are up 104% compared with last year.
The DRC still accounts for the majority of cases, but Kaseya said numbers were rising elsewhere. He said he was “really concerned” by a reported case of mpox in a seven-year-old child in Guinea, which potentially represents the first case of the new clade Ib variant detected in west Africa. Sequencing tests are still in progress.
Clade Ib is a mutated form of the virus, newly detected in eastern DRC, which appears to be spreading via close contact between people and driving the large jump in case numbers.
The outbreak, which has spread to nearby countries, has been declared a public health emergency by both the World Health Organization (WHO) and African health officials. A response plan is estimated to require almost $600m (£455m) over the next six months, officials said.
About 380,000 doses of mpox vaccines have been pledged by western partners including the EU and US, according to Africa CDC. However, they said 3m doses would be needed to end outbreaks of the virus in the country.
Vaccination programmes are expected to focus on contacts of suspected cases as well as healthcare and frontline workers in areas with active transmission.
However, the programme is unlikely to get under way until October at the earliest, with local healthcare and logistical workers still being trained on how to store and administer the vaccine. A large public information campaign is also being rolled out to improve awareness of mpox and tackle vaccine hesitancy.
Most cases in the DRC are among children. Regulators are assessing information submitted by Bavarian Nordic that could see the vaccine authorised for 12 to 17-year-olds by the end of the month, but approval for younger children will take longer.
There are concerns about the affordability of vaccines for a wider programme, with the WHO putting the cost at $50 to $75 a dose.
“Most vaccines cost around £1 or less,” said Dr Andrew Hill, of Liverpool University. “If there are large orders for millions of vaccine doses for Africa, Bavarian Nordic should lower their prices. Otherwise, they should allow a generic company to mass produce their vaccine for a low price.”
A Bavarian Nordic spokesperson said: “While we are proud that our mpox vaccine has arrived to help people in Africa, it remains a concern for Bavarian Nordic that artificial prices are being mentioned, as there exists no published dose price range. And we have not started to discuss prices with relevant organisations.”
The company had previously suggested it would be open to a tiered pricing model, in which countries with fewer resources or those able to place larger, longer-term orders paid less.
Within the DRC, clade Ib was reported in Kinshasa for the first time this week. In a case report about one patient, Dr Eddy Lusamaki, of the DRC’s National Institute of Biomedical Research, wrote that it suggested the variant was spreading across the country.
Lusamaki said: “Its presence in Kinshasa, the capital city, with multiple international connections by air traffic and multiple exchanges with Brazzaville in the Republic of Congo, illustrated the need for improved surveillance strategies to control the spread of the disease.”
Cases of the clade Ib variant were also reported in Thailand and Sweden last month.