South Africa is one of 14 countries that will be financially supported by the Africa Centres for Disease Control and Prevention (Africa CDC) and World Health Organization (WHO) from this month until February 2025 to draw up and roll out plans, including vaccination strategies, to fight mpox.
The budget for the “Mpox continental preparedness and response plan for Africa” is about $600m of which just over half of the money — 53% — will go towards the mpox responses of 14 of the 55 Africa Union member states in which cases have escalated, and human-to-human transmission of the monkeypox virus has become relatively common.
In addition to South Africa, the 13 other countries that will be helped to design and roll out plans are: Democratic Republic of Congo (DRC), Burundi, Central African Republic (CAR), Congo, Cameroon, Côte d’Ivoire, Gabon, Liberia, Kenya, Nigeria, Republic of Guinea, Rwanda and Uganda.
Most of the rest of the money — 45% — will be spent on funding the efforts of partners such as Unicef, the International Organisation for Migration and the International Federation of Red Cross, to help countries to set up their plans, become better at testing and contact tracing, managing cases and rolling out vaccines.
The budget for South Africa is $45.5m (R815m), of which $10.1m (R181m) will be spent on the logistics of rolling out vaccines against mpox. This money can’t be used to buy jabs. The Africa CDC and WHO say vaccines will be funded via in-kind donations and in cases where countries can afford to buy shots, the prices will depend on ongoing negotiations with drugmakers.
In August the WHO declared mpox a public health emergency of international concern, and in the same month the Africa CDC announced it a public health emergency of continental security.
This was the first time that the Africa CDC has made such a declaration since its inception in 2017. The World Health Organization’s declaration is the second in two years with regards to mpox — in 2022, the WHO also declared mpox a public health emergency of international concern, after a multicountry outbreak, but announced the emergency over in May 2023.
An invitation for vaccine manufacturers to express their interest in listing their anti-mpox shots for emergency use was announced by the WHO on August 7.
SA now has 25 confirmed mpox cases
Meanwhile, South Africa’s health department announced another mpox case on Monday — a 38-year old man who was diagnosed at a private medical facility in Cape Town — on September 6.
This brings South Africa’s total number of 2024 cases to 25. Twelve cases were diagnosed in Gauteng, 11 in KwaZulu-Natal and two in the Western Cape. Three have died.
South Africa’s first 2024 case was reported on May 8.
None of the country’s cases are the relatively new strain, clade 1b, which seems to be deadlier than other forms of the virus. All of South Africa’s cases were infected with clade 2b, the same type of the virus that caused outbreaks in Western Europe and the UKin 2022 and 2023, according to health department spokesperson Foster Mohale.
Almost all South Africa’s cases were among gay and bisexual men, most in their 20s or 30s, and many of them were infected with HIV but untreated.
South Africa’s latest case does not have an international travel history and went to the doctor on 4 September after he noticed typical mpox-like blisters on his face, chest and genitals. He wasn’t hospitalised, but is in a stable condition and isolating at home.
The differences between clade 1 and 2
Mpox is caused by the monkeypox virus and there are two known clades: clade 1 and clade 2. Mpox starts off with a fever, muscle aches and a sore throat, followed by blister-like bumps on the skin on any part of someone’s body. Most people recover spontaneously, but people with weakened immune systems, such as those with untreated HIV, often fall very ill with the disease, and some die.
Clade 1 has been rampant in the DRC, where mpox has been recorded for more than a decade, but in August cases were also detected in Sweden and Thailand. Moreover, from 2023 onwards, clade 1 cases were found in Kenya, Rwanda, Burundi, the CAR and Uganda; all countries close to the DRC. The cases in Sweden and Thailand had both travelled to African countries where clade 1 cases had been detected.
The World Health Organization says clade 1 cases in the DRC have increased steadily over the past decade, especially in 2023. At over 15,600 cases and 537 deaths, the numbers reported so far in 2024 are more than last year’s total.
Clades 1 and 2 cause the same type of disease, but infection with the clade 1 virus makes people feel sicker and can lead to more deaths. Though symptoms of a clade 2 infection are milder, virus of this type spreads easier. Clade 2b cases have mainly spread among gay and bisexual men with HIV, but who are not on treatment, or don’t use their treatment correctly. Clade 1 cases, however, can also spread via children and heterosexual adults who live closely together in a household and may share a bed or linen.
A worldwide vaccine shortage
Last week, the DRC received two shipments from the EU donation programme of about 100,000 vaccine doses used against mpox — but it’s not nearly enough. Two such jabs are currently being used globally, both recommended by the WHO’s advisory group on immunisation.
Vaccines specifically against mpox are being developed, but there have not yet been clinical trials that include thousands of people, a necessary step in getting any medicine into commercial production.
Though the US medicines regulator, the Food and Drug Administration, issued an emergency use licence for a new type of smallpox vaccine to be used against mpox infection in August 2022, in most other places earlier anti-smallpox jabs are used against mpox, because the two diseases are caused by similar-looking viruses.
In South Africa, people were vaccinated against smallpox until the 1980s, when the pandemic was eradicated; those who were vaccinated have about 85% protection against getting infected with mpox.
The health department has previously announced that it will start to vaccinate four groups of people with a higher chance than the general population to contract the monkeypox virus — men who have sex with men, sex workers, health and lab workers — against the monkeypox virus as soon as jabs arrive in the country.
But the department has not yet managed to secure donations.
Mohale says the department has tried to source mpox jabs from Western countries, but “it’s difficult to tell when we can expect the vaccines”. “The department is still considering several options, while looking at the epidemiological surveillance data.”
With a huge shortage of mpox jabs, the current spread of clade 1 cases is unfolding against the background of vaccine inequity “and yet another looming failure”, experts wrote on 15 August in the British Medical Journal (BMJ).
“We have seen this before, and it does not end well for anyone,” they said.
“Vaccine inequity is already evident,” the BMJauthors wrote, “with Africa CDC reporting a need for approximately 10-million vaccine doses to control the outbreak, of which only about 280,000 are available — less than 3% of the estimated need, even as wealthy countries hoard, stockpile, and refuse to share vaccines.”
The WHO and Africa CDC’s continental plan aims to get 10-million people in Africa vaccinated within the next six months.
The BMJ authors, however, concluded: “Having observed Covid-19 and previous epidemics, we have every reason to worry that high-income nations will make the same mistakes again — from vaccine hoarding to unfair travel bans and anti-black racism.”
Timeline of health department announcements
May 13 2024: The health department asked for “public vigilance” about mpox after the first case was diagnosed on May 8. Read the press release.
May 27 2024: The second case, a 39-year-old man from KwaZulu-Natal, is reported. Read the press release.
June 5 2024: Two more cases are reported, both from KwaZulu-Natal. Read the press release.
June 11 2024: The health department announces a press briefing to be held on June 12. Here’s the notice.
June 12 2024: At a press briefing on June 12, the health department announces a fifth case, who had died on June 10. This was the first death recorded in this outbreak.
At the briefing the health minister, Joe Phaahla, and experts from the NICD and the World Health Organization answered questions about the outbreak.
June 13 2024: An announcement of the sixth case, reported from KwaZulu-Natal on June 12, was made. The patient passed away the same day as the diagnosis was confirmed. Read the press release.
June 14 2024: A seventh case is reported, from the Western Cape. Read the press release.
The Africa Centres for Disease Control and Prevention earlier announced that all seven cases in South Africa were classified as severe and required hospitalisation. All cases are male, between the ages of 30 and 39 with comorbidities (HIV positive), and five of the seven identified as “men who have sex with men”, they said. Read the press release here.
June 20 2024: Six more cases are announced, three from KwaZulu-Natal and three from Gauteng. Read the press release.
June 25 2024: Three more mpox cases, of which one person died are announced. Two of the cases are from Gauteng (Johannesburg, Mamelodi) and one from KwaZulu-Natal (Ladysmith). The person who died was the case from KwaZulu-Natal — a 40-year-old male. Read the press release.
July 4 2024: Four more mpox cases are announced. Three of the cases are from Gauteng (The West Rand and Hillbrow in Johannesburg and a case from East Pretoria) and one from KwaZulu-Natal (in Durban). Read the press release.
July 11 2024: Two more mpox cases are announced — two cases from KwaZulu-Natal; one who was diagnosed in Durban (but is from Johannesburg and travelled to Durban over the weekend) and one from Nqutu. Read the press release.
August 4 2024: Two more cases are announced — one from Durban and another from Johannesburg. The Gauteng case had travelled to Peru, a high-risk mpox country. Read the press release.
August 13 2024: The Africa Centres for Disease Control and Prevention declares mpox a public health emergency on the continent.
August 14 2024: The World Health Organization declares mpox a global public health emergency after a surge in cases in Africa. Read the press release.
August 18 2024: The health department announces that South Africa’s mpox cases remain at 24 cases, of which 19 have recovered, three have died and two are still active. Read the press release.
September 9 2024: The health department announced another mpox case, a 38-year-old man from Cape Town, bringing South Africa’s cases to 25. All cases are clade 2b. Read the press release.
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
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