Smallpox outbreaks in Africa: we must avoid another failure of global solidarity

Are we going to repeat the same mistakes?

After watching COVID-19 and previous outbreaks, we have every reason to fear that high-income countries will make the same mistakes again, from vaccine hoarding to unjust travel bans and anti-Black racism.456 We fear that the rest of the world will once again resort to performative charity and fail to act in genuine solidarity with Africa. The region is always the last to access life-saving tools, as we have seen with HIV/AIDS, Ebola in West Africa, COVID-19 and the 2022 mpox outbreak.4

Whenever outbreaks have seemed to be confined to Africa, we have seen the world do little and only act when high-income countries were directly affected.5 Until Ebola affected populations in the United States and Europe, it was barely considered a problem for leaders and donors in the Global North,7 and this happened again in 2022 when MPOX clade IIb was declared a PHEIC.8 Once these diseases affected populations in rich countries, millions of dollars were invested in research for cures and vaccines.8 We simply cannot do that again with the current MPOX crisis in Africa.

Vaccine inequality is already evident: the Africa CDC reports a need for about 10 million vaccine doses to control the outbreak, of which only 280,000 are available,19 less than 3% of the estimated need, even as rich countries hoard, stockpile, and refuse to share vaccines.10 These same countries have hoarded COVID-19 vaccines, blocked or actively delayed the patent waiver that could have allowed countries in the Global South to manufacture COVID-19 vaccines during the pandemic, and eroded equity clauses in the draft pandemic agreement after lobbying by Big Pharma.3111213

This year’s World Health Assembly therefore failed to reach agreement on the pandemic deal, with key articles of the draft text still unresolved, including the strategy for equitable sharing of vaccines and medicines in emergencies. Had a pandemic deal been reached, it could have helped Africa address the current COVID-19 crisis.

After WHO declared this mpox outbreak a PHEIC, rich countries may resort to travel bans against affected African countries, rather than offering them real support. The unfair and racist travel bans that were imposed on some African countries during the SARS-CoV-2 omicron wave are a clear example of this.14 We are concerned about a resurgence of stigma and racism targeting African countries, as we saw during the omicron wave and the 2022 mpox outbreak.15

What would authentic solidarity look like?

In proclaiming the PHEIC, Tedros Adhanom Ghebreyesus, WHO Director-General, said that “a coordinated international response is needed to end these outbreaks and save lives.” This is exactly what we need today. In fact, if we had learned the lessons of HIV, Ebola, COVID-19 and the previous mpox outbreak, we would have already acted to help African countries with speed and cohesion to avoid the current crisis.

In the immediate term, we must ensure that the Africa CDC has adequate funding, as well as the full supply of MPOX vaccines needed to control the outbreak, as well as diagnostics and medicines. We need more affordable vaccines and more committed manufacturers. The Africa CDC response plan needs the full support of the international community.1 African countries must work together and mobilize domestic funding and resources to expand public health surveillance, contact tracing, and implement other essential public health measures to contain the spread of the virus.

In the longer term, the African region must invest in its own vision of a New public health order for Africa, Africa’s strategic framework is based on five pillars: strengthening public health institutions; strengthening the public health workforce; expanding the production of vaccines, diagnostics and therapeutics; increasing domestic resources for health security; and respectful and action-oriented partnerships in Africa and globally.16 This framework will enable Africa to shift from the current global health model based on aid and charity to a paradigm rooted in self-reliance and self-sufficiency. In particular, the African region must manufacture tests, drugs and vaccines, and must have full access to modern technologies such as the mRNA platform.

Finally, the latest MPOX crisis is another reminder that the world desperately needs a robust pandemic agreement based on equity and accountability.13 Moreover, history shows that repeated failures of equity are the norm in global health, not the exception.