Closing Africa's mpox knowledge gaps key to effective public health and vaccination campaigns I Medicines for Africa

African scientists have urgently called for additional research to close the existsing knowledge gaps to improve responsiveness to the mpox global emergency. Dr. Dimie Ogoina, an infectious diseases expert at Niger Delta University Hospital in Nigeria and chairs the WHO’s mpox emergency committee says is this. “I worry that in Africa, we are working blindly.” These concerns are stemming from the fact the new strain of the mpox virus, known as clade Ib, is changing so much faster than expected leaving scientists to play catch up to the virus to improve their current understanding of it. Clade I has typically caused more severe disease, with fatality rates ranging between 4%-11%, compared to around 1% for clade II. The clade 1b strain is a mutated version of clade I, that has been endemic in Congo for decades.

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What complicates matters further is that these mutations or changes on the virus are happnening in an environment in which the resources and funding available to scientists are very limited which contraints their ability to unravel the virus’ mysteries faster. The Programme Director for WHO’s Health Emergencies, Mike Ryan has described mpox as a “neglected disease”, with “not one dollar” received from donors to support the response in endemic countries during the 2022 global outbreak. Leading mpox scientists in Africa continue to struggle to secure critical research funding. As a result of limited research funding, so little is known about the new variant that designing effective vaccination campaigns is in essence like scientists flying blind.

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In the context of existing knowledge gaps, African scientists caution that planning effective public health campaigns vaccination campaigns for the mpox outbreak will be challenging. Prof. Salim Abdool Karim, the Chair of the Africa CDC mpox advisory has in fact warned that planning vaccination campaigns without further research and information will prove difficult. Scientists need to know many disease parameters including how severe is the disease and under what circumstances? What are all the ways that the new variant can transmit? Why are children particularly vulnerable and why does it cause such high rates of miscarriages in pregnant women? Not having scientific data to address these questions complicates the ability to mount an effective and most optimal public health responses.

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A major limitation is that a significant part of the diagnosis by physicians are currently not supported by laboratory confirmation of infection. According to Dr Emmanuel Nakoune, an mpox expert at Institut Pasteur de Bangui in CAR, many African laboratories are struggling to get the reagents and supplies they require for diagnosis. The logistics of getting samples to laboratories remain a challenge when the healthcare system are under significant pressure. Limited access to diagnostics tests impedes the ability to effectively track the virus and better understand its transmission dynamics.

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African countries need to allocate domestic budgets to strengthen their national surveillance and public responses and to support scientists to allow then to better track the virus and its transmission dynamics and improve knowledge.. ?Mpox-endemic countries need sustainable, access to diagnostics, infection and prevention control materials, lab reagents, diagnostic laboratories and research capacity. It is also critical to support scientist to access equipment and reagents they need to perform laboratory confirmation of cases to support diagnosis. Strengthening support for scientific collaborations will help to catalyse vaccines, therapeutic research and expedite the development of products needed to prevent and treat mpox.

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However, medical countermeasures that are already available on the market such as vaccines and therapeutics, but currently unavailable to African countries are critical to an effective public health response. To close the gaps in knowledge of their use in African populations, they will however need concurrent implementation studies to better characterise their safety and efficacy in African epidemiological contexts. African researchers have been studying the virus for decades . They are a treasure trove of knowledge that should lead the way in establishing multidisciplinary, multi-country Mpox Research Consortia (MpoxReC) in Africa to expedite out knowledge and understanding of mpox and design effective public health interventions.

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