Why MPOX has been ignored for too long in Africa and is killing children – Podcast

In the east of the Democratic Republic of Congo (DRC), a smallpox epidemic is spreading rapidly, especially among young children. At least 20,000 people are infected in the country, more than 600 people have already died, more than two thirds of them children. The first cases are also appearing in the neighboring countries of Burundi, Kenya, Rwanda and Uganda.

Mpox is a serious, sometimes fatal virus. The world knows how to prevent it. Effective vaccines are available in many Western countries. But after an earlier global epidemic was largely brought under control in Europe and North America in 2022, the ongoing fight to protect people in Africa from Mpox has been ignored.

In this episode of The Conversation Weekly podcast, we ask a virologist and a pediatrician why the MPOX crisis in Africa has been so neglected – and what needs to happen now to save lives, especially those of children.

Wolfgang Preiser is head of the Department of Medical Virology at Stellenbosch University in South Africa. In a compelling article for The Conversation, he argued that the current Mpox epidemic was yet another example of how infectious diseases, often perceived as someone else’s problem in predominantly poor developing countries, can suddenly pose an unexpected global threat.

We thought this virus circulated naturally in small mammals in the rainforests of Africa, but it is just another worrying reminder that these viruses are always good for nasty surprises.

The Mpox virus was discovered in captive monkeys in 1958, and the first case of Mpox in humans was identified in an infant in the Democratic Republic of Congo in 1970. However, human-to-human transmission has rarely occurred.

I think we have all become complacent. Yes, there were occasional reports of monkeypox in the World Health Organization’s (WHO) weekly report, as it was called last year. There were cases in some village and some contacts, and they were investigated, but there is still a lot we don’t know about this virus.

A small outbreak in the United States in 2003, caused by the importation of infected rodents that spread to domestic dogs, raised alarm around the world. And then in 2022, an outbreak that had started in Nigeria a few years earlier developed into a global epidemic, causing over 99,000 laboratory-confirmed cases in 116 countries. The disease spread particularly in communities of men who have sex with men.

In May 2023, the WHO announced that this outbreak was no longer an international health emergency. “I was stunned,” says Nadia Sam-Agudu, a professor of pediatric infectious diseases at the University of Minnesota in the US, who is also affiliated with the Nigerian Institute of Human Virology and the University of Cape Coast in Ghana. Transmission was still occurring on the African continent, and not long after, a new strain of Mpox began to emerge in the Democratic Republic of Congo.

In African countries, we have lost ground because the pandemic was declared over in 2023. And we are feeling the effects of that declaration right now because disease outbreaks are completely out of control.

In August 2024, one day after the Africa Centers for Disease Control (CDC) classified the current epidemic as a public health emergency of continental concern, the WHO again declared Mpox a public health emergency of international concern.

Children at high risk

Previous Mpox outbreaks in Africa have hit children particularly hard. As a zoonosis, the disease is often transmitted from animals to humans – often by boys hunting small rodents in forests where the virus is endemic.

However, even in the current outbreak in the Democratic Republic of Congo, which has been caused by human-to-human transmission, young children are particularly vulnerable to severe disease and complications from the infection. Current data suggest that 58% of cases in the current epidemic in the Democratic Republic of Congo affect children under 15 years of age.

The African CDC said 10 million doses of vaccines would be needed by 2025 to bring the current epidemic in Africa under control. Some donations have already arrived in the Democratic Republic of Congo, but they are not vaccines approved for children. One vaccine, Jynneos, made by pharmaceutical company Bavarian Nordic, is not yet approved for use by under-18s, although trials are planned for children ages two to 12. Another Japanese vaccine, called LC16, has been given to children in Japan but has not yet received global approval.

According to Sam-Agudu, this is part of a larger problem where the approval of vaccines for children and vulnerable adults, such as pregnant women, is not seen as a priority.

Their vulnerability has led to them being marginalised, yet it is precisely because of their vulnerability that they continue to be disproportionately affected by the impacts and consequences of these diseases.

Listen to the conversation with Nadia Sam-Agudu and Wolfgang Preiser on The Conversation Weekly podcast, which also includes an introduction by Nadine Dreyer, health and medicine editor at The Conversation Africa based in Johannesburg.

A transcript of this episode is available on Apple Podcasts.

This episode of The Conversation Weekly was written and produced by Mend Mariwany with assistance from Katie Flood. Sound design is by Michelle Macklem and our theme music is by Neeta Sarl. Gemma Ware is the executive producer.

This episode features news clips from BBC News, CNBC Television, DW News, TRT World, Sky News and Reuters.

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