Mpox Vaccination in Africa: What Needs to Happen Next

The recent surge in mpox cases across Africa, including in previously unaffected countries, brought a powerful call for an increase in resources to mount a swift and equitable response. The good news is that calls for vaccine access—as one tool in outbreak response—are beginning to be answered.

While vaccine needs remain large, several governments, including the US, Japan, and European partners among others, have recently stepped up to pledge millions of vaccine donations to African countries. Additionally, the World Health Organization prequalified Bavarian Nordic’s vaccine, an important step that allows purchase by international funders. And wasting no time following prequalification, Gavi, the Vaccine Alliance subsequently secured an advance purchase agreement to procure 500,000 doses with money from its new First Response Fund, further boosting global vaccine efforts.

But securing vaccine donations and purchases is just the first step—it’s necessary but insufficient on its own. To truly prevent further outbreaks and protect communities, a lot more needs to happen next. This blog explores three priorities— targeting the right groups for vaccination, strengthening delivery systems, and building public trust—to translate vaccine doses into vaccinations for the most affected communities on the ground.

Prioritizing populations at risk

With recent progress on vaccine donations and purchase agreements underway, national leaders in affected countries will need to decide how to allocate available vaccines. For example, will allocation of vaccine doses be focused on curbing outbreaks that spread beyond the Democratic Republic of the Congo’s (DRC) borders? Or will they be focused on preventing the larger ongoing burden of disease in high-risk regions of DRC?

Most recent global attention has focused on outbreaks due to subclade Ib, a strain  that has spread beyond DRC into neighboring Burundi, Kenya, Uganda, and Rwanda—and also been detected beyond Africa. But the bulk of global mpox cases originate from subclade Ia, characterized by animal-to-human transmission in central DRC. While both subclades affect children, most cases—and deaths—continue to be from subclade Ia in endemic, rural provinces of DRC, which receives far less attention despite its impact.

If preventing the highest number of cases is the priority, healthcare workers, people living with weakened immune systems, and vulnerable communities in areas where mpox is known to occur should be the top priority. Ultimately, how vaccine doses get allocated will indicate what disease control target gets prioritized.

Strengthening immunization delivery

Beyond identifying priority groups, ensuring vaccines reach everyone in need is no small task. The need for timely support to countries around readiness for rollout and last-mile delivery was another a key lesson from the COVID response.

Immunization coverage in DRC has historically struggled, with even inexpensive and routine vaccines like measles vaccine rarely exceeding 70 percent coverage in many parts of the country.  

Strengthening the immunization delivery system—from human resources to storage to transportation—will be essential. It won’t be quick or easy to fix but without investment and sustained focus on strengthening delivery systems, vaccines won’t turn into vaccinations that ultimately protect communities. And leveraging early support, including timely financing, from the World Bank and UNICEF for instance, can help, in tandem with close coordination with humanitarian partners in conflict-affected areas. 

Sustained investments in immunization delivery systems would also open the opportunity to stretch limited vaccine supplies through fractional dosing, an approach that becomes easier to adopt as delivery systems are strengthened.

Avoiding stigma, building trust, and engaging communities early

If past outbreaks have taught us anything, it’s that avoiding stigma and building community trust is essential. Stigmatizing those at risk can lead to fear, discrimination, and delays in care-seeking, as experienced with Ebola and HIV. During the COVID-19 vaccine rollout in Africa, even health care workers were hesitant to get vaccinated due to lack of trust, despite their high risk status. As mpox vaccination in Africa ramps up, actively working to prevent the same mistakes will be essential.

Inclusive messaging focused on health risks not identities of specific groups can help avoid stigma. It’s important to communicate how mpox can affect anyone, not just specific groups; this in turn avoids wording that reinforces stereotypes about who is at risk.

Mitigating hesitancy requires public health officials to acknowledge concerns and provide clear, culturally appropriate explanations about the safety and benefits of the mpox vaccine. Health officials should start engaging with communities early, while also listening to concerns, meeting people where they are, and bringing them into the process of deciding how to prevent disease, including with vaccination. Using trusted channels and locally relevant approaches will be key to building support and controlling disease. Early engagement is also essential to reducing hesitancy down the line.

Conclusion

The donation of mpox vaccines to Africa is a critical first step, but there’s much more to do to ensure that these vaccines are used effectively and equitably. By focusing on targeting the right groups for vaccination, strengthening delivery systems, and building public trust via early community engagement, vaccination can protect African communities from future mpox outbreaks.