A security agent talks with a worker as he prepares to transport mpox vaccines as first batches arrive at N'Djili International Airport in Kinshasa, Democratic Republic of Congo on Sept. 5.Justin Makangara/Reuters
With costs soaring and prices sky-high, Africa’s leading health agency is hoping that donations will provide the four million vaccine doses it needs to fight the rapidly escalating mpox outbreak over the next six months.
Vaccines are urgently needed to combat the viral infection, the agencies say. But manufacturers are charging as much as US$140 per dose, making them unaffordable for most African governments and leaving officials dependent on donations from wealthy countries with large stockpiles.
Nearly 25,000 cases of mpox, including 643 deaths, have been reported across Africa this year. So far only 200,000 vaccine doses have arrived in the worst-hit country, the Democratic Republic of the Congo, and all were donated by the European Union.
The Africa Centres for Disease Control and Prevention unveiled an mpox response plan on Friday with a proposed US$600-million budget. But the plan contains no budget for vaccine procurement. Instead the plan counts on donations to fill the need, while health leaders plead with wealthy countries to share their stockpiles.
“We call on countries with stockpiles of vaccines to work with us and our partners to get those vaccines to where they are needed now,” World Health Organization director-general Tedros Adhanom Ghebreyesus told a briefing in Geneva last week.
The government of Spain has made a similar plea, asking European countries to donate 20 per cent of their vaccine stockpiles to help African countries.
The WHO issued its own mpox plan on Friday, estimating that four million vaccine doses and US$290-milion in international funding will be needed over the next six months. But it excluded the vaccine procurement cost from its budget, without saying why.
Secrecy has shrouded the size of existing stockpiles and the cost of doses. The WHO has estimated that it could reduce the vaccine cost to US$50 to US$75 per dose, but so far it has relied mainly on donations.
A growing number of health activists have voiced concern that Africa will suffer a repeat of the situation during the COVID-19 pandemic, when many wealthy countries hoarded vaccines and refused to share them with poorer countries.
The Canadian government, which has a large stockpile of mpox vaccines after signing a US$470-million contract with a manufacturer in 2022, said on Aug. 14 that it is “actively working” on the possibility of donations or other measures to help African countries.
Since then, several European countries and the United States have announced vaccine donations, but Canada has made no announcement.
Foreign Affairs Minister Mélanie Joly, in an interview with The Globe and Mail on Aug. 22, said the government might provide funding, rather than vaccine doses, to help Africa in the mpox crisis.
The high price of vaccines seems to be deterring some countries from launching vaccine campaigns. Burundi, which has the second-highest number of mpox cases in the world, has not sought to obtain vaccines so far, WHO officials say.
The most widely used vaccine, manufactured by Denmark-based Bavarian Nordic, requires two doses to vaccinate each person, which adds to the cost.
“With a vaccine that costs $100 a dose, $140 a dose, if you want to vaccinate five million people in Congo, that’s going to cost you a billion dollars,” WHO emergencies chief Mike Ryan told a briefing last week.
African governments have to balance the high cost of mpox vaccines against other health emergencies that need funding, he said. Many are facing outbreaks of cholera, measles or meningitis.
“If I had a billion dollars tomorrow, would I be spending it on mpox vaccines?” he asked. “Maybe I’d spend it on making sure my measles coverage is better, making sure my kids with malaria get treated. Countries face real trade-offs, real difficulties. Maybe Burundi is considering what to spend its money on.”
A group of non-profit health organizations has written to Bavarian Nordic to seek a lower price and greater transparency in contract negotiations. “Bavarian Nordic’s price for mpox vaccines is far, far too high,” said Peter Maybarduk, access to medicines director at the U.S.-based non-profit consumer advocacy organization Public Citizen, in a statement.
Public Citizen says it is worried that manufacturers may be profiteering in their mpox pricing. Its research, based on manufacturing processes that are similar to Bavarian Nordic’s methods, suggests that similar types of vaccines could be sold for US$4 or less.
Bavarian Nordic says it is still in “active discussion” with global health organizations over how much the vaccine will cost. “Any figures for price floated by third parties are speculation,” Thomas Duschek, a company spokesman, told The Globe in an e-mailed response to questions. “We remain focused on doing as much as we can to ramp up production and save lives.”
Health agencies are also calling for technology transfer from existing manufacturers to African vaccine companies, so that mpox vaccines can be made in Africa. Bavarian Nordic is “exploring” this possibility, Mr. Duschek said.
“If we are successful in finding a partner, it will take time. What we are currently hearing from partners interested in a tech transfer is that they want the world to assure them that there is global support for mpox vaccination over multiple years and at scale.”