Just a little over a year since declaring that Covid-19 was no longer a public health emergency of international concern and that the 2022-23 mpox crisis had subsided, the World Health Organization finds itself warning of another crisis as cases of yet another new strain of the mpox virus spread from the Democratic Republic of the Congo to other countries in Africa and beyond.
On Thursday the WHO’s director-general, Dr Tedros Adhanom Ghebreyesus, was in the DRC reviewing the situation on the ground as the organisation issued an emergency appeal to fund a £102m ($135m) mpox global strategic preparedness and response plan to stem transmission.
Unfortunately, countries with the resources and power to help stem the outbreak have been slow to offer help. Once again people are dying as vaccines, tests, and treatments that are available in the west, and which could have been assigned long before now to countries at the sharp end, have yet to arrive.
The WHO is growing concerned because the virus is mutating into a strain that is spreading across and beyond Africa. Already, 615 people have lost their lives this year in the DRC, where 90% of cases in Africa have been recorded. The Africa Centres for Disease Control and Prevention, Africa CDC, last week reported 20,000 cases in 13 African countries, almost certainly an underestimate owing to the absence of adequate surveillance. Now the first cases have been registered as far away as Thailand and Sweden.
The tragedy is that what could have remained a locally contained outbreak has turned into a killer disease because the countries that have the vaccines have been slow to act, even when they were aware that the 2022 outbreak led to more than 100,000 mpox cases in 121 countries. Today, effective vaccines that could help prevent the disease from spreading are being stockpiled in America and Europe, while countries affected, including the DRC, have yet to receive doses.
It is a solvable problem. Of course the engagement of local communities is needed to stop transmission. But international support is also essential.
First, thousands of available vaccines could be released now. The Africa CDC estimates that the continent may need as many as 10m doses to end the outbreak – but that may be a worst possible scenario that can be avoided. Currently, Japan has pledged to donate 3m doses of its LC16m8 vaccine, which is also recommended for children. Spain will donate 500,000 vaccines. The European Commission has pledged to donate 215,000 vaccines, while Germany and France have each separately pledged to donate 100,000. Soon, the US will send 50,000 doses to the DRC. The arrival there of the first vaccines is expected within days, and key decisions will need to be made about how best to allocate these precious doses. More will be needed to meet the needs of a country of almost 100 million people.
Second, the burden can be shared, and the cost of the two shots of the vaccine people need can be negotiated downwards. While the market price – between $70 and $100 – remains prohibitive for the poorest countries, the global nature of the threat shows why wealthier countries should help. The pandemic, and the work of Covax, the initiative to guarantee access to Covid-19 vaccines, already demonstrate that no one is safe until all are safe, and global coordination in getting vaccines to the right places is imperative. Furthermore, the recent establishment of global mechanisms such as the $500m First Response Fund of Gavi, the vaccine international alliance working to protect children, helps provide low-income countries with resources immediately for vaccine responses to a public health emergency.
Third, we must ramp up our manufacturing capacity to ensure more supply. This will require pooled procurement mechanisms backed by financing from donors to coordinate purchasing. The lesson of Covid-19 is that local vaccine manufacturing in Africa must now also play a key role. Western vaccine manufacturers should enter into agreements to transfer manufacturing technology to African manufacturers.
But a bigger lesson needs to be learned quickly, for it is now urgent that we fund the investment plans set out by the WHO to make sure it can respond to crises. The mpox outbreak reminds us that communicable diseases are rising to become the leading cause of premature mortality and, for the first time in recent history, the number of children who have not received any vaccine dose is climbing. All this adds to the rising threats to life from conflicts and extreme weather events, which are aggravating air pollution and malnutrition. The WHO needs the resources to act because more than 4 billion people lack access to health services and are so poorly protected that they cannot afford to be sick. Yet today, we offer the WHO just 30 cents per person a year to support its life-saving work.
It is time to move from the insanity of the hand-to-mouth approach. That means richer countries pass the begging bowl around only after too many avoidable deaths have occurred. Making long-term financial provision for proper healthcare is the best insurance policy in the world.
It should not be seen as a cost but as a critical investment – one that if made through the WHO will yield an impressive return of $35 for every $1 invested. And so we urgently need donor countries to provide the WHO with the flexible and predictable funding necessary to execute its strategy over the next four years. To bridge the difference between assessed contributions of $4bn and the need for $11.1bn of sustainable financing for the four years up to 2028, the WHO needs $7.1bn – $1.5bn of which will go directly to expanding healthcare in low- and middle-income countries. This must now be on the agenda of every major donor country in the run-up to November’s G20, chaired by President Lula of Brazil.
The cold war-era eradication of smallpox demonstrated that countries can work together and muster the political will to sustainably support WHO in the non-proliferation of infectious diseases. So, we have to ask: how many more outbreaks of disease can the world allow to happen before we realise that if the WHO did not exist, it would have to be created to deal with the challenges ahead?
Gordon Brown is the former UK prime minister and a World Health Organization ambassador
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