“This region is rich in minerals and mining sites,” says Nachega. “A significant number of the workers come from these countries. They get their paycheck at the end of the month, relax with commercial sex, and then return to their country of origin to visit their family, and so spread the disease regionally.”
For Nachega, these patterns of behavior indicate a particularly concerning aspect of how mpox has adapted in recent years. Mpox outbreaks were traditionally mediated through wild animal bites, consuming infected meat, or so-called spillover events where rural populations living in close proximity to infected animals would contract the disease. However, it now appears that the virus has evolved into an illness which is not only sexually transmitted but can be easily passed on to family members or anyone who comes in contact with an infected person’s body fluids, allowing it to spread far more widely.
“It’s kind of becoming the new HIV,” says Nachega. “When I finished medical school, the HIV pandemic was taking off. We don’t want to see this become another pandemic of a sexually transmitted infection. So that’s why we need to stop this clade 1 outbreak regionally before it gets to the levels of the 2022 one, which ended up going around the globe.” On Thursday, Sweden confirmed its first case of clade 1 mpox, in a person who had been infected while traveling in Africa.
To stop mpox from spreading further, Titanji says, a massive surveillance program is needed, involving a combination of contact tracing, isolation, and testing followed by large-scale immunization campaigns. Existing vaccines can be used both to prevent people contracting the virus and to stop infected individuals from spreading it further. However, carrying out such a program poses both logistical and financial challenges.
Armed conflict is raging in the eastern DRC, where the majority of the cases have been identified, while nations like Burundi lack the resources to carry out the necessary surveillance. “Of the 15,000 cases that have been reported, only about 10 to 20 percent are actually getting confirmatory testing for mpox, because many of these countries don’t have access to testing tools,” says Titanji.
While the company Bavarian Nordic has an effective vaccine for mpox, the current pricing points, which reportedly range between $70 and $300 per dose, are unaffordable for many countries given the many doses required to combat the threat. Earlier this month, both Bavarian Nordic and the European Commission’s Health Emergency Preparedness and Response Authority announced a collaboration which will see 215,000 vaccine doses donated to the African continent, but Nachega says that this is a mere fraction of the number required to truly suppress the outbreak.
“To control this outbreak in high-risk populations, the DRC needs 10 million doses,” he says. “So those 215,000 doses are better than nothing, but there has to be some creative way of ramping up vaccine production in the next couple of months if we want to make a meaningful difference in terms of controlling this disease. It’s also going to take some time and much negotiation about who’s going to pay. People affected in these countries can’t afford the vaccines if there is no donation or subsidies from governments or philanthropic organizations.”
