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Efforts to tackle mpox intensify over vaccine hesitancy

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Efforts to tackle mpox intensify over vaccine hesitancy


On August 14, the World Health Organisation described mpox as a global health emergency by declaring it a Public Health Emergency of International Concern – the highest possible alarm the WHO can sound.

With this declaration, experts in several African countries began to study the outbreak of mpox, conduct surveillance tracking and make several recommendations.

Mpox, previously known as monkeypox, is a viral illness caused by the monkeypox virus, a species of the genus Orthopoxvirus. There are two distinct clades of the virus: clade I, with subclades Ia and Ib, and clade II, with subclades IIa and II.

This viral disease which leads to rash and flu symptoms, occurs mostly in central and western Africa. It has been reported in the Democratic Republic of Congo and as of last week, Congo health officials confirmed more than 22,000 mpox cases and recorded over 716 deaths.

Despite the morbidity of this illness which is transmitted by sexual intercourse and physical contact with someone who has been infected, the level of awareness and preventive measures among many have been abysmally low.

The first human case of mpox was reported in the DRC in 1970. Since then, outbreaks have been reported in Sierra Leone, Ghana, Cameroon, Liberia, and Nigeria, predominantly among children who had not received the smallpox vaccine.

Between July and August, the clade Ib strain of mpox has been reported in four countries neighbouring the DRC that have not reported mpox before: Burundi, Kenya, Rwanda and Uganda.

As of the end of week 35 of 2024, the Africa Centres for Disease Control and Prevention has estimated a total of 26,544 reported cases of mpox, out of which 5,732 were confirmed and 724 resulted in deaths in 15 African Union member-states.

“Experts believe the true number of cases to be higher as a large proportion of clinically compatible cases have not been tested. Several outbreaks of different clades of mpox have occurred in different countries, with different modes of transmission and different levels of risk,” noted the WHO.

The Nigeria Centre for Disease Control and Prevention has shown that more males are getting infected with mpox in Nigeria. The figures released revealed that a total of 1,031 suspected cases have been reported across 47 local government areas in 23 states and the Federal Capital Territory, with 67 confirmed cases in 2024.

Risk factors

Although the virus responsible for mpox was first identified in monkeys, nonhuman primates are thought to be infected like humans. Several rodents, including rope squirrels, tree squirrels, Gambian pouched rats, and dormice, have been suggested as natural hosts of the virus.

A Lagos-based pharmacist, Moyosore Odedeyi, in an interview with Sunday PUNCH, explained that the clinical symptoms of mpox infection include fever, headache, muscle pains, general body weakness and lymphadenopathy, which are the main features of the first phase of the disease.

He noted that the second phase of the infection, which manifests with rashes, usually begins between one and three days after the onset of fever.

Highlighting the ways by which the mpox virus is transmitted, he stated that the virus is passed from animals to humans, “mainly through direct contact with blood, body fluids, or cutaneous or mucosal lesions of infected animals.

“Human-to-human transmission has also been reported via direct contact with infected materials from skin lesions of infected persons, through respiratory droplets following prolonged face-to-face contact, and through recently contaminated objects such as cloths and beddings.

“Vertical transmission through the placenta and during childbirth has also been reported. Additionally, the epidemiological patterns of recent outbreaks in Europe suggested a sexual route of transmission.

“Although the mechanism of sexual transmission has not been fully elucidated, recent reports have established sexual transmission. Over 80 per cent of cases were in men who had sex with men.”

dedeyi further explained that the number of mpox cases is grossly underestimated due to factors such as a poor index of suspicion due to a lack of awareness of healthcare workers, poor surveillance and weak health systems.

“Other factors include an inadequate number of laboratories with the capacity to diagnose the disease, lack of access to approved antiviral medicines and vaccines, and stigmatisation,” he said.

Experts have also identified the burden of HIV/AIDS, tuberculosis, hunger and malnutrition/undernutrition, malaria and insecurity as known risk factors for mpox and many other infectious diseases.

The giant of vaccine hesitancy

Presently, two vaccines have been recommended by the WHO’s Strategic Advisory Group of Experts on Immunisation for use against mpox: the Modified Vaccinia Ankara-Bavarian Nordic mpox vaccine and the ACAM 2000 (the smallpox vaccine).

In August, the Director-General of the WHO, Tedros Ghebreyesus, triggered the process for emergency use listing for mpox vaccines, which will accelerate vaccine access for lower-income countries which have not yet issued their national regulatory approval.

This emergency use listing would also enable partners including Gavi the Alliance and UNICEF to procure these vaccines for distribution. On Wednesday, the Vaccine Alliance, Gavi and Bavarian Nordic announced an advance purchase agreement to secure 500,000 doses of the MVA-BN mpox vaccine, for it to be supplied to African countries affected by the mpox outbreak.

The MVA-BN vaccine received prequalification from the WHO on September 13, and Bavarian Nordic has expressed its readiness to supply the vaccine pending the signing of the supply agreement with the United Nations Children Fund which will deliver these doses.

The Chief Executive of Gavi, Dr Sania Nishtar, said, “We are committed to working with affected governments and our partners to turn these vaccines into vaccinations as quickly and effectively as possible and, over time, to build a global vaccine stockpile if sufficient funding is secured for Gavi’s work through 2030.”

Unfortunately, the health gains anticipated by the planned distribution of vaccines may be washed ashore by insidious anti-vaccine propaganda that has been spread across African countries.

In Nigeria, several anti-vaxxer videos and messages are being disseminated via messaging platforms like WhatsApp as well as social media pages that have religious leanings.

These anti-science, panic-driven messages are disinformation tools aimed at instilling fears into their audience about “vaccines being used by caucasian eugenics to reduce the African population.”

“I can’t take any vaccine supplied by the WHO,” Glory Edet, a marketer, tells our correspondent. “These vaccines are killing us slowly and I don’t trust anything that comes from these white people. There are videos on the internet of people who took vaccines and have died.”

Corroborating Emordi’s claims, an architect, Innocent Osaze, said, “Any vaccine that is made mandatory for the public is suspect. These vaccines can make men impotent and cause autism in children.

“I have read these things online and they are true. Have you noticed nowadays that people getting married are not having the ‘fruit of the womb’ like years ago? Then look at how people are dying suddenly these days, it’s those vaccines.”

The idea underpinning these outlandish claims is what experts have defined as vaccine hesitancy. According to the European CDC, it refers to “delay in acceptance or refusal of vaccines despite availability of vaccination services.”

Commenting on the scourge, a healthcare provider, Dr Samuel Iyke, pointed out that the bulk of vaccine hesitancy is founded on misinformation and blind obedience to religious authority.

He added that vaccine hesitancy is often based on conspiracy theories which spread to others by fear and uncritical acceptance of half-truths.

“Vaccines are just like medicines founded on research and science. Although all through history, there have been pockets of religious people who rejected medical science for faith healing or mental healing, it has never really fared well in the long run.

“You find more incidents of preventable deaths and disabilities in such circles because they relied on fantasies, wishful thinking and denial instead of reality. The world has evolved scientifically so that when people die suddenly, autopsies can be conducted.

“If a couple are infertile, there can be tests conducted to know what is wrong. For anyone to blame vaccines on that is a demonstration of transmitted ignorance,” Iyke stated.

Vaccines are lifesavers

Data provided by UNICEF revealed that immunisation is one of the most cost-effective public health interventions, averting an estimated 4.4 million deaths yearly.

An analysis published in The Lancet in April 2024 shows that between 1974 and 2024, 40 per cent of the global reduction in infant mortality is attributable to vaccination, with a benefit that goes up to 52 per cent in Africa.

According to the WHO, the measles vaccine alone averted 23 million deaths between 2000 and 2018. The CDC also estimated that about four million deaths worldwide are prevented by childhood vaccination every year.

A study published in 2014, based on the study of routine childhood immunisation programmes in the United States indicated that vaccines protect against 13 diseases and for a single birth cohort, nearly 20 million cases of diseases were prevented, including over 40,000 deaths.

Speaking with Sunday PUNCH, a public health consultant, Solomon Jolaoso, described vaccines as “one of the most proven tools in public health.”

He added, “Vaccines have saved millions of lives globally, including in Africa and Nigeria. Vaccines play a crucial role in curbing that spread because they help your immune system recognise and fight the virus before it can cause harm.

“In fact, studies have demonstrated that the vaccine can reduce the risk of severe disease by up to 85 per cent. Here’s the thing: vaccines don’t just protect the individual who receives them; they also help prevent the spread of disease in the community.

“When enough people are vaccinated, it creates a protective barrier that prevents the virus from spreading easily. This is especially important for people who are more vulnerable to severe illness, like older adults, young children, and those with compromised immune systems.”

Jolaoso described the unfounded claim of vaccines “being unsafe or a tool designed to reduce African populations” as lacking scientific evidence and based purely on conspiracy theories.

He added, “Vaccines are rigorously tested through multiple stages, including trials specifically conducted in African populations, to ensure they’re safe for everyone. It’s also important we look at history: if you remember, during the polio outbreak in Nigeria, there were similar fears.

“But after Nigeria ramped up its polio vaccination campaigns, we saw the disease nearly eradicated in the country. What that tells us is that when vaccines are embraced, they can prevent suffering and save countless lives, rather than harm them.

“We can even look at the success of the smallpox vaccine. It was a global problem, but with widespread vaccination, smallpox was eradicated from the world. The idea that vaccines would be used to harm populations just doesn’t add up when you consider that they’ve been consistently used to stop major health threats like polio, smallpox, and even meningitis in Africa. In the end, vaccines are here to protect us, not harm us.”

Jolaoso called on the government and stakeholders to ensure vaccination against mpox as part of efforts to protect communities, loved ones, children, and the elderly.



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