Mpox outbreak: How WHO 'vaccine apartheid' deepens Global North and South divide

It's no surprise that nearly two years after the World Health Organization (WHO) triumphantly declared the end of Mpox — formerly known as monkeypox — as a global public health emergency, we find ourselves in a worse position today.

Once again, the WHO has done the bare minimum. Instead of challenging how the world’s media and public health officials frame and categorise Mpox, the WHO has maintained the stigma of Africans as vectors of diseases, despite transmission and reporting now being global. 

And contrary to the public health brainiacs in Geneva, changing the name of the disease from monkeypox to Mpox has not brought about increased awareness or meaningful change. 

What does this say about the WHO and, by extension, the field of global health, that nothing has changed after two years? It seems that the WHO is failing the world, particularly Africans, once again.

The surge of Mpox cases in the Democratic Republic of Congo (DRC) has not only raised concerns of yet another global outbreak — with nearly 15,000 suspected cases and 581 estimated deaths alone — but is a glaring reminder that the global health community wilfully ignores the warnings and science coming from African nations. 

The story of Mpox did not end in May 2023, as the WHO thought. Rather, Mpox has been a decades-long struggle in African countries where the disease has been endemic. This is not a coincidence. 

In the last few weeks, Mpox has been detected in other countries. More than 50 cases have been confirmed in African countries that haven’t had cases before: Burundi, Kenya, Rwanda, and Uganda. As of June 2024, there were 175 cases reported across South, North and Central America; 100 cases reported in Europe, and 11 cases reported in Southeast Asian countries, according to the rolling situation report published by the WHO. 

Yet the media continues to push Mpox as being solely present across Africa, even though in the UK there are more confirmed Mpox cases in 2024 than in 53 of 54 African countries.

Mpox: Haves and have-nots

Whereas Mpox can be attributed to various modes of transmission, such as sexual and airborne transmission, the underlying cause for the re-emergence of Mpox as a global public health emergency is the vaccine apartheid between the Global North and the Global South.

In 2022, during the last outbreak, WHO member states pledged more than 31 million smallpox vaccine doses. However, relatively few were distributed to African countries. While vaccine doses were rapidly disseminated in the US and Europe in 2022, they have only started to trickle into African countries today.

Nigeria has just received 10,000 vaccines donated from the US government this month, becoming the first African nation to do so in 2024. Meanwhile, African researchers, scientists, and public health officials warned the world about the potential for the virus to spread more widely and rapidly, but their warnings have fallen on deaf ears. 

Mpox has been endemic in twelve central and western African countries, including Cameroon, the Central African Republic, the DRC, and Nigeria, for years now. 

The World Health Organization (WHO) has not taken any action to ensure vaccinations for those who need them the most. 

The lack of attention and resources provided for the procurement or manufacturing capacity of vaccinations in the worst-affected countries demonstrates the lack of commitment to international agreements made during the peak of the COVID-19 pandemic, such as the unsigned Pandemic Treaty.

If vaccines were made available to African nations as early as possible, we would not find ourselves in this position again. However, racism in global public health helps maintain the status quo, even if it means disregarding what is right for our health priorities and our commitment to achieving health equity.

During the last Mpox outbreak in 2022, 95% of cases were between sex workers, and gay and bisexual men through sexual transmission or close contact with another infected person. Addressing the outbreak was targeted which allowed vaccinations to be prioritised amongst this demographic and proved to be effective. 

Predictably, however, the international response mainly consisted of countries in the Global North, who scrambled to suppress the outbreak within their borders. 

This meant that viral surveillance among African nations that had experienced a steady rise in Mpox cases over the last 40 years was soon deprioritised, allowing for mutations of Mpox to occur and the emergence of a more dangerous undetected strain.  

Mpox exists in two main subtypes, Clade 1 and Clade 2. Of the two main subtypes, Clade 1 is deadlier amongst demographics with developing and weaker/weakened immune systems such as children under the age of 5, pregnant, people with comorbidities and immunocompromised people. At present, this is the strain behind the rapid transmission of the current Mpox outbreak and is a serious cause for concern. The 2022 global outbreak was dominated by Clade 2, which had a mortality rate of less than 1 percent, but this new strain has a mortality of close to 10 percent. 

However, African nations are trying to fight back. Instead of waiting for the WHO’s re-declaration of Mpox as a global public health emergency, the Africa Centre for Disease Control and Prevention (CDC) declared the spread of Mpox a year ago. They are taking back their autonomy by building an intranational surveillance network to avoid being overlooked, abandoned and forced to rely on the performative ‘vaccine donations’ of Western nations. 

But the ugly truth is that most scholars of disease from the Global North want to keep the Global North/South binary. Despite transmission being faster, deadlier, and confirmed to be airborne, the majority of public health scholars in the Global North continue to downplay the potential of Mpox to cause a pandemic.

The pattern that typically follows an outbreak like this is predictable. Instead of addressing the underlying issues, health and global organisations throw money at the problem and hope it goes away. 

For instance, the African Union recently released $10.4 million in response to the outbreak, and the WHO promised $1.45 million in emergency funds, with more to come. However, simply providing funds without addressing the root causes won’t even scratch the surface. It's crucial to prioritise the protection of vulnerable groups such as children, African communities, sex workers, and LGBTQ+ individuals, as well as health workers, to prevent further spread of the disease.

Addressing the root causes of Mpox will mean that global health bodies will also have to reckon with the ongoing genocide in the DRC — which causes Mpox to fester and spread — something they are unwilling to do.

If organisations like the WHO fail to apply pressure and hold their member states accountable, they risk becoming obsolete if we are serious about improving global health. We cannot wait for the Global North to selfishly control and gatekeep access to health solutions, especially as we face multiple global health crises. It is important to take action outside of these organisations now, or we risk losing the loose international solidarities that currently hold global public health by a thread.

Beauty Dhlamini is a Tribune columnist. She is a global health scholar with a focus on health inequalities and co-hosts the podcast Mind the Health Gap.

Follow her on Twitter: @BeautyDhlamini

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Opinions expressed in this article remain those of the author and do not necessarily represent those of The New Arab, its editorial board or staff.