As an infectious disease specialist in Atlanta, Dr. Boghuma Kabisen Titanji spent much of 2020 on the front lines of the COVID-19 battle in the United States.
When a vaccine arrived in December of that year, he felt some relief. But also, fear.
“I had seen what COVID was capable of doing to people my parents’ age,” Titanji said.
“I was absolutely terrified because from the time I had access to the vaccination until my parents had access to the vaccination, it was eight months.”
In Cameroon, where Titanji is from, his parents didn’t get their first shot of the coronavirus until August 2021. By then, most Canadian and American adults had already gotten over the second shot.
“It was the most nerve-wracking experience living in fear of having COVID,” she said.
Despite pleas from the World Health Organization for rich countries to stop stockpiling COVID vaccines and share them with low-income nations, especially in Africa, global health experts agree that we failed.
Dr. Boghuma Kabisen Titanji, an infectious disease specialist in Atlanta, says there are no vaccines or antiviral drugs available when she has treated monkeypox in her native Cameroon. (Boghuma Kabisen Titanji)
Nor is it surprising to them, because the same unequal distribution of vaccines and treatments has been a pattern for decades.
On July 23, the the WHO declared monkey pox a “public health emergency of international interest” — and doctors fear the same pattern will repeat itself as Canada, the United States and European countries rush to vaccinate at-risk populations.
They are using a vaccine originally made for smallpox, which has been eradicated. In Canada, it’s called Imvamune, and years ago small amounts were stockpiled in case smallpox came back. Imvamune is also approved to vaccinate people against monkeypox.
However, monkeypox has been endemic in several African nations for 50 years. Dozens have died this year alone, Titanji said, but no vaccine has ever been made available except for targeted studies involving health care workers.
When he treated outbreaks of monkeypox in Cameroon, he said there was also no access to antivirals to treat the disease.
“If you diagnose someone with monkeypox [in Africa], provide supportive care. So you basically make the diagnosis and tell them to isolate themselves and, you know, take paracetamol for their fever…and rest and recover.”
Although anyone can become infected through close contact with someone who has smallpox or through personal items such as bedding, in countries outside of Africa the population most at risk right now are men who have sex with men In Africa, it has historically spread mainly through contact with infected animals.
Lack of concern for disease in Africa
If a pandemic on the scale of COVID didn’t prompt a global response that was equitable, Titanji said, she’s skeptical that the response to monkeypox, not to mention future outbreaks of other diseases, will treat Africa differently .
“The problem is that there has been a widespread neglect of health acuity in Africa,” said Dr. Githinji Gitahi, head of Amref Health Africa, a Toronto-based group that works to improve access to health care throughout the continent.
“The view is that as long as the health threats are limited to African communities, it’s okay for the world not to worry.”
WHO has 31 million doses of smallpox vaccines (effective against monkeypox), mostly stored in donor countries & intended as a rapid response to any resurgence of the disease, which was declared eradicated in 1980. Doses have never been released for any outbreak of monkeypox in Africa.
—@daktari1
But if rich countries want to end epidemics that affect their own citizens, it is in their best interest to ensure that low- and middle-income nations have the resources to stop the spread of the disease, Gitahi said.
“Pandemics and disease threats start in a community,” he said. “If you have a community that is not secure, the whole world is not secure in our current connection.”
“This must change not only for monkeypox, but also for other neglected diseases in low-income countries, as the world is once again reminded that health is an interconnected proposition,” said the head of the WHO
What is the solution?
One of the things that must change is the monopoly that rich countries have on vaccines and drugs, including antivirals, African doctors and global health experts said.
During COVID-19, donations through the COVAX vaccine exchange program helped, but they reached African countries too late, Gitahi said. “People died while waiting for vaccines.”
In many cases, the vaccines were unusable because they landed with “very little shelf life remaining.”
Also, by the time they arrived, people who would have previously lined up to get vaccinated had lost both a sense of urgency and trust in the health system, with the perception that they were getting vaccines rejected by rich countries, Gitahi added. .
LISTEN | African doctors say the response to monkeypox is another example of vaccine inequality:
CBC News2:44African doctors say response to monkeypox is another example of vaccine inequality
Health experts say they are skeptical that the world has learned from COVID-19 as wealthy countries grapple with monkeypox outbreaks. (CBC The world this weekend)
The way to level the playing field for low- and middle-income countries, some experts say, is to remove intellectual property protections on essential vaccines and treatments.
Rich countries invest huge amounts of money in vaccine manufacturing companies during emergencies, Titanji said. This gives them the power to condition funding on giving low- and middle-income countries an equal chance to buy them at a fair price, he said.
Dr Mary Stephen, technical officer at the WHO Regional Office in Brazzaville, Republic of Congo, says it is critical to develop Africa’s capacity to manufacture its own vaccines and therapeutics. (Dr. Mary Stephen)
But an even better solution, experts said, is to ensure that Africa is able to mount its own emergency responses to epidemics, rather than being forced to wait for charities and rich nations to act.
“If we want to build a resilient system, there is much, much, much more to do beyond just donating vaccines,” said Dr Mary Stephen, technical officer for the Health Emergencies Program at the WHO Regional Office in Brazzaville, Republic of Congo.
“Imagine if … countries on the continent could produce their own PPE, could produce their own laboratory reagents, their own test kits. [If] they were able to produce vaccines, medicines… it will go a long way,” he said.
An important step in building this self-sufficiency has been the opening of the “MRNA Vaccine Hub for Africa” in Cape Town, South Africa, with the support of the WHO. Scientists there have produced their first batches of COVID-19 mRNA vaccine.
As Africa works towards health self-sufficiency, it is important for the world to remember that the continent has already made significant contributions to global health, Titanji said.
For example, African participants in many clinical trials have enabled the development of HIV/AIDS treatments received by patients in rich countries, he said.
Now that the world is grappling with monkeypox, Africa has decades of knowledge about the virus that rich nations depend on, Titanji said.
“It’s 50 years of research by African scientists, sometimes with incredible challenges to publish that data,” he said of the monkeypox studies, including one on health workers in the Congo that tested the effectiveness of the Imvamune vaccine.
“Now we’re building on that to be able to address outbreaks in non-endemic countries, all the while leaving behind the very people who contributed to this body of knowledge.”