Why it's so difficult to get mpox vaccines to areas facing an outbreak

The Democratic Republic of Congo received its first delivery of mpox vaccines. It comes nearly a month after the World Health Organization declared the outbreak a public health emergency of international concern. Mpox has infected an estimated 18,000 people and killed more than 600 in the DRC alone. William Brangham discussed the outbreak and response with Lawrence Gostin of Georgetown University.

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Geoff Bennett: The Democratic Republic of Congo finally received its first delivery of vaccines for mpox today, but it comes nearly a month after the World Health Organization declared the outbreak a public health emergency of international concern.

William Brangham has more in the outbreak and the response.

William Brangham: The WHO has finally changed its approach, so that those mpox vaccines can be delivered and administered in Congo and across Africa.

But those countries say the WHO has been too slow. The DRC first asked for vaccines two years ago amid a different outbreak. Mpox has infected an estimated 18,000 people and killed more than 600 in the DRC alone.

Joining me to discuss the challenges of getting care there is Lawrence Gostin. He’s professor of global health law at Georgetown University.

Larry, great to have you back on the show.

Lawrence Gostin, Georgetown University: Really happy to be with you, William.

William Brangham: Help us understand why this has all taken so long.

Lawrence Gostin: Yes.

Well, let’s just begin by just looking at a map. You see, on one map in Central Africa are all of the deaths, the suffering, the cases. Another map is where the vaccines are. That’s in Japan, Europe, and the United States. And a lot of it is just pure greed. A lot of it is pure complacency.

And then the other is that they really — even when the United States wanted to donate vaccines, they wouldn’t take them because, even though the U.S. FDA had approved them, they weren’t approved at WHO or in the DRC.

William Brangham: So, greed. Is there also some level of just a bureaucracy at work here that’s complicating matters?

Lawrence Gostin: I think greed and complacency and bureaucracy would pretty much sum it up, yes, I think a lot of bureaucracy.

I mean, the main stumbling block is, is that the World Health Organization didn’t give the vaccine emergency use listing, even though it was being…

William Brangham: Which would have freed it up.

Lawrence Gostin: Which would have freed it up. It would allow UNICEF and Gavi, the vaccine organizations, to actually deliver it and deliver it at speed.

You still need the donations though, because Africa can’t make its own vaccine. And so Bavarian Nordic, a Danish company, has been charging a lot of money for it, making it unaffordable. The United States, even to this day after the global emergency, has only delivered 10,000 doses to Nigeria. It’s promised 50,000 to the Congo, which should be delivered on Saturday.

But that pales in comparison to the 10 million that the Africa CDC say they need, and they need it urgently.

William Brangham: Right.

How confident are you that that continued enormous flow will actually happen?

Lawrence Gostin: If history is any gauge, it’ll be too little and too late, because, whenever we wait for vaccines, what Africa knows is that it never arrives on time and that it’s insufficient quantity.

So I think, eventually, it will. Maybe by the end of the year, we will figure this out. But we will have so many preventable deaths. With these vaccines, you can actually prevent the deaths, prevent the outbreak, and you can prevent it from coming to the United States, to Europe, and to other high-income countries. It’s a win-win for everybody. Why don’t we get our act together?

William Brangham: If somebody didn’t know when they had just switched on this conversation, and they might think we were talking about COVID.

Lawrence Gostin: It’s exactly what happens. And it happens with almost every global health emergency.

We had the opportunity to deliver the vaccines a long time ago. We wait, we prevaricate, we have bureaucracy, and then you have enormous vaccine inequities. And working with WHO and Africa CDC and the U.S. government at the White House, I can’t even express how much distrust and anger there is in Africa over this whole thing since COVID and now with mpox.

William Brangham: The DRC and other countries are starting to get some of these vaccines. What do we know about their health infrastructure and their ability to deliver them and get people this protection?

Lawrence Gostin: It’s a great question. I mean, it’s weak.

So what we need to do is not just deliver the doses of vaccines. We need trained health workers. We need testing, because the number of cases and deaths that you mentioned, William, are really just the tip of the iceberg, because we’re not testing. We’re not doing surveillance. We don’t have labs. We don’t have health workers. We don’t have vaccinators.

And so it’s really top to bottom. We need to have kind of a health infrastructure that can deliver these vaccines. And the vaccines need to get there on time and into people’s arms.

William Brangham: So what can we, meaning the global north, the wealthier nations of the world, do to make this move faster?

Lawrence Gostin: Well, I think there are several things, very, very clear.

First, let’s get the vaccines to where they’re needed now. Let’s invest in a real surge investment in the health infrastructure, the health system, the health workers, to actually get those vaccines delivered and protecting people.

And, ultimately, we’re going to need to have Africa be self-reliant. They don’t want to wait for charity. They want to be able to manufacture and deliver the vaccines themselves with strong health systems. We can do this if we only had the political will.

William Brangham: Larry Gostin, Georgetown University, always great to talk to you. Thank you.

Lawrence Gostin: Thank you, William.