South Africa awaits new batch of mpox treatment and vaccines amid rising cases

Male hands with rash
Mpox is a viral infection that causes a rash, fever, headache, muscle aches, back pain, low energy and swollen glands (lymph nodes). (Shutterstock)
Male hands with rash
Mpox is a viral infection that causes a rash, fever, headache, muscle aches, back pain, low energy and swollen glands (lymph nodes). (Shutterstock)

South Africa is expecting a second batch of the mpox treatment, Tecovirimat, in the next few weeks amid an expected increase in cases as contact-tracing intensifies.    

Mpox is a viral infection that causes a rash, fever, headache, muscle aches, back pain, low energy and swollen glands (lymph nodes). But the disease is preventable and treatment is available for mild and severe cases.  

Tecovirimat is reserved for people with severe complications of mpox, while vaccination against mpox is only recommended for those at risk of the disease. 

Speaking at a World Health Organisation webinar last week Dr Shanal Nair, a public health medicine registrar at Steve Biko Academic Hospital, says one mpox vaccination is only recommended for people at risk of mpox. 

These include health workers at risk of exposure, men who have sex with men, and people with multiple sex partners and sex workers. 

“There are two vaccines that may be used for prevention of mpox which are Jynneos vaccine which is approved and recommended for the prevention of mpox and smallpox. The second one is ACAM2000 vaccine approved for immunisation against smallpox and could be made available for use against mpox under an Expanded Access Investigational New Drug protocol,”she says. 

Like Tecovirimat, the vaccines aren’t registered in South Africa but the National Advisory Group on Immunisation is working on recommendation to the national health department to consider the vaccine for pre and post exposure administration for high risk groups.

“In technical terms in public health we call it ring vaccination when we try to vaccinate the potential  contacts and a network of potential transmission. This decreases risk behaviour. The WHO guidelines are clear that the mpox vaccine can prevent infections and it should be given within four days for someone with mpox or within 14 days for the contact of the person who did not develop symptoms,” Professor Tulio de Oliveira, director of the Centre for Epidemic Response and Innovation (CERI) at Stellenbosch University told Health-e News earlier.  

Currently the country has 20 confirmed cases and three deaths since the outbreak started in May.

Vaccine inequity

The national health department announced two weeks back that it is trying to source vaccines from World Health Organisation (WHO) member countries who have stockpiles that exceed their needs as well as from GAVI. 

This raises the question of vaccine inequity that was so glaring during COVID when rich well-resourced countries stockpiled enough vaccines to inoculate their populations several times over while people in developing countries went without a single dose. 

“Ensuring that vaccines are distributed fairly and equitably is crucial for global health security,” says Dr Duduzile Ndwandwe, a vaccinologist from Cochrane South Africa at the South African Medical Research Council.

“Unequal access can lead to ongoing outbreaks and allow viruses to mutate, potentially undermining global efforts to control them. Disparities in vaccine access can prolong the economic fallout of pandemics while equitable distribution helps stabilise global economies and promote recovery.”  

She says vaccine inequity can lead to unrest and exacerbate existing inequalities, whereas equitable distribution fosters social cohesion and trust in the public health systems. 

“Addressing these issues and ensuring vaccine equity also prepares us better for future pandemics as lessons learned from current inequities can inform more effective and fair management of global health threats,” she says. 

Ndwandwe says the stockpiling of vaccines by rich countries during COVID-19 highlighted several key lessons. It underscored the need for global cooperation to ensure equitable vaccine distribution as stockpiling led to shortages in lower-income countries, exacerbating health disparities. 

South Africa is currently taking part in the pandemic treaty global agreement negotiations towards strengthening pandemic prevention, preparedness and response. 

“Building robust health systems worldwide, including investing in healthcare infrastructure, workforce and supply chains is essential for managing pandemics effectively. Transparent supply chains and clear communication about vaccine availability and allocation can prevent inequities and foster trust between countries,” she says. 

She says ethical decision-making in public health, prioritising equitable access to vaccines should be guided by principles of fairness and global solidarity. 

The issue of vaccines is a double-edged sword in South Africa. As important as it is to secure a supply of vaccines, measures must be taken to ensure that people will actually get vaccinated. During the country’s COVID vaccine roll-out, vaccine hesitancy reared its head, fuelled by misinformation and scepticism about their safety and efficacy.

“Some communities still exhibit hesitancy due to misinformation and fears about potential side effects. Measures to tackle these issues revolve around educating the public and providing transparent communication about vaccine safety and effectiveness,” says Ndwande. 

She says a comprehensive strategy should be put in place to increase vaccination rates in South Africa. 

“This strategy should include public education campaigns to provide accurate information and address misinformation as well as deployment of mobile clinics to reach remote and underserved areas making vaccines more accessible. Transparent communication about vaccine availability, identifying and addressing logistical, cultural and economic barriers can help overcome obstacles to vaccination.” 

Ndwandwe says public education campaigns must disseminate accurate vaccine benefits and safety information while actively debunking myths. 

“Engaging trusted community leaders, religious figures and influencers can leverage existing networks to promote vaccination.  Also partnering with businesses to provide workplace vaccinations and extending vaccination hours with more sites in accessible locations like malls and schools can enhance access,” she says.  – Health-e News

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