Mpox spread in SA a cause for concern

Disease outbreak and pandemic unpreparedness is the bane of creaking global health systems irrespective of their economic status.

The ‘once-in-a-century’ Covid-19 pandemic which hit the world in March 2020, brutally exposed the inadequacies of public and private health systems, although in a twisted way it unleashed human ingenuity in developing a vaccine in a record one year, instead of the normal decade or so gestation of bringing a major drug to the market.

Vaccine deniers and sceptics apart, ideological hubris, bureaucratic complacency and policy drag are not options.

South Africa, for instance, is amid a wave of community transmission of mpox following its reporting to the World Health Organization (WHO) a few days ago of 20 confirmed cases between 8 May and 2 July 2024, including three deaths (with a case fatality ratio (CFR) of 15%), largely concentrated in Gauteng and KwaZulu-Natal.

“The sudden appearance of unlinked cases of mpox in South Africa without a history of international travel, the high HIV prevalence among confirmed cases, and the high case fatality ratio suggest that community transmission is under way, and the cases detected to date represent a small proportion of all mpox cases that might be occurring in the community,” according to the WHO in a disease outbreak notice.

The reality is the authorities do not know how long the virus may have been circulating. This, says the WHO, may in part be due to the lack of early clinical recognition of an infection with which South Africa previously had little experience during the ongoing global outbreak, potential pauci-symptomatic manifestation (presenting few symptoms) of the disease, or delays in care-seeking due to limited access to care or fear of stigma.

The tragedy is that vaccination as an effective disease control and viral transmission mitigator is a proven tool in the fight against a range of pathogens.

A new WHO/Europe retrospective surveillance study published in The Lancet Respiratory Medicine journal early this month showed that “from the time of their introduction in December 2020 through to March 2023, when the Omicron variant was dominant, Covid-19 vaccines reduced deaths due to the pandemic by at least 59%, saving more than 1.6 million lives in the WHO European Region.”

This means that had the WHO Europe region not resorted to the use of vaccines, the Covid-19 death toll could have been 4 million instead of the actual 2.4 million. Most of those saved were aged 60 or older, the group at highest risk of severe illness and death from Sars-CoV-2.

This latest mpox outbreak in South Africa is inextricably linked to the country’s high HIV/AIDS prevalence, including about 30% of same-sex (male) transmission, of whom only 44% are on antiretroviral therapy. This makes this group extremely vulnerable to severe mpox disease and death.

There is also a hazard to health workers if they are not appropriately using PPE when caring for patients with mpox. The WHO is concerned about the “extremely high (15%)” CFR among cases reported in South Africa in 2024, as most detected cases are among persons who are immunocompromised with uncontrolled HIV and other co-morbidities.

Vaccination with the two available mpox vaccines has been shown to be effective. But WHO remains concerned that the mpox outbreak in South Africa will continue to evolve, given the high likelihood of under-detection and under-reporting of local transmission, given that reported cases have to date almost exclusively affected the most vulnerable and have presented with severe disease and extensive skin lesions, which could lead to more viral transmission and risk poor outcomes for the patients.

In this respect, WHO’s invitation to mpox vaccine manufacturers to submit an Expression of Interest for Emergency Use Listing, assumes much greater importance given the worrying trends in the disease’s spread including in Africa.

* Parker is an economist and writer based in London

Cape Times