Mpox has been endemic in parts of Africa for years bit only came to global attention during an outbreak in the US and Europe in 2022-2023. Sporadic outbreaks continue in the US and Europe, but vaccination and information campaigns have been successful in bringing numbers down. The story on the African continent is different. The Mpox Research Consortium, an group of African and global researchers have a call to action for the African mpox crisis in The Lancet Global Health (UK).
 
They write, “The increasing burden of endemic African mpox, geographic expansion into previously unaffected areas, novel transmission via sexual contact, rising case fatality rates in rural areas, and transmission in urban areas raise serious health concerns, but African researchers still struggle to obtain funding to study this disease….We have proposed the establishment of an African-led, multidisciplinary, multicountry Mpox Research Consortium (MpoxReC) in Africa with an overarching goal of establishing a research network to advance the elimination of mpox as a public health problem….
 
MpoxReC will integrate basic research; clinical studies; disease surveillance; risk communication; community engagement; phylogeographic, ecological, and anthropologic studies; novel studies for use of medical countermeasures; and capacity building to address mpox epidemics and ultimately eliminate its human-to-human transmission.”
 
This call comes as South Africa identified a mpox case in a man who had not traveled to an area where the disease is endemic according to IOL (South Africa) and a preprint study identifies the likely source of an outbreak in DRC. As CIDRAP reports, “Researchers examined the demographic and clinical characteristics of 371 patients with suspected mpox infections who were admitted to the hospital between September 2023 and April 2024. Slightly more than half were women, and cases were reported from 15 health areas…. Data revealed that 88.4% had recently visited bars for professional sexual interactions, which researchers said was the likely source of infection.”

If You're in a Hurry

• Listen to the Inside Geneva Podcast for what’s happening with pandemic accord negations and read more in Health Policy Watch. (Spoiler alert: it’s not looking good.)
• Then read a viewpoint in Lancet Global Health on how the treaty is not addressing racism and colonialism in global health.
• Read a call to action on the avian flu outbreak in the US in Think Global Health.
• Read The Standard on a call from Kenyan civil society to address childhood vaccine shortages in the country.
• Read a new study in Nature Scientific Reports on causes of vaccine hesitancy in six African countries.

Will There Be a Pandemic Accord?

On the Inside Geneva Podcast (Switzerland), asks, “Countries are gathering in Geneva to try to hammer out a pandemic treaty. Do they have the vision? And the courage?” Kerry Cullinan, deputy editor of Health Policy Watch, says, “There’s been so much lip service paid to equity, but when it actually comes to nailing down what that means, and how to avoid a repeat, it seems like governments are struggling… “I think it would be an insult to the seven million people plus who died during the pandemic for there not to be a historic agreement.”
 
Health Policy Watch (Switzerland) reports the WHO’s “Intergovernmental Negotiating Body (INB) failed to reach consensus on a pandemic agreement by Friday (10 May)… But the exhausted INB delegates have resolved to solider on with talks right up to the eve of the [World Health Assembly], which begins on 27 May…. Whatever happens in the next two weeks, the INB is obliged to report an outcome at the WHA, including sharing the latest draft of the agreement so far, including all of the bracketed, green and yellow text, WHO’s legal department has reportedly told delegates on Friday. The INB will also recommend a way forward on final negotiations, with the WHA making the final decision.”
 
The Star (Kenya) reports, “Some Kenyan groups have rejected the proposed global pandemic treaty, saying it allows rich countries to behave as they did during Covid-19 when they hoarded vaccines…. Timothy Wafula, programme manager at the Kenya Legal & Ethical Issues Network on HIV and Aids (Kelin) said the proposal lacks tangible provisions for monitoring and compliance, perpetuating past failures in global health security. ‘Equity will not be operationalised without effective mechanisms for accountability and enforcement,’ he said. The civil society groups said they were marginalised in the decision-making processes.”
 
Conservative politicians in wealthy countries are increasingly voicing opposition to the treaty, often not connected to facts. AP (US) reports, “U.S. Republican senators wrote a letter to the Biden administration last week critical of the draft for focusing on issues like ‘shredding intellectual property rights’ and ‘supercharging the WHO.’ They urged Biden not to sign off. Britain’s department of health said it would only agree to an accord if it was ‘firmly in the UK national interest and respects national sovereignty.’”
 
A viewpoint in Lancet Global Health (UK) argues, “The negotiations for the WHO Pandemic Agreement have brought attention to issues of racism and colonialism in global health. Although the agreement aims to promote global solidarity, it fails to address these deeply embedded problems. This viewpoint argues that not including the principle of subsidiarity into Article 4 of the agreement as a pragmatic strategy was a missed opportunity to decolonise global health governance and promote global solidarity. Subsidiarity, as a structural principle, empowers local units to make decisions and address issues at their level, fostering collaboration, coordination, and cooperation. By integrating subsidiarity, the agreement could have ensured contextually appropriate responses, empowered local communities, and achieved justice in global health.”
 
Vox (US) reports, “at the same time they are demanding One Health investments, those rich nations are balking at a proposal that would help the world identify and fight potentially dangerous pathogens…. Some experts have noted the irony of the US and Europe insisting on unfettered access to pathogens from low-income countries at the same time the US government is facing criticism for being slow to share data about H5N1. ‘The situation with avian influenza across the United States exemplifies the inherent hypocrisy and vested economic interests around Pandemic Prevention, Preparedness, and Response,’ Dr. Christian Walzer, executive director of health at the Wildlife Conservation Society, said in a statement. ‘While the Global North is demanding transparent and rapid access to pathogen data from the Global South … it seems unwilling to share such information with the world.’”

Report Details Failures in Polio Vaccine Policy
 
Science (US) reports on a new draft report that says the decision in 2016 to switch the oral polio vaccine to one that did not include the eradicated type 2 polio, since the only type 2 polio cases were vaccine derived cases. “But ‘the switch,’ as this global move has become known, became “an unqualified failure,” according to an unusually blunt draft report commissioned by the Global Polio Eradication Initiative (GPEI) that is now open for public comments. Unexpectedly, vaccine-derived poliovirus type 2 has continued to circulate after the switch, paralyzing more than 3300 children. And GPEI has spent more than $1.8 billion trying to quash these outbreaks, mostly in Africa. Those numbers are certain to increase until the polio program finds a way to deal with the problem it inadvertently—and with the best of intentions—created…. The authors end with an unusual epilogue for a technical report, saying there’s a ‘moral imperative’ for the partners in GPEI to provide more rehabilitation and education to the thousands of children who have been paralyzed by vaccine-derived polio-virus type 2.”

Avian Flu in Dairy Cattle in the US
 
Nature (UK) reports, “there’s no sign that the outbreak [of avian flu in US] cows is over, and scientists are increasingly concerned that cattle will become a permanent reservoir for this adaptable virus—giving it more chances to mutate and jump to humans. New data show that the virus can hop back and forth between cows and birds, a trait that could allow it to spread across wide geographical regions. Although the virus kills many types of mammal, most infected cows don’t develop severe symptoms or die, meaning that no one knows whether an animal is infected without testing it. Moreover, a single cow can host several types of flu virus, which could, over time, swap genetic material to generate a strain that can more readily infect humans.
 
CIDRAP (US) reports, “The Centers for Disease Control and Prevention (CDC) today unveiled a new influenza A wastewater tracker, part of its surveillance for H5N1 avian influenza, as three states reported more detections in dairy herds. With the strong possibility that dairy cows can be spreading H5N1 asymptomatically and because testing in dairy herds has been spotty with delays in reporting, virologists and public health officials are looking at other ways—including wastewater testing—to gain better visibility on where H5N1 might be spreading.” STAT (US) reports, “Wastewater monitoring, at least at this stage, cannot discern the sources—be they from dairy cattle, run-off from dairy processors, or human infections—of any viral genetic fragments found in sewage, although the agency is working on having more capability to do so in the future.”
 
A group of researchers writing in Think Global Health (US) write, “Should this influenza virus adapt to human transmission—a possibility that continued mammalian transmission will test again and again—the consequences will play out on both global and domestic stages even as One Health components of the pandemic accord negotiations look likely to be pushed to future deliberations. The pivot point is now—or a month ago. Indeed, calls for aggressively increased surveillance in animals since early 2022 have gone unheeded, creating blind spots that may be fueling the current situation…. Even if this outbreak is contained, the prevention, detection, and response efforts needed are exactly the dress rehearsal the United States requires to be prepared to answer a future zoonotic global pandemic threat that emerges on its own soil. The USDA must do its part but cannot on its own handle this large-scale event that cuts across diverse sectors. Federal regulators need to pick up the pace, expand the scope of active surveillance and response—and take this threat more seriously.”

COVID Border Closures and HIV
 
CIDRAP (US) reports, “Closing the border separating San Diego and Tijuana, Mexico, during the COVID-19 pandemic didn't stop drug tourism and may have increased the spread of HIV, concludes a study posted in The Lancet Regional Health Americas…. In effect, the border closure was a structural risk factor for harm, [study author Britt] Skaathun said: ‘The Frontera [border region] is one integrated community that is not defined by place of residence. Efforts to end the HIV epidemic in the US also need to be integrated by extending to Tijuana.’ The study authors said COVID-19 mitigation measures such as border closures may have resulted in diminished access to services and an oversupply of drugs in Tijuana, leading to the disruption of drug-treatment and syringe-service programs on both sides of the border. Read the study.

Shortage of Childhood Vaccines in Kenya
 
The Standard (Kenya) reports, “health advocates under the umbrella of Health NGO Network (HENNET) and other health Civil Society Organisations—including Stop TB Partnership Kenya, [have] raised concern over the vaccine shortage. In the letter by the Executive Director of Hennet, Dr Margaret Lubale said vaccine shortages and stockouts are alarming. ‘There have been alarming reports of vaccine stock-outs and shortage of some routine immunisation antigens such as BCG, Rota and Oral Polio Vaccine and measles in various health facilities,’ notes the letter. The vaccine stockout according to the health stakeholders may result in the spread of measles that has been reported in Garissa. As a preventive measure, the stakeholders want the ministry to expedite the procurement and distribution of measles vaccines to replenish depleted stocks and ensure uninterrupted vaccination programmes.”

COVID Vaccines and Heart Failure
 
CIDRAP (US) reports, “The first study of COVID-19 vaccine effectiveness in a large population of adult heart-failure patients suggests that vaccinated participants are 82% more likely to live longer than their unvaccinated peers, according to an analysis presented over the weekend at the Heart Failure 2024 scientific congress of the European Society of Cardiology (ESC) in Lisbon, Portugal…. Relative to one or no vaccination, COVID-19 vaccination was tied to an 82% lower risk of death from any cause, a 47% lower risk of hospitalization for heart failure, and a 13% reduced risk of infection over 6 months. Vaccination was also linked to significantly lower risks of stroke, heart attack, myocarditis/pericarditis, and venous thromboembolism.” Read a press release about the study.

Vaccine Trust in Six African Countries
 
A new study in Nature Scientific Reports (UK) looks at “vaccine hesitancy for recently available vaccines related to polio and HPV which we benchmark against a COVID-19 vaccine. Leveraging unique primary data on 5203 individuals from six countries (Ghana, Kenya, Nigeria, South Africa, Tanzania, and Uganda), [study authors] showed that individuals’ trust in the government and society are key predictors of vaccine hesitancy. Furthermore, we demonstrated that these relationships are remarkably stable across vaccine, disease, and country contexts…. Leveraging primary data from six SSA countries, our analysis showed that low levels of trust in the government go along with a higher likelihood of vaccine hesitancy. Our results also emphasized the role of societal trust and social norms in the decision to get vaccinated. Specifically, we found that individuals are more likely to get vaccinated if (they believed that) others do so. Lastly, we found empirical evidence for a lack of trust in pharmaceutical companies to influence vaccine hesitancy.”