The latest outbreak of mpox virus is exposing once again global vulnerability to new pandemics. This outbreak had been largely ignored by politicians and media in wealthy countries when it remained confined to Africa. Since 2022, 40 874 cases and 1,512 deaths have been reported across fifteen African states.
An upsurge of mpox cases is taking place in the Democratic Republic of Congo (DRC). During the first six months of 2024 over 15,000 cases and 500 deaths occurred – more than all 2023. Instead of mobilising resources to control this outbreak and prevent it spreading, very little was done.
On 15 August, after the first case was reported in Sweden, the World Health Organisation declared a “Public Health Emergency of International Concern”. Only then did widespread reports in the international media appear.
2022 outbreak
Mpox is not a new virus. Discovered in 1958, the first human case was identified in 1970. Formerly known as monkeypox, the name was changed as monkeys were not the host animal or usual source of infection. Some right-wing publications, like the Spectator magazine, still call it monkeypox, with underlying racist connotations, just as Trump called Covid-19 “a Chinese virus”.
An earlier global outbreak took place in 2022, starting in Nigeria, spreading across West Africa, the USA (where 30,000 cases were reported) and other countries. 87,000 cases were recorded in total, but many more were likely to have occurred. After ten months, new reported cases fell.
New York City declared an end to the mpox outbreak in February 2023, when transmission remained very low in the city for two consecutive months. 100,000 New Yorkers were vaccinated, over 155,000 doses administered and a community education programme introduced.
However, Professor Dimie Ogoina, president of the Nigerian Infectious Diseases Society, warned in 2023, “I think this is a false decline. I believe that in Nigeria and many other African countries we have continuous transmission. We’re just seeing the tip of the iceberg.”
New outbreak
Now a new mpox variant, clade 1b, is spreading from DRC, with cases reported in neighbouring Burundi, Kenya, Rwanda and Uganda since July. Burundi has identified 100 new cases, 28 being young children. Argentina quarantined a ship on 20 August after a crew member became ill, although he subsequently tested negative.
Close physical contact can lead to transmission. Children in overcrowded homes are especially vulnerable. The death rate of infected under one year-olds is 8.6%, compared to 2.4% in over 15 year-olds. As with HIV, sex workers and their clients are particularly vulnerable to infection.
After the rigged election in December 2023, civil war in the DRC eastern region has flared up (see here). Half a million refugees and injured people have fled their homes to squalid camps around Goma, near the Rwandan border. It is in this region that new mpox cases have surged.
Health services are at the point of collapse, after past outbreaks of Ebola and Covid-19, long-standing diseases like malaria and TB, lack of staff and medical supplies. In some health centres patient intake is 4,000% higher than their capacity.
Vaccines and treatments
Unlike Covid-19, mpox vaccines and treatments already exist. The problem is they aren’t available where desperately needed now. The preferred vaccine is made by Danish company, Bavarian Nordic. Development was subsidised by large US government contracts. It says it can supply ten million doses by the end of 2025, with two million by the end of the year. While children and health workers suffer, shareholders profited as the share price rose more than 40% between 11-16th August.
In the meanwhile, there are plentiful alternative vaccines. US multinational Emergent BioSolutions’ smallpox vaccine ACAM2000 is in national stockpiles around the world. It is kept for national security in case the now-eradicated smallpox virus somehow resurfaces, or is deployed as a biological weapon. It has a higher risk of potentially serious side-effects, but in the short-term could help save many lives. It’s share price also shot up 40% in four days.
Japan’s government has a large stock of vaccine, manufactured by KM Biologics. But despite the corporation’s “mission of making the world a healthier place through the unlimited possibilities of biotechnology” the vaccine is not available commercially.
Russia also has a vaccine, developed by the Vector institute, historic home of the Soviet Union’s biological weapons programme and host to one of two globally authorised smallpox repositories (the other being the US government’s).
These stockpiles could be quickly mobilised for those at highest risk in central and east Africa, along with the money needed to provide the health workers, refrigeration, logistics and transport to deliver them. Capitalist national interests and profit-seeking corporations’ business interests prevent this.
The same situation exists for treatments. The antiviral drug tecovirimat (TPOXX) is licensed for use and made by US corporation SIGA. In July 2024, SIGA received a $138 million order from the U.S. Government for delivery to the U.S. Strategic National Stockpile. On 21 August there were 1,200 ‘call options’ to buy its shares, compared to 78 on an average day. Profit-hunters can smell an opportunity to make a fortune.
However, a new study in DRC showed those with mpox who took the drug did not recover more quickly than those given placebo. 1.7% died, regardless of whether they received the drug or not. But this was much lower than the 3.6% death rate reported among all cases in the DRC. Fewer people with mpox die if hospitalised and provided high-quality supportive care.
Three in four Congolese people live on under $2.15 a day, making it one of the world’s five poorest countries. Average health expenditure per head was $25 in 2021 (latest figures). Buying vaccines, treatments and providing decent health services can’t be done while DRC’s vast mineral wealth is stripped out by big business and multinationals, corrupt politicians and warlords – or while the global pharmaceutical industry seeks vast profits.
A health threat anywhere can rapidly become a health threat everywhere. International socialist action with public ownership, democratic workers’ control and democratic planning to meet need instead of profit, is the only way this can be prevented.
