Critical lessons from COVID-19 for dealing with mpox

With the spread of mpox in several African countries, as well as in Europe and other parts of the world, the World Health Organization has declared a global emergency. The wisdom behind making this decision at this stage of spread of the highly contagious and potentially fatal disease will only be known with the benefit of hindsight.
Like the virus that causes COVID-19, mpox, formerly known as monkeypox, is spread mainly by very close direct human-to-human contact. It can also be spread by contact with animals or their droppings or by eating undercooked contaminated meat, the so-called bushmeat. Among animals, mpox is found mainly among rodents and nonhuman primates.
Though the disease was endemic in Central Africa, it had remained under control. But a waning immunity to smallpox, with which mpox shares numerous characteristics, is one possible reason for the increase in the number of cases, leading to the WHO sounding the alarm.
However, the European Centre for Disease Prevention and Control has estimated the risk of a global outbreak of mpox as currently being low. It is highly likely that, this time around, the WHO, which was harshly criticized for being too slow in recognizing the threat posed by COVID-19 nearly five years ago, has taken the approach of being better safe than sorry.
But COVID-19 offers a number of lessons and it is imperative that the WHO and governments and businesses around the world remember the countless missteps made during that pandemic and avoid repeating them, even if there is internal or external pressure on them to take some measures.
Even though it is still very early days in terms of the emergence of mpox as a potential global threat, the similarities with the way the problem is emerging and the position in which the world, or at least some parts of the world, finds itself are uncannily like during COVID-19. And hence it is vital that governments and other stakeholders do not forget the lessons learned from the pandemic.
The first is to ensure the availability of medicines, especially vaccines, that are key in controlling the spread of the disease. Though mpox vaccines have been available for many years, they are beyond the reach of almost every African government, at least on the scale of mass inoculations like those carried out during the COVID-19 pandemic.
Getting vaccinated is not cheap, with jabs costing $100 each and two being required to make the vaccine totally effective. According to recent estimates, at this price, Africa would need to invest upwards of $4 billion to purchase the vaccines and to vaccinate the most vulnerable.
Even assuming that African nations are able to find the money needed to purchase the vaccines and administer them, they would then run into another problem: availability of the vaccine. Currently only one company has production capacity of any significance and even that company, Nordic A/S, says that it will not be able to meet the immunization needs of African countries until a year after their orders have been placed.

Big Pharma firms ought to be pressured to sell mpox vaccines at cost price and share their intellectual property rights.

Ranvir S. Nayar

So, this is a deja vu scenario from the COVID-19 pandemic, when the vaccines were at first not available and, even when they were tested and orders placed, the capacity to produce and distribute them was heavily lopsided, with the richest countries having a near-monopoly over them.
Even a country like India, which is said to be the pharmacy of the world, found itself scrounging for vaccines for at least two years during the COVID-19 pandemic. It was only by late 2021 that the country’s pharmaceutical firms began producing enough vaccines to begin to meet the needs of the country and eventually other nations as well.
And it was not until mid-2022 or even later that African countries, which once again found themselves at the bottom of the pyramid, got access to vaccines. What was especially callous about this vaccine inequity was that, by the time most Africans were getting their first shots, people in the developed world had already received six or more doses and their governments were sitting on stockpiles of tens of millions of doses, refusing to share them with the countries in need. Eventually, the vaccines in rich countries’ warehouses expired and had to be thrown away in a typical display of widespread inequity.
This time around, the world, especially the rich world, would do well to learn the lessons of COVID-19 and readily share the vaccines it has already stockpiled. This will help minimize the fatalities from mpox.
Another key action the rich nations can take is to put adequate pressure on the Big Pharma companies, each of which made record profits during COVID-19 thanks to the billions of doses of vaccines that were ordered. These firms should, for once, take their eyes off their balance sheets and shareholder returns and instead focus on the human lives that are impacted by their avarice. Big Pharma firms ought to be pressured to sell mpox vaccines at cost price and share their intellectual property rights to help the generic manufacturers ramp up production globally.
Since it is still early days in the spread of mpox outside of Africa, it may be possible to ensure that the disease remains largely within that continent. And, with adequate vaccinations, it can even be eradicated there.
Another key mistake that the world, especially governments, needs to avoid this time is knee-jerk steps like lockdowns or shutting down international transportation links. Lockdowns pummeled more than half the population of the world and left people poorer, a situation from which most are still struggling to recover almost five years on.
It is almost certain that these vulnerable people cannot handle another similar shock, so governments and the WHO would do well to stay off that course of action, irrespective of the extent to which mpox spreads in the interim.
It would be a tragedy and indeed a crime if the world’s leaders failed to learn from their numerous blunders when dealing with COVID-19.

• Ranvir S. Nayar is the managing editor of Media India Group and founder-director of the Europe India Foundation for Excellence.