As an infectious disease specialist in Atlanta, Dr. Boghuma Kabisen Titanji spent much of 2020 on the front lines of the battle with COVID-19 raging across the U.S.
When the vaccine arrived in December of that year, she felt some relief. But also fear.
“I had seen what COVID was capable of doing to people my parents’ age,” Titanji said.
“I was absolutely horrified because from the time I had access to a vaccination to the time my parents had access to a vaccination was eight months.”
In Cameroon, where Titanji is from, her parents didn’t get their first coronavirus shot until August 2021. By then, most Canadian and American adults had already had their second shot.
“It was the most nerve-wracking experience living in fear of them getting COVID,” she said.
Despite pleas from the World Health Organization for rich countries to stop stockpiling COVID vaccines and share them with lower-income nations — especially in Africa — global health experts agree that we have failed.
Dr. Boguma Kabisen Titanji, an infectious disease specialist in Atlanta, says there were no vaccines or antiviral drugs available when he dealt with monkeypox in his home country of Cameroon. (Boguma Kabisen Titanji)
Nor are they surprised because the same inequitable distribution of vaccines and treatments has been a pattern for decades.
On July 23 at WHO announced monkeypox a”public health emergency of international concern” – and doctors fear that the same pattern will repeat itself as Canada, the US and European countries rush to vaccinate at-risk groups.
They use a vaccine originally made for smallpox that has been destroyed. In Canada it’s called Imvamune and years ago small quantities were stockpiled in case smallpox ever returned. Imvamune is also approved to vaccinate humans against monkeypox.
Yet monkeypox has been endemic in several African nations for 50 years. Dozens have died this year alone, Titanji said, but no vaccine has ever been available except in targeted studies involving health care workers.
When she dealt with outbreaks of monkeypox in Cameroon, she said she also had no access to antivirals to treat the disease.
“If you diagnose someone with monkeypox [in Africa], you provide supportive care. So basically you make the diagnosis and tell them to isolate themselves and, you know, take paracetamol for their fever … and rest and recover.”
Although anyone can become infected through close contact with a monkeypox patient or personal items such as bedding, in countries outside of Africa the population most at risk is currently men who have sex with men. In Africa, it has historically been spread primarily through contact with infected animals.
Lack of concern for diseases in Africa
If a pandemic on the scale of COVID doesn’t prompt a global response that’s just, Titanji said, she’s skeptical that the response to monkeypox — let alone future outbreaks of other diseases — will treat Africa any differently.
“The problem is that there is a general neglect of health acuity in Africa,” said Dr. Githinji Gitahi, head of Amref Health Africa, a Toronto-based group working to improve access to health care across the continent.
“The point is that as long as the health threats are limited to African communities, it’s good for the world not to worry.”
WHO has 31 million doses of smallpox vaccine (effective against monkeypox), stored mostly in donor countries & intended as a rapid response to any re-emergence of the disease, which was declared eradicated in 1980. No doses have ever been released for outbreaks of monkeypox in Africa
—@daktari1
But if rich countries want to end epidemics that affect their own citizens, it is in their best interest to ensure that low- and middle-income nations have the resources to stop the spread of the disease, Gitahi said.
“Pandemics and disease threats start in a community,” he said. “If you have one community that’s not safe, the whole world is not safe in our current connectivity.”
“This must change not only for monkeypox but also for other neglected diseases in low-income countries, as the world is once again reminded that health is an interconnected proposition,” the WHO chief said.
What is the solution?
One of the things that needs to change is the monopoly rich countries hold on vaccines and drugs, including antivirals, African doctors and global health experts said.
During COVID-19, donations through the COVAX vaccine sharing program helped, but they arrived in African countries too late, Gitahi said. “People died while waiting for vaccines.
In many cases, the vaccines were unusable because they landed with “very little shelf life remaining.”
Also, by the time they arrive, people who would have previously queued up to get vaccinated have lost both a sense of urgency and trust in the health care system, with the feeling that they are getting vaccines rejected by rich countries, he added Gitahi.
LISTEN | African doctors say monkeypox response is another example of vaccine injustice:
CBC News2:44African doctors say monkeypox backlash is another example of vaccine injustice
Health experts say they are skeptical that the world has learned from COVID-19 as rich countries grapple with monkeypox epidemics. (CBC The World This Weekend)
The way to level the playing field for low- and middle-income countries, some experts say, is to remove intellectual property protections for essential vaccines and treatments.
Rich countries are investing huge sums of money in vaccine companies during emergencies, Titanji said. This allows them to make financing contingent on giving lower- and middle-income countries an equal chance to buy them at a fair price, she said.
Dr Mary Stephen, technical officer at the WHO Regional Office in Brazzaville, Republic of Congo, says it is critical to develop Africa’s capacity to produce its own vaccines and therapeutics. (Dr. Mary Stephen)
But an even better solution, experts said, is to ensure that Africa is able to organize its own emergency responses to epidemics, rather than being forced to wait for charities and rich nations to act.
“If we want to build a sustainable system, there is much, much, much more to do beyond just donating vaccines,” said Dr Mary Stephen, technical officer in the Health Emergencies Program at the WHO Regional Office in Brazzaville, Republic of Congo .
“Just imagine if … countries on the continent are able to produce their own PPE, can produce their own laboratory reagents, their own test kits. [If] they have been able to produce vaccines, drugs… it will go a long way,” she said.
An important step in building this self-reliance was the establishment of the ‘mRNA Vaccine Center for Africa’ in Cape Town, South Africa, supported by the WHO. Scientists there have produced the first batches of an mRNA vaccine against COVID-19.
As Africa works towards health self-sufficiency, it is important for the world to remember that the continent has already contributed significantly to global health, Titanji said.
For example, African participants in many clinical trials have enabled the development of HIV/AIDS treatments received by patients in rich countries, she said.
Now that the world is facing monkeypox, Africa has decades of knowledge about the virus that rich nations are relying on, Titanji said.
“It’s 50 years of research by African scientists, sometimes with incredible challenges, to get this data published,” she said of studies on monkeypox, including one on health workers in the Congo that tested the effectiveness of the Imvamune vaccine.
“We are now building on this to be able to deal with epidemics in non-endemic countries, while leaving behind the same people who contributed to this knowledge.”
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