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Salim Abdool Karim, chair of the Africa CDC's emergency consultative group, has called Trump's "abrupt closure of USAID support for the mpox control effort in Africa" a "major blow."
Nearly 800,000 doses of the mpox vaccine, which were initially promised to fight the epidemic in Africa, are set to go to waste due to Trump's cuts to the U.S. Agency for International Development.
According to Politico, which quotes the Africa Centres for Disease Control and Prevention, the vaccine doses cannot be shipped because they are too close to their expiration date.
"For a vaccine to be shipped to a country, we need a minimum of six months before expiration to ensure that the vaccine can arrive in good condition and also allow the country to implement the vaccination," said Yap Boum, an Africa CDC deputy incident manager.
In September, the Biden administration pledged that the U.S. would provide more than 1 million doses to fight the epidemic in Africa, which has killed nearly 2,000 people, many of them children.
However, Politico reports that just 91,000 of them were delivered, and only 220,000 of them still have a long enough shelf life to be used if the Trump administration signs off on them.
The continent is already facing a dangerous shortage of mpox immunizations. As Science reported last month:
In September 2024, Africa CDC and the World Health Organization (WHO) jointly issued an mpox "continental preparedness and response plan" that called for vaccinating 10 million people in Africa within 6 months. An updated version of the plan, issued in April, narrowed who should be offered the vaccine and scaled back the target to 6.4 million people by August.
But according to a May 29 WHO situation report, only 720,000 people in seven African countries have received mpox vaccines. Doses are scarce, vaccination teams are short on health workers and transportation, and identifying who might have been exposed to the mpox virus and should get the vaccine first is a challenge.
Salim Abdool Karim, chair of the Africa CDC's emergency consultative group, called Trump's "abrupt closure of USAID support for the mpox control effort in Africa" a "major blow, especially since it played a key role in the logistics of vaccine storage and distribution."
A June report by Public Citizen put the striking shortfall of doses into even greater perspective. The group reported that Africa had nearly six times fewer doses of the vaccine than the United States had during the 2022-23 outbreak, which was markedly less severe than what Africa currently faces.
Graphic: Public Citizen www.citizen.org
They pointed to high prices charged by the vaccine's manufacturer, Bavarian Nordic. The company has sold the vaccines to UNICEF for $65 per dose, making them the second most expensive drug UNICEF pays for.
UNICEF called for Bavarian Nordic to quarter the price of the drug and increase doses available to fight the crisis, but the company did not respond to the request. As a result, UNICEF fell 350,000 doses short of the one million that it had hoped to commit.
This shortfall was made worse by the actions taken by the Trump administration. While halting USAID operations, the U.S. also ceased cooperation with the World Health Organization (WHO), which is a major player in organizing the allocation of vaccines.
The Trump administration's actions, the report said, have "prompted a concurrent crisis of disrupted care and severe funding shortfalls across a range of disease areas and health services."
Mpox vaccines are not the only form of international aid going to waste as a direct result of the Trump administration's cuts to USAID.
On Monday, Hana Kiros reported in The Atlantic that the Trump administration had given the order "to incinerate food instead of sending it to people abroad who need it":
Nearly 500 metric tons of emergency food—enough to feed about 1.5 million children for a week—are set to expire [Tuesday], according to current and former government employees with direct knowledge of the rations. Within weeks, two of those sources told me, the food, meant for children in Afghanistan and Pakistan, will be ash.
The Trump administration formally shut down USAID on July 1, after cancelling 83% of its programs at the beginning of Trump's term.
On the same day, a study was published in The Lancet, revealing that the organization's efforts over the past two decades had saved over 90 million lives, with the biggest reductions in mortality coming from its work to prevent HIV/AIDS, malaria, and other tropical diseases.
"Is [USAID] a good use of resources? We found that the average taxpayer has contributed about 18 cents per day to USAID," James Macinko, a health policy researcher at UCLA and study co-author, told NPR. "For that small amount, we've been able to translate that into saving up to 90 million deaths around the world."
According to Impact Counter, a database created by Brooke Nichols, associate professor of global health at the Boston University School of Public Health, nearly 250,000 children and 120,000 adults already had died over less than six months as a result of cuts to these programs, as of June 26.
According to the Lancet study, if those cuts extend into 2030, 14 million people who might otherwise have lived—including millions more children—might die.
"These deaths will not be the result of droughts, earthquakes, pandemics, or war," said Olivier De Schutter in a piece published Friday in Common Dreams. "They will be the direct consequence of a single, lethal decision made by one of the wealthiest men to ever walk this planet."
"We must question why Bavarian Nordic refuses to adjust its unconscionable approach to pricing and access," wrote the director of Public Citizen's Access to Medicines program.
A U.S.-based watchdog group on Friday called out what it described as the "profiteering approach" taken by one of the only companies in the world with an approved vaccine for mpox, an infectious disease whose rapid spread in the Democratic Republic of Congo prompted the World Health Organization to declare a global emergency earlier this month.
Peter Maybarduk, the director of Public Citizen's Access to Medicines program, wrote a letter to the Danish pharmaceutical giant Bavarian Nordic expressing deep concern that the company "may be exploiting the latest global health crisis, putting profits over people."
A spokesperson for Bavarian Nordic, the maker of the mpox vaccine Jynneos, told STAT in a recent interview that the firm doesn't "tend to talk about price," a lack of transparency that set off alarm bells amid a pressing international crisis. Mpox has spread to the DRC's neighboring countries, and Thailand and Sweden each recently reported a case.
Maybarduk elaborated on his concerns:
In 2022, the Pan American Health Organization (PAHO) resolved to procure mpox vaccines despite Bavarian Nordic’s refusal to provide a single low price for all PAHO Member States. Consequently, the vaccine costs much more than any of the other vaccines available through the Revolving Fund, PAHO's bulk vaccine purchaser. In negotiations with manufacturers, the Revolving Fund usually seeks to obtain a supplier's lowest available price to ensure that all PAHO Member States can access affordable vaccines, regardless of size or level of development.
Given Bavarian Nordic's troubling approach to pricing with PAHO then, we remain concerned about pricing implications now for group procurement by Africa CDC and multilateral purchasers such as Gavi, as well as wider ramifications for the global public health response.
"While many actors have roles to play in ensuring a coordinated international effort to contain the spread of mpox, including how best to make use of vaccines," Maybarduk added, "we must question why Bavarian Nordic refuses to adjust its unconscionable approach to pricing and access."
The WHO's emergency declaration and the lack of vaccine access in the countries most affected by mpox has sparked concerns of a repeat of the vaccine apartheid that undermined the global response to Covid-19, with deadly consequences.
Lawrence Gostin, Sam Halabi, and Alexandra Finch, experts at the O'Neill Institute for National and Global Health Law at Georgetown University, wrote in a New York Times op-ed earlier this week that "we shouldn't discount the pandemic potential of mpox."
"Africa CDC has estimated that it needs 10 million doses to stop the current outbreak. But as was the case with the Covid vaccines, mpox vaccines are in the hands of the world's richest countries and companies," the experts wrote. "An agreement between Africa CDC, the European Union, and Bavarian Nordic has already been reached for the procurement and rapid distribution of about 200,000 doses, but many more are needed. The United States has said it will donate 50,000 doses to Congo from its stockpile. But this still leaves Africa nowhere near the 10 million doses needed."
"Bavarian Nordic says that by the end of this year it could manufacture two million more doses, and then eight million doses next year, if purchase orders are made," they added. "But there is no clear commitment to make these doses affordable for African countries."
"Every necessary step must be taken to get mpox vaccines to the adults and children who need them now," said an epidemiological coordinator for Doctors Without Borders.
The international medical charity Doctors Without Borders on Friday appealed to wealthy countries that have stockpiles of mpox vaccines to immediately donate doses to several countries in Africa that have been affected by recent outbreaks, as global officials warned the spread of the disease is now a public health emergency of international concern.
The group, also known by its French name, Médecins Sans Frontières (MSF), expressed support for the World Health Organization's (WHO) call for donor countries to help fund a coordinated response to the outbreak, including surveillance, building laboratory capacity, increasing community engagement, and guaranteeing access to treatments, vaccines, and testing.
The current outbreak has been reported mainly in the Democratic Republic of Congo (DRC), where the number of mpox cases this year has surpassed 15,600. More than 530 people have died of the disease this year.
Mpox has been reported in DRC for more than a decade, but with far fewer annual case numbers. More than 100 cases have also been confirmed in the past month in four neighboring countries which have not reported cases of the disease before: Burundi, Kenya, Rwanda, and Uganda.
Dr. Jean Kaseya, director-general of the Africa Centers for Disease Control and Prevention, estimated this week that at least 10 million doses of mpox vaccines will be needed to respond to the growing outbreak.
"We need to have vaccines," Kaseya told NPR. "Today, we are just talking about almost 200,000 doses [becoming] available. We need at least 10 million doses. The vaccine is so expensive—we can put it around $100 per dose. There are not so many countries in Africa that can afford the cost of this vaccine."
Without improved access to vaccines, said Justin Eyong, an intersectional epidemiological coordinator for MSF in DRC, "thousands of people—including children under 15 years old who are particularly affected by mpox (representing 56% and 79% of all cases and deaths from mpox in 2024, respectively)—may be left unprotected."
The U.S. Food and Drug Administration and European Medicines Agency have both approved the MVA-BN vaccine for mpox, which can cause a rash that can be painful and initially look like blisters, as well as fever, chills, and other symptoms.
"Mpox, originating in Africa, was neglected there, and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself."
With the current price of the MVA-BN vaccine placing it out of reach for most low- and middle-income countries where mpox is endemic or is now spreading, MSF called on its manufacturer, Bavarian Nordic, to partner with African companies "for a full and timely tech transfer" that would allow a vaccine to be produced in Africa.
"With the mpox outbreak in DRC continuing to evolve rapidly, the situation is urgent," Eyong said. "Every necessary step must be taken to get mpox vaccines to the adults and children who need them now."
The current outbreak of mpox is being driven by one of the two genetic clades, or groupings, that characterize the disease. Clade II was behind an outbreak that was declared a global health emergency from 2022-23, but the current spread of the virus is being driven by clade I, which causes more severe disease.
Dimie Ogoina, chair of the International Health Regulations Emergency Committee said Wednesday that the upsurge in cases is "an emergency, not only for Africa, but for the entire globe."
"Mpox, originating in Africa, was neglected there, and later caused a global outbreak in 2022," said Ogoina. "It is time to act decisively to prevent history from repeating itself."
Ogoina's comments were echoed by Ayoade Alakija, chair of the Africa Vaccine Delivery Alliance, who told The Guardian that if European countries were experiencing the current outbreak instead of African nations, "mpox would have already been considered a major international health emergency."
The declaration of an emergency "of international concern," said Alakija, "should focus minds and loosen purse strings so that the response recovers from a sluggish start."
Instead of confronting the threat of a potential new outbreak, said Global Justice Now director Nick Dearden, "the British government has spent more time actually stopping a pandemic treaty being agreed because it threatens Big Pharma power."
Policymakers in wealthy countries including the U.K. and the U.S. have objected to provisions in a pandemic treaty proposed by WHO, such as those that call for countries to donate vaccine doses to low-income countries or waive intellectual property laws for vaccines and treatments during a pandemic.
Such objections are "bad for all of us," said Dearden. "If we'd dealt with this internationally years ago, we could have prevented this dangerous new strain."
MSF called on WHO to accelerate its Emergency Use Listing (EUL) Procedure for two mpox vaccines that have been approved internationally, which would encourage manufacturers to increase production and allow agencies including the United Nations Children's Fund to distribute the vaccines.
The stockpiling of vaccines by "rich countries that do not need them," said economist Jayati Ghosh, "is exactly what the world does not need to confront this latest health threat."