South Africa is among 14 countries set to receive financial aid from the Africa Centres for Disease Control and Prevention (Africa CDC) and the World Health Organisation (WHO) to combat the ongoing mpox outbreak. This support, available from this month until February 2025, aims to help these nations develop and implement strategic responses, including vaccination plans, to curb the spread of mpox.
The “Mpox Continental Preparedness and Response Plan for Africa” has a total budget of approximately $600 million. Over half of this — 53% — will be directed toward supporting the mpox response in 14 African Union Member States, including South Africa, where human-to-human transmission has been a significant concern.
Other countries receiving this assistance include the Democratic Republic of Congo (DRC), Burundi, Central African Republic (CAR), Congo, Cameroon, Côte d’Ivoire, Gabon, Liberia, Kenya, Nigeria, Republic of Guinea, Rwanda, and Uganda.
The remaining 45% of the budget will fund collaborations with partners such as UNICEF, the International Organisation for Migration, and the International Federation of Red Cross. These efforts will focus on enhancing testing, contact tracing, case management, and rolling out vaccines across the continent.
South Africa has been allocated $45.5 million (approximately R813 million), with $10.1 million (R178.7 million) specifically set aside for managing vaccine logistics. However, this funding cannot be used to purchase vaccines directly; the Africa CDC and WHO will provide vaccines through in-kind donations or negotiations with manufacturers for countries that can afford them.
In August, the WHO declared mpox a public health emergency of international concern, while the Africa CDC announced it as a public health emergency of continental security — the first such declaration since the Africa CDC’s establishment in 2017. This marks the second time the WHO has declared mpox an international emergency in two years, with a previous declaration in 2022 lifted in May 2023.
On August 7, the WHO issued an open invitation for vaccine manufacturers to express interest in listing their anti-mpox vaccines for emergency use.
As of September 6, South Africa has reported 25 confirmed mpox cases, including a recent case involving a 38-year-old man from Cape Town. This brings the total cases in 2024 to 25, with 12 in Gauteng, 11 in KwaZulu-Natal, and two in the Western Cape. Three fatalities have been reported.
None of the current cases in South Africa are from the more virulent strain, clade 1b. All are from clade 2b, the same strain that caused outbreaks in Western Europe and the UK during 2022 and 2023. Most cases have been among gay and bisexual men in their twenties and thirties, many of whom are living with untreated HIV. The latest patient has no history of international travel and is isolating at home.
Mpox, caused by the monkeypox virus, has two known clades: clade 1 and clade 2. The disease usually begins with fever, muscle aches, and sore throat, followed by blister-like rashes. While most individuals recover without severe illness, those with weakened immune systems, such as untreated HIV patients, face a greater risk of severe complications and death.
Clade 1 has been circulating in the DRC for over a decade and has recently spread to countries like Sweden and Thailand. In Africa, cases have also been reported in Kenya, Rwanda, Burundi, CAR, and Uganda. The DRC has seen a surge in clade 1 cases, with over 15,600 infections and 537 deaths reported in 2024 alone.
While both clades present similar symptoms, clade 1 tends to cause more severe illness and has a higher mortality rate. Clade 2b spreads more easily but generally results in milder symptoms. The current spread of clade 1 is exacerbated by vaccine shortages and inequity.
Recently, the DRC received two shipments of approximately 100,000 vaccine doses each from the European Union. However, this supply falls short of what is needed. Globally, two vaccines recommended by the WHO are being used to combat mpox, though vaccines specifically designed for mpox are still in development and have not yet undergone large-scale clinical trials.
In South Africa, smallpox vaccinations — which provide about 85% protection against mpox — were administered until the 1980s. The health department plans to vaccinate high-risk groups, including men who have sex with men, sex workers, and healthcare workers, once vaccines become available. However, securing these vaccines remains a challenge.
Despite efforts to procure vaccines from Western countries, South Africa faces uncertainty regarding delivery timelines. Vaccine inequity continues to be a significant issue, with the Africa CDC estimating a need for 10 million doses, though only around 280,000 are currently available. Experts warn that vaccine hoarding and inequitable distribution, similar to what occurred in previous epidemics, could worsen the situation.
