A family nurse practitioner prepares a syringe with the mpox vaccine in New York, on Aug. 30, 2022.Jeenah Moon/The Associated Press
Dr. Joanne Liu is a former international president of Médecins Sans Frontières. Rosemary McCarney is the James Coutts Scholar in International Relations at the University of Toronto’s Trinity College. Christine McNab is an independent consultant in global public health. They have been involved with and advocate for the Independent Panel for Pandemic Preparedness and Response’s recommendations.
One major lesson from the COVID-19 pandemic is that no country is safe from a dangerous pathogen unless all countries are safe. COVID spread to almost every country in the world within three months. There are now about 100,000 commercial flights a day, and viruses don’t need a passport to travel. There may be 24 time zones, but there is really only one health zone.
On our southern border, Canada is monitoring the evolution of H5N1 influenza, which has infected cattle herds in 13 U.S. states; a mutation could trigger an influenza pandemic. Should H5N1 start to infect people easily, we would have to race to develop a vaccine against that virus strain.
But further afield, yet less than a day by air, a new strain of mpox is spreading faster and killing more people in the Democratic Republic of the Congo, and has crossed its borders. The World Health Organization has just deemed it a public-health emergency of international concern – the highest level of health alert in international law.
The new “clade Ib” strain of mpox, a variant of the long-established “clade I,” is spreading from person to person, seemingly more easily than the strain that caused a global emergency two years ago. These surging outbreaks in central Africa are killing about three adults for every 100 infections, and about five in 100 infected young children. People living with untreated HIV are particularly at risk, as are mothers and children, as the virus can spread through touch or contact with infected materials.
This dangerous new strain has already spread into several African countries in just a few weeks. Left unchecked, it is only a matter of time before it lands here in Canada.
But unlike for a potential H5N1-influenza pandemic, a vaccine for mpox already exists. It’s the same vaccine that successfully largely contained it in most wealthy countries two years ago. The problem is that the wealthy world then forgot about Africa, and vaccines were never made widely available there. Canada and other high-income countries now have a stockpile of millions of doses. After saying that it had no intention of sharing, Canada is now “actively working” with an international vaccine alliance to consider possible vaccine donations or other measures to help.
Reports now say Africa has secured some 280,000 doses, but the Africa CDC says at least 10 million are required. Had African countries had access to the vaccine as we did, this dangerous surge in mpox may never have happened. It’s now both Canada’s responsibility, and in Canada’s interest, to support what will be a difficult response to the mpox emergency.
For one, Canada should offer some of its mpox vaccine doses as a gesture of solidarity and equity. During the worst of COVID-19, Canada advance-purchased about five times more vaccines than required during a global shortage. Canada also acquired doses from COVAX, a stockpile mainly intended for low- and middle-income countries. By donating mpox vaccines now, Canada can lead by example, and help protect people in Africa.
Millions of dollars will also be required for the response in Africa, to help train health and community workers and to communicate the risks of mpox to people living in areas affected by conflict and those who speak minority languages. Here, too, Canada must be generous. Money is also required for more testing for mpox in laboratories, and to develop tests that can be administered closer to home. Right now, experts say that only a fraction of mpox cases are being identified.
Finally, through mechanisms such as pandemic treaty negotiations, Canada can support an international movement that will see all regions eventually equipped to research, develop and manufacture their own health products. When it comes to health security, no country can really afford to depend on the charity of others as national instincts will always be to look after your own population first. Donation of mpox vaccines is critical right now as there is no other choice – but in the longer term it is not the way to manage outbreaks.
The COVID-19 pandemic taught many lessons about the failure to be ready for a new virus. One of them was that when it comes to pathogens, all countries are connected, and therefore all countries must collaborate to stop outbreaks before they spread. At a time when there is no longer an “over there” for pathogen travel, a Canadian offer of vaccines, dollars and longer-term support for a self-reliant Africa is a matter of mutual interest.