Five years of corona

Expert: Potential for many new epidemics

(Bild: ©rangizzz - stock.adobe.com)

Five years ago, the start of the Covid-19 pandemic kept the world on tenterhooks. However, many infections with high mortality rates are taking their course with little attention globally. There have been 180 epidemics on the African continent alone this year - from Mpox to major cholera outbreaks.

"In the 21st century, it is absolutely unacceptable that people are dying of cholera," said Marcus Bachmann from Doctors Without Borders Austria, criticizing the lack of help.

In the case of Mpox (formerly monkeypox), the World Health Organization (WHO) has declared the highest alert level of a "public health emergency of international concern", as was also the case with corona for some time, and extended it on 22 November. Even if we don't hear much about the news situation, it remains an epidemic of major proportions for those affected, Bachmann points out. According to the WHO, more than 15,600 cases of Mpox have been registered in two dozen African countries since the beginning of last year, mainly in the Democratic Republic of Congo. The number of unreported cases is high due to limited diagnostic options.

A cholera patient in South Africa

(Bild: AFP)

Mpox vaccines limited
It is still the case that a considerable number of people fall ill and some die. "In this context, it is particularly regrettable that preventive measures such as vaccines are not available to a sufficient extent," emphasized Bachmann. "This is a reverberation, an echo, of what we know from the Covid-19 pandemic, with the great injustice of distribution."

Production of Mpox vaccines is limited. There is little interest in factories in the global North in creating additional capacity by reallocating production. In addition, wealthy countries have ordered and are storing larger quantities of the vaccine. As with Covid vaccines, the situation with Mpox is such that "doses are running out in the global North and are being destroyed", emphasized the humanitarian advisor from Doctors Without Borders Austria with professional experience in the pharmaceutical industry.

An Mpox-infected person with the characteristic smallpox.

(Bild: AFP/APA/Glody MURHABAZI)

Marburg virus contained
The response to the outbreak of the Marburg virus in Rwanda this year, on the other hand, can be taken as an example of what is possible "if there is no lack of political will and prioritization". The hemorrhagic fever disease, similar to the Ebola virus, was combated with an internationally coordinated approach, reported Bachmann. A vaccine candidate and a drug were used on a trial basis "so that the outbreak could be brought under control". Of the 66 documented cases, 15 people have died. This is the lowest mortality rate in the history of Marburg outbreaks.

The Marburg virus, with previous mortality rates of 25 to over 90 percent per outbreak, is assessed differently than Mpox in terms of its threat potential, explained Bachmann, explaining the reason for the different international response. Mpox, on the other hand, is a disease without long-term consequences if it breaks out in the global North with the health care available there.

Massive vaccination gaps
This year in Africa there were also "regrettably largely vaccine-preventable diseases", such as measles, diphtheria and whooping cough, reported Bachmann. "It is not only, but also due to the Covid-19 pandemic that there has been a massive vaccination gap worldwide, but again disproportionately in the Global South." Preventive measures such as vaccinations have been deprioritized. The MSF expert was in Niger at the beginning of the year when there were diphtheria epidemics with a ten percent mortality rate. "We haven't seen diphtheria and whooping cough outbreaks on this scale for decades," he said.

(Bild: Scharinger Daniel)

In addition, there is cholera, which is also the largest epidemic of the disease in decades, Bachmann reported. The movement of refugees from the conflict in Sudan to South Sudan has led to a massive outbreak with a high mortality rate. There are not enough vaccines against the bacterial intestinal disease. One of the two manufacturers ceased production this year. Now, although optimal protection is provided by two partial vaccinations, only one vaccination is administered in order to reach more people. But even with this vaccination schedule, not everyone who needs to be vaccinated can be vaccinated, said Bachmann. "It is actually unacceptable that we have to manage shortages here."

Zoonoses are becoming more likely
People outside of Africa are also affected by epidemics in countries of the global South. Bachmann referred to India and Bangladesh, where around 900,000 Rohingya are being held in detention-like conditions in the refugee camp in Cox's Bazar. The sanitary and hygienic situation is catastrophic, making the living conditions "ideal for disease outbreaks". Around 40 percent suffered from scabies or the scabies mite before the outbreak could be contained through targeted mass treatment. At 20 percent, there is also an "extremely high prevalence of hepatitis C in these camps".

"The reservoir of known pathogens is large," emphasized Bachmann. In view of the "dramatically widening vaccination gap", there is great potential for further epidemics. In addition, there are areas such as the Congo Basin and the Central African rainforests that are particularly susceptible to zoonoses, i.e. diseases that can be transmitted from vertebrates to humans. "We humans are penetrating deeper and deeper into these habitats, mobility patterns are changing and urbanization is also progressing in Africa," said Bachmann. This makes zoonoses more likely.

People in sub-Saharan Africa are already affected by multiple epidemics, warned the humanitarian expert from Médecins Sans Frontières. "This is leading to an extreme bottleneck when it comes to providing healthcare for people."