Africa says it needs an estimated  of mpox vaccine to control this public health emergency.

The situation is particularly concerning in the Democratic Republic of the Congo, which  more than 27,000 suspected mpox cases and more than 1,300 deaths so far this year.

 and the  have promised to donate mpox vaccines. In an emergency, donations are welcome. But donations are a charity “bandaid” solution that can’t be relied on.

Here’s what needs to happen next to ensure equitable access to mpox vaccines for this and the next health emergency.

How did we get here?

It’s been less than a month since the World Health Organization (WHO)  an international public heath emergency of international concern, after rising cases in the Democratic Republic of the Congo and the potential for further spread.

Mpox, once known as monkeypox, hasĚýĚýinto countries that have never seen it before, possibly driven by a new, more infectious strain of the virus.

But the WHO has yet to approve mpox vaccines. This is necessary before groups such as  and  can begin to buy vaccines and start distributing them to affected countries that have not already independently approved them.

Once WHO has approved the vaccines, vaccine donations can also be distributed. These include  from the European Commission and another 40,000 from vaccine company Bavarian Nordic. The  50,000 doses from its national stockpile.

Even for countries such as the Democratic Republic of the Congo, which issued an emergency approval for the vaccines back in June, donated vaccines have only .

Other wealthy countries haven’t been so forthcoming with donating vaccines. Canada so far has  to sharing any of its several million doses. Australia has secured  for its population but hasn’t said anything about donations.

There are also  about how well the current vaccines will work against the new strain of the virus.

We’ve seen this before

In 2022, the Democratic Republic of the Congo saw another . The US, Canada and the European Union were sufficiently worried that they  from Bavarian Nordic. But that left none for poorer countries.

If vaccines were available in Africa then, the current emergency could have been stopped in its tracks, said , acting director of the Africa Centres for Disease Control and Prevention.

Low-income countries, especially those in Africa, are always at the end of the line when it comes to accessing vaccines, diagnostics and treatments.

This is a story that has been  in the past few decades – with HIV/AIDS, Ebola and most recently COVID.

Within the first year COVID vaccines were available, 75-80% of people in high-income countries had been vaccinated  fewer than 10% in low-income countries.

This maldistribution is not inevitable. It is a legacy of rich countries’ exploitation of the colonised world’s natural resources, a practice that continues underĚýĚýthat keep low-income countries poor and dependent on wealthier ones.

Here’s what happened with COVID products

One key example is the international system of intellectual property governed by the World Trade Organization’s (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). This agreement gives companies control over the manufacturing and pricing of their products – including COVID vaccines – until their patents expire. As a result, only rich countries can afford these vaccines.

In 2020, India and South Africa, eventually supported by more than 100 other low- and middle-income countries,  for COVID medical products for a limited time. This would have freed up scientific knowledge, technology and other intellectual property to allow for scaling up the manufacturing of vaccines, diagnostics, treatments and other products necessary to deal with the pandemic.

Less than two years later, the WTO approved aĚýĚýof the original proposal. The waiver, which lasts just five years, only made exporting COVID vaccines slightly easier. It did not include any other COVID medical products including treatments and diagnostics, or transfer of know-how and technology needed to safely and effectively scale-up production in the fastest way possible.

We must make sure this does not happen again

Mpox and future infectious disease outbreaks are sure to occur as climate change and environmental destruction increase the risk of animal-to-human disease transmission.

Such outbreaks will not be prevented and controlled by relying on charity, voluntary sharing by pharmaceutical companies or the goodwill of countries at the WTO.

African countries have recognised the need toĚýĚýof their public health systems. To address the current global imbalances, they have recognised they need to boost their collective voice on global health matters and become efficient in preparing and responding to disease threats. There is a framework for action.

But the global maldistribution of medicines for emergencies is not a problem Africa can solve on its own. A new set of  is also needed to ensure all countries work cooperatively to prevent, prepare for and respond to pandemics and to share vaccines and other needed medical products. This is vital so the global vaccine inequity experienced during COVID doesn’t happen again.

WHO member states  such an agreement in December 2021. But they missed the deadline they had set for themselves to conclude it by mid-2024.

While not a pandemic at this stage, the current mpox public health emergency reinforces the need for a concerted global effort to negotiate arrangements that ensure a fairer distribution of vaccines, medicines and diagnostic tests.

All countries should take note. Perhaps the upcoming negotiation for the WHO pandemic agreement – which sets out how the world manages pandemic prevention, preparedness and response – is the perfect opportunity.

Co-authored by Professor Emeritus, Joel Lexchin, Health Policy and Management,Ěý91ŃÇÉ«.

This article is republished fromĚý.

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From street dwelling to living in youth shelters as a teen, Ahmat Nokour Mahamat has overcome many challenges to achieve his post-secondary education dream

TORONTO, June 19, 2024 – “Tomorrow is going to be the happiest day of my life and I am so proud right now,” says Ahmat Nokour Mahamat, who says he has not had an easy life either in his native Chad, or in Canada, where he and his older brother Ahmat Nokour Brahim sought asylum eight years ago.

Mahamat is graduating with a degree in business economics at 91ŃÇɫ’s spring 2024 convocation, crossing the stage during a convocation ceremony at 3:30 p.m., Thursday, June 20.

Theirs is a remarkable story of resilience, perseverance and passion: From living on streets and in youth shelters where they didn’t feel safe, to working midnight shifts, Mahamat and his brother have overcome many challenges to be where they are now. The brothers arrived in Canada at the age of 18 and 20, in 2016 and decided to start their new chapter in Montreal, a natural choice for the native French speakers.

“It was tough. But we didn’t give up and worked through those tough times,” says Mahamat, hoping their success story will serve as an inspiration to those who are having a hard time.

In Montreal, the siblings were initially supported by the YMCA with accommodation for 30 days in a shelter. They were then on their own for several months, finding jobs in a vegetable processing factory outside the city, where they worked from midnight to 5 a.m. cleaning spinach. “A car would come to take us to the factory and bring us back. It was cold and very difficult to live like that. So, my brother and I decided to come to Toronto.”

They left for Toronto with each other, $300 cash, and an unwavering determination to build a better life. Their first stop was Streets to Homes Assessment and Referral Centre downtown.

“At times, I wanted to give up and return to Montreal, but my brother and I took turns encouraging each other. On the fifth day, we agreed that if we didn’t find a shelter, we would go back,” recalls Mahamat. Fortunately, they were provided a more permanent shelter by the same day. “We did not have close relatives or friends in Canada at that time, and we did not speak a word of English either. We started taking English classes immediately.” Mahamat is now fluent in English thanks to Ed-Vance, a program offered by the Toronto District School Board’s .

He hasn’t looked back. While Brahim opted to apply for International Studies at 91ŃÇɫ’s bilingual Glendon Campus, Mahamat took the required high school credits and English as Second Language proficiency tests, before applying for the Business Economics Program at the Keele Campus. “Initially, I didn’t consider applying to 91ŃÇÉ« because I thought I wouldn’t get accepted.”

However, a friend suggested Mahamat apply as he had heard of 91ŃÇÉ« providing access to those in precarious situations if they met eligibility criteria and had the passion to pursue higher education. “I still remember vividly the moment I found out I was accepted to the program at 91ŃÇÉ«.”

During his final year, Mahamat received an Aspiration Award for progressively improving his grades. “I was not doing all that well in the first two years but in the third year, I got straight As in most of the subjects,” says Mahamat, who took advantage of peer mentoring support from higher year students.

Needless to say, Mahamat was pleasantly surprised to receive the bursary that eased some of the financial burden on his tight budget. “I wasn’t expecting this money – it was definitely a great help financially.”

The awards program is run with the support of 91ŃÇÉ« alumni and other donors. It ensures that outstanding undergraduate students like Mahamat, who have financial needs and have improved their GPA, receive the help they need to succeed, says J.J. McMurtry, dean of the Faculty of Liberal Arts and Professional Studies. “It's an incredibly important promise to our students that we try as hard as we can to offer support to them, be it for mental well-being, numeracy and language help, or financial assistance. It is heartening to note that 91ŃÇÉ« has been an impactful part of Mahamat’s path to success.”

As it is, Mahamat is thought to be the first student from Chad to graduate from 91ŃÇɫ’s Keele Campus, and an English-language program, unlike many others including his brother, who opt for French-language programs at Glendon.

Mahamat has already found a full-time job in the auto financing sector and hopes to return to 91ŃÇÉ« to complete his honours in finance. The 26-year-old, who received his Canadian citizenship in 2023, is now able to focus on further stabilizing his life in Canada. 

The Scarborough resident has taken the day off from his job in Mississauga to attend the convocation ceremony and celebrate the occasion with his brother and best friend Brahim, and with close friends from Toronto and Montreal. “I am so excited!”

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Those countries with the highest rates of severe infections also had the highest rates of reported cases

TORONTO, Sept. 20, 2023 – A new analysis of COVID-19 cases in Africa shows that for most of the continent’s countries the rate of infection was likely much higher than reported in the initial stages, found 91ŃÇÉ« researchers.

Case counts reported by most African countries suggest the virus spread slowly during the early part of the pandemic, but the researchers say those numbers likely didn’t capture the true extent of the spread.

“The low reporting numbers was likely due to a lack of public awareness, public health resources, monitoring practices, testing availability and stigma,” says Faculty of Science Professor Jude Kong, senior author of the paper and director of the (AI4PEP).

To get a better handle on the real number of those infected, the researchers used an epidemiological mathematical model, along with observed data, for 54 countries in Africa to estimate the number of hidden infections. Data on cumulative number of cases and daily confirmed cases were used to build an epidemic profile for Africa of the initial stage of COVID-19.

What may be most surprising is the estimation that some 66 per cent of all infections in Africa were asymptomatic, while about five per cent were severe and about 27 per cent were mild.

“Africa is primarily comprised of a young population so it’s possible there were fewer cases, less severe symptoms or more people with asymptomatic symptoms than in a population that has a higher percentage of seniors,” says Postdoctoral Fellow Qing Han, lead researcher on the paper. “This suggests the possibility of a lower rate of detection of the virus.”

The researchers found that the basic reproduction number (R0) in each country was much higher than when only reported cases were used as the average overall case reporting rate was low – estimated at about five per cent continent-wide – in the early stages for each country. They estimate that the real mean R0 is 2.02 compared to the reported R0 of 0.17 and ranged from 1.12 in Zambia and 3.64 in Nigeria.

“Counties that showed a R0 of less than one, which basically means there was no outbreak, likely have a much higher true R0. Not investigating the underreported figures could cause an underestimation of the severity and magnitude of the epidemic locally in each country,” says Han.

Those countries with the highest number of severe infections also tended to have the highest reported cases and those with the lowest severe infections generally had the lowest report rate. The researchers say the predicted true numbers of cumulative cases are high above what was reported for all countries with Sudan and Gambia reporting collectively most at 27 per cent and 22 per cent, while most countries reported less than five per cent.

Northern and southern African countries had higher reporting rates compared to central Africa, which could be explained in part by higher health-care spending in the north and south regions. Libya topped all the African countries for having the most nurses and physicians per 1,000 people.

“The estimated low reporting rates in most African countries point to a need for improved reporting and surveillance systems especially for central Africa,” says Kong, co-executive director of the .

The paper, , was published today in the Royal Society Open Science Journal.

The work was funded by under the Global South AI4COVID Program.

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TORONTO, Aug. 11, 2021 – With a scarcity of COVID-19 vaccines in many African countries and the rise of new variants of concern, a collaboration led by 91ŃÇÉ« is using Artificial Intelligence (AI) and big data to define public health policies and interventions to contain and manage the spread of the virus in Africa.

The Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC) is playing a pivotal role in providing locally nuanced analysis of data to inform public health decision making, as well as vaccination rollout strategies.

ACADIC brings together an interdisciplinary team of data scientists, epidemiologists, physicists, mathematicians and software engineers, as well as artificial intelligence, disaster and emergency management, clinical public health, citizen science, and community engagement experts. It is leveraging big data and AI-based techniques in nine African countries with experts from 11 different countries – Botswana, Cameroon, Canada, Eswatini, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Zambia and Zimbabwe.

These techniques help identify and analyze emergent COVID-19 hotspots and outbreaks, and develop strategic, highly targeted and staged delivery plans for vaccines to priority areas. The team is also using ongoing monitoring to enhance COVID-19 testing to ensure public health interventions are equitable and effective.

Half of the world’s doses of vaccines have been secured by a handful of economically developed countries, but most African nations have received very few and continue to prepare and test their vaccination campaigns for when sufficient vaccine doses are made available.

A defining challenge is to develop local strategies that will reduce the number of COVID-19 cases even as variants of concern circulate amidst a dearth of vaccines.

Assistant Professor of the Department of Mathematics and Statistics in the Faculty of Science at 91ŃÇÉ« and the founding director of ACADIC can speak to the following:

• Making big data and artificial intelligence actionable for real-time delivery of reliable and comprehensive information to predict the spread and impact of an epidermic, and to guide governmental policies and best practice in an epidemic
• Obtaining locally relevant COVID-19 data in Africa
• The role of big data and artificial intelligence in understanding and intervening in pandemics
• Big data, artificial intelligence and COVID-19 in Africa
• The
• Vaccine acceptance/hesitancy across Africa
• Vaccination roll-out strategies in South Africa

Distinguished Research Professor , director of the Laboratory for Industrial and Applied Mathematics () in the Faculty of Science can discuss the following:

• Incorporating AI and mathematical modelling for smart vaccination rollout in vaccine limited regions
  • AI solution of vaccine-inequality: balancing the booster program in the North and prime series in the South for global recovery

Professor James Orbinski, director of Dahdaleh Institute for Global Health Research, can talk about the following:

• Clinical Public Health practices in epidemics and pandemics
• Medical issues associated with COVID-19
• Intervention systems in disasters and health emergencies
• Disease dynamics and modelling

Associate Professor of the Faculty of Liberal Arts and Professional Studies, and associate director of the (ADERSIM) can talk about the following:

• Transferring lessons learnedĚýfrom mass vaccination simulation to Africa
  • Disease modelling and simulation in refugee camps in Africa
  • Use of AI to model economic impacts of COVID-19 in Africa

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91ŃÇÉ«Ěýis a modern,Ěýmulti-campus, urban university located in Toronto, Ontario. Backed by a diverse group of students, faculty, staff, alumni and partners, we bring a uniquely global perspective to help solve societal challenges, drive positive change and prepare our students for success. 91ŃÇÉ«'s fully bilingual Glendon Campus is home toĚýSouthern Ontario's Centre of Excellence for French Language and BilingualĚýPostsecondaryĚýEducation. 91ŃÇɫ’s campuses in Costa Rica and India offer students exceptional transnational learningĚýopportunitiesĚýand innovative programs. Together, we can make things right for our communities, our planet, and our future.

Media contact:

Sandra McLean, 91ŃÇÉ« Media Relations, cell 416-272-6317, sandramc@yorku.ca

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