A Shot in the Arm Podcast

Episode: Sharing the Mic with Frontline AIDS: Africa’s Forgotten Mpox Outbreaks

Host: Ben Plumley
Guests: Dr. Ejide Harajirimana (Village Health Action, Burundi), Zodwa Ntembu (Frontline AIDS), Agari Aluso (Pandemic Action Network)
Date: October 14, 2024

Episode Overview

This episode explores the ongoing, under-discussed outbreaks of Mpox (formerly known as Monkeypox) in Africa, particularly focusing on the Democratic Republic of Congo and Burundi. Host Ben Plumley and his guests examine the current epidemiological landscape, the shortcomings of international and national responses, challenges in vaccine and commodity access, and the critical role of community-led organizations. The episode grapples with persistent patterns of neglect towards African health crises and highlights strategies to avoid repeating mistakes from past pandemics.

Key Discussion Points & Insights

1. Current Status of Mpox in Africa

• Worrying Outbreaks: Recent months have seen a rapid increase in Mpox cases in DRC and spread to Burundi, with further outbreaks across Africa ([00:05]).
• Dr. Ejide describes Mpox as a “viral, infectious disease” (Orthopox virus), which, like COVID-19, spreads through close contact, including sexual transmission, and contact with contaminated materials ([03:25]-[04:54]).
  • "The current outbreak we have is mainly spreading person to person, it's not animals to persons." —Dr. Ejide ([05:10])
• Mpox is closely related to smallpox; smallpox vaccination can offer some cross-protection ([05:55])

2. Community Leadership and Advocacy

• Zodwa emphasizes that community-based interventions are essential for effective epidemic responses, as seen during HIV/AIDS and COVID-19 ([07:07]):
  • "The community-led advocacy remains the most important entry when dealing with epidemics and pandemics such as the monkeypox." —Zodwa ([07:19])
• Integration of Mpox response into existing health services, technical assistance, capacity building, and partner information exchange are key tactics as financial resources remain limited ([09:46]-[12:12]).
• Social media and regular information sharing are used to keep communities up-to-date ([11:20]).

3. Stigma, Language, and Transmission

• Discusses stigma surrounding Mpox, especially considering its modes of transmission (sexual behavior) and the implications for at-risk communities.
• On the naming debate (“Monkeypox” vs. “Mpox”), Dr. Ejide notes that, locally, the term isn’t regarded as racist:
  • "To be honest, I haven't seen anything like great racism around it because it's a monkey." —Dr. Ejide ([12:48])

4. The Outbreak vs. Epidemic Debate

• Agari Aluso explains that by technical criteria, the situation is a pandemic:
  • "It's been seen in a number of African countries and beyond... in about 20 countries... so the criteria has clearly been fulfilled for MPOX in this case to be a pandemic." ([16:10]-[17:23])
• Emphasizes the recurring global pattern of "panic and neglect," where crises prompt urgent action but are quickly forgotten once deemed 'over' ([18:42]).

5. One Health, Zoonosis, and Surveillance

• Mpox outbreaks are fundamentally linked to zoonoses and environmental changes (e.g., climate, food systems):
  • "...diseases are emerging from zoonosis, they're coming from the animal kingdom because of human activity, because of climate change, because of our food systems." —Agari ([18:42])
• The need for robust surveillance, especially at points of human-animal interface, and nimble health systems capable of early detection and response is underscored ([18:42]-[22:44]).

6. Pediatric Impact in Burundi

• Alarmingly high proportion of pediatric cases:
  • "We see... 51% of people who are infected of MPOX are children." —Dr. Ejide ([25:04])
• Despite high infection rates, no reported deaths in Burundi, though morbidity remains significant ([27:11]).
• "We don't have any death from MPOX now... But again, as Agari was saying, in my opinion, we don't prepare pandemics. Once a pandemic or an outbreak is over, we just relax..." —Dr. Ejide ([27:11]-[28:40]).

7. Barriers to Access: Vaccines, Testing, and Data

• Zodwa calls for community and civil society organizations (CSOs) to be involved in national response planning and data transparency:
  • "Our community organizations need to be involved... they need to have the level at which information and data of MBOX and its response is being updated. It’s too slow." ([31:07]-[32:43])
• Highlights the sluggish process of vaccine approval and distribution, with the first vaccines only arriving after long delays:
  • "They are in the process of being distributed. I'd heard that the very first vaccine in DRC had been made available on 8 October. And that when you think about it, is a really significant long time—over two years..." —Ben ([34:46])

8. Global Solidarity & Systemic Challenges

• Agari advocates for a reimagined, agile global health governance:
  • "We have to explore how we do business so that we have a system that is ready to plug and play in events that we have outbreaks.... Time is the most critical." ([36:29]-[37:30])
  • Criticizes stockpiling vaccines in countries without outbreaks; urges rapid, equitable deployment:
    • "The vaccines are stockpiled in countries that do not have outbreaks; they are useless in those countries." —Agari ([38:26])
• Calls for these lessons to be enshrined in the developing global pandemic treaty ([39:38]).

9. Sustained Preparedness and CSO Empowerment

• Dr. Ejide: "We need ourselves to prepare for the pandemics, to know what is coming, to mobilize resources, internal resources, external resources, training healthcare workers." ([41:01])
• Community and CSO involvement remains pivotal before, during, and after outbreaks ([43:19]).
• Zodwa: "It is a bit stressful that we are dealing here with a neglected disease.... I encourage and support the integration of services as well. Tap into the already available resources..." ([44:10]-[47:24])

Notable Quotes & Memorable Moments

• On Persistent Neglect:
  "In 2022, we had this disease, but then it just died out and disappeared in 2023. Nobody spoke about it until now, which is why we find ourselves going back to where we were before. Because once it goes down, it's forgotten. It's a forgotten disease." —Zodwa ([45:49])

• On Data and Community Action:
  "People need to have updated... The disease is spreading quite rapidly, which means we also need to be very quick in the way that we are acting as well. And our interventions are informed by the data that is available." —Zodwa ([32:26])

• On Preparedness and Resilience:
  "Once a pandemic or an outbreak is over, we just relax and it's okay. And when we hear like another outbreak or an epidemic, we keep rushing... have resilience of our system is really low." —Dr. Ejide ([28:40])

• On Global Equity:
  "We are only as strong as our weakest link." —Agari ([22:44])

Timestamps for Key Segments

• [00:05]: Introduction, focus of the episode
• [03:25]: What is Mpox and how does it spread?
• [07:07]: Importance of community interventions
• [09:46]: What Frontline AIDS is doing, role of integration
• [12:48]: On the continued use of the term "Monkeypox" in Africa
• [16:10]: Is this an epidemic or a pandemic?
• [18:42]: The “One Health” perspective and zoonotic transmission
• [25:04]: 51% of Mpox cases in Burundi are children
• [27:11]: No reported deaths in Burundi; challenges of sustained preparedness
• [31:07]: The need for data sharing and CSO involvement
• [36:29]: Global system failures and calls for change
• [38:26]: Stockpiling vaccines where they aren't needed
• [41:01]: Need for proactive pandemic preparedness
• [45:49]: The recurring neglect of diseases like Mpox
• [47:24]: Closing reflections and call to action

Conclusions & Takeaways

• The Mpox outbreak in Africa, especially among children, is under-recognized and under-resourced.
• Global and national responses have been slow, with vaccine equity and resource mobilization lagging behind pandemic needs.
• Community and civil society organizations must be at the center of epidemic preparedness, response, and data sharing.
• Agile, equitable health governance—both in Africa and globally—is indispensable to close the cycle of panic and neglect.
• There is a critical need to learn from past failures, embed resilient systems, and not wait for diseases to become global before acting.

End of Summary