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

Summary

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

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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.

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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])

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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])

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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

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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.

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End of Summary

Transcript

[A]

Foreign.

[B]

Welcome to A Shot in the Arm podcast. I'm your host, Ben Plumley and we're sharing the mic again with Frontline aids. Now this is a conversation that really we, in a sense, should not be having. The state of the MPOX outbreaks across Africa. In the last couple of months, we have seen rapid increases in infections in the Democratic Republic of Congo. More notably, we've seen those spreading into Burundi. And we're also seeing other outbreaks happening across the continent. But the Democratic Republic Congo and Burundi linkage, we think, is really important. And so in this episode, we're really going to look at what's going on, what the response has been at the national and international level. And are we falling into the same trap of forgetting Africa and not getting the continent the resources, the commodities it needs to manage the range of infectious diseases and the outbreaks that are happening? So our guests today, really excited to welcome, first up, Dr. Ejide Harajirimana, who is the co chair and co founder of Village Health Action in Burundi. Ejide, welcome to A Shot in the Arm podcast and look forward to sharing the mic with you.

[C]

Hi, Ben, thank you very much for coming on this podcast and up to enjoy with you and talk about AMPOX and what's around it on African Rebel. Also Grapery, thank you very much for hosting me.

[B]

And where are we, where are, where are you ringing in from?

[C]

From Burundi. Based in Bijumbora. Yeah, the capital city now is economy. Capital city of Germany. We switched from Jambora to Gitega, which is not political city. Capital city of Burundi.

[B]

Brilliant. Well, it's really good to have you. I'm not going to say anything about the quality of the technology because I believe the technology gods will be on our side in this podcast. And we are also joined from Frontline AIDS by unto Bizodwa Ntembu, going by the name Zodwa. She is the advisor to programs for Frontline aids. Zodwa, welcome to A Shot in the Arm and we're looking forward to sharing the mic with you too.

[A]

Hi, Ben. Hi, Dr. Ejida. I'm super delighted to be here. Thanks for having me.

[B]

And you are joining us from South Africa.

[A]

Yes, I'm in Johannesburg, South South Africa. That's correct.

[B]

Brilliant. Well, let's get right into it, into this conversation. And Ejida, could I perhaps start with you? You're a physician, you've been deeply involved in the management of infectious disease in Burundi. You're at the forefront of the current MPOX outbreaks. Could you Step back a bit first and tell us just a little bit, remind us what MPOX is, who it's affecting, you know, how serious the mortality and morbidity rates are.

[C]

So mpox is not new. And now we have an outbreak and we know mpox is viral disease, infectious disease from.

Monkeypox and from the species of Orthopox virus. And as a COVID 19 is it is prayed through contact and whether.

Affected person through things they touch, touch or kissing or through sex. And also in some way.

Animals. Animals in different ways while cooking them, hunting them or skinning. And also contaminated materials such as anything which is contaminated, whether it's clothes or whatever. And also mpox sometimes is what you contaminate from mother to baby. And yeah, and as Covid is you, you, you need to, to avoid contact. And when as I was saying, it's through sex also you need to, to protect yourself. Even though the sense says this doesn't protect 100% and are getting inpox when you are protected using condoms. So it's like it's a viral disease, it's from virus. And though the current outbreak we have is mainly spreading the person to person, it's not animals.

To peasants. I don't know. We can go because it's dominantly in Africa, but now it's globally, many in Central Africa. Even though we are in East Africa, the central part of the African region, Central, east and West Africa. And as the name is monkeypox is, is those from the different species of monkeys, such as squirrels that are found in this rainforest of Central and eastern and West Africa.

[B]

Yeah, and it's closely related to smallpox, right?

[C]

Yeah, yeah. It's really is great in smallpox. And when we be talking about vaccination we see that even the people who have been vaccinated against smallpox, they can benefit from cross vaccination from smallpox and then.

Get mpox because they've been getting smallpox vaccine.

[B]

So we in theory, mpox is not unknown to us. There was a global outbreak in 2022, again deeply centered in the continent of Africa, particularly West Africa in that environment. But it also spread to the US and Europe transmission, particularly in the gay and men who have sex with men communities. And I guess oddwa, that sort of brings us on to the role of communities in helping those at risk understand their risk and what they can do about it. I guess this plays to the strengths of frontline aids. Does it?

[A]

Yes Ben, from the work that we do with partners as frontline aids we have learned that the community based interventions are effective. We saw this during the early days of the AIDS epidemic and again during COVID and as Frontline aids, we also put our communities at the forefront because we do development differently by allowing partners and communities to lead and be at the front of the responses. So what I've done, gathered so far from the partners, is that the community led advocacy remains the most important entry when dealing with epidemics and pandemics such as the monkeypox. Things can be all over the news and until the community gets involved, the community sensitization campaigns that need to be conducted and making sure that our communities are well informed to be able to tackle situations such as this one.

[B]

So you're seeing it much more as an advocacy role that communities are playing given that, you know, we're dealing with, what is it that who calls it? Close contact, a euphemism if ever there was one. But given that we're dealing with the questions on, you know, deep stigma of intimate sexual contact and intimate sexual behaviors, do you think that communities have a role in being frontline prevention and indeed health awareness leaders in outbreaks like this?

[A]

They do have at different levels because at government levels I'd say, Ben, probably it's the coalitions that would have more say. But our communities, our key populations, the, they have a very big role. Which is why as frontline aids, we always involve the community led organizations. And being at the forefront actually means that it is our duty to ensure that they are well informed and.

They'Ve got all the information that they need so that they can lead the advocacies on the ground.

[B]

And what is the Frontline Aid Secretariat doing to support, help, support and help coordinate partners? What are you up to?

[A]

For now.

We don't have any financial resources available to support the interventions for our partners. So what we are doing, we are encouraging our partners to integrate services where possible.

Leverage on resources available already for other services so that they include.

Support and screening and education for pandemics such as monkeypox. Because at the moment Frontline AIDS doesn't have financial resources. So for now the option has been integration. And secondly, we provide technical assistance, we build capacity and we've had workshops with the partners. We are planning to have partner information session from the workshop. So the workshop we were capacitating our communities and community led organizations on the.

[C]

Ground.

[A]

On the basics of monkeypox.

The symptoms.

And contact.

Tracing for the communities along the borders. Because I think that is what is important at this stage. We are planning also to have a learning exchange amongst our partners, a learning exchange session where our partners will be sharing information and best practices around monkeypox response.

Also, we will be releasing.

Emails with resources from the Global Fund from.

Africa, cdc, from.

World Health Organization to our partners because we want them to always have updated information and when things change, the statistics, everything we need, we need to make sure that our partnership has got that information. So we have seen it as our duty to always communicate with them. At least once a month, send this bulk email with all the recent updates on Monkeypox and we have social media cards that we'll be posting on our social media platforms as well. So this is how, this is the technical assistance that we are planning at this point.

[B]

So a question for both of you. A really interesting thing that you've both said is the term monkeypox, not mpox. I wonder. You know, in the Global north we're being told to be, and rightly so, to be very clear about the language we use. I think it's just sort of interesting to me that you've both used the terms interchangeably. What's your thinking there? Or do you know, are you aware of this and I suppose in your context, does it matter? Ejide, Perhaps you want to go first.

[C]

We see, we see the disease where the original from is from Mankey and we don't, we don't see any other things. Yeah, as the other this comes from, you know, TB came from a cow and somehow we don't, we don't, we don't, we don't see. To be honest, I haven't seen anything like great racism around it because it's a monkey. But again we. The Roko name is. It may be even pejorative the way it sounds. But yeah.

We don't see anything which is based racism because of its monkeypox. Yeah.

[B]

Yeah, thank you.

[C]

But again it's the way of course is now it's fabric. It's like the manky pox mainly seen as Covid is like people are. It's like we see from COVID now is manky pox what's next? So they just see as virus. Mainly as virus. We had the COVID and we have Monkeypox. What's next?

[B]

I hear you. Well, as a first on both a shot in the arm podcast and sharing the mic, we have a third surprise guest who's just joined us with the magic of technology.

We were hoping to get him in at the start, but we've been able to connect him. Agari Aluso, who is the director of the African region of the Pandemic Action Network Agri. Welcome to A Shot in the Arm and sharing the mic.

[D]

Thank you. Thank you and apologies in Ivory coast and got quite a bit of mix up, but happy to be here.

[B]

Oh, it's great you are in a conference. I think you look as if you are sitting in a small conference breakout room.

[D]

Yes.

[B]

Well, I hope they don't come in and try and get you to participate in a session while we're, while we're recording. But your timing in joining the call is actually really good, in joining the podcast is really, really good because Ejide had given us the overview of where we are with mpox, its sort of clinical articulation. Zodwa had explained to us the role of communities in both advocacy and driving the response. And I think that gets to the heart of the challenges of dealing with infectious diseases that are.

That are driven again to use the WHO euphemism, driven by close contact, intimate sexual behavior particularly and I guess Agra. Two questions I think for you. The first is.

Do you feel that it is right to call this a set of MPOX outbreaks or are we dealing with an epidemic and I guess related to that or where else are we seeing MPOX beyond in this current outbreak? DRC and Burundi.

[D]

Thank you. Can you hear me okay?

[B]

Yes.

[D]

All right. So yeah, so as we know, the current inpox outbreak has been declared a global emergency, a public health emergency of international concern. It's also been declared public health emergency of intercon of continental security. So the criteria for such categorization are one, depending on the regions or number of countries that have been impacted. And it has to be in a number of WHO regions or countries to meet that criteria for declaration. And Africa CDC also has nearly similar criteria, but at the continental level. So it's been seen in a number of African countries and beyond. And I think currently we know that it's in more than it's in about 20 countries and it's gone beyond Africa in Asia, it's been recorded in Europe, but mostly tracing their contacts with their previous visits to Africa region, mostly Rwanda and drc.

And therefore, yeah, so the terminologies, outbreaks and pandemics I think are very well governed by the WHO International Health Regulation framework, which lay out steer clear stipulations in terms of what category of is spread outbreak, you know, in terms of disease emergence and spread constitute an outbreak and what, you know, type of disease outbreak and spread constitute a pandemic. So the criteria has clearly been fulfilled for MPOX in this case to be a pandemic. Because of the number of regions that have reported the outbreak. And could you just ask the second question?

[B]

I think you've dealt with it.

Where are you seeing other outbreaks? Emergence.

Of MPOX and I guess agra. That goes to the question which I didn't really get to ask you as you joined us. Tell us a bit about the Pandemic Action Network and the work you're doing both to track and to monitor from a community perspective what, what is going on?

[D]

Yes. So Pandemic Action Network, as the name suggests, is a network of organizations which came together at the advent of COVID outbreak with the motivation to really mobilize collective action to bring an end to the then public health emergency, which was Covid, that was really spreading very fast. And its concern was mostly to and has remained to really bring equity to bear in the response and also to break the cycle of panic and neglect because that's what has characterized our response in previous iterations of outbreaks and pandemics. When we have outbreaks, all system go, everybody's panicking. We're running here and there, trying to mobilize tools. And when the emergency phase is declared over, we go back to our usual vertical programs where we focus on individual diseases. We don't build a resilient health system that is able to detect and contain outbreaks before they become pandemics. And that is where we've been failing really, not building a system that is nimble and that is tooled to be able to monitor vital signs of community health and of disease, you know, likelihood of disease emergence because we know where diseases are emerging from. And I just came in, as Dr. Gide was explaining, you were having a conversation about why MPOX and why monkeypox previously, what's the reason for that transition in naming? But I think the bottom line, however we want to call it now, the bottom line is diseases are emerging from the, from zoonosis, they're coming from the animal kingdom because of human activity, because of climate change, because of our food systems. And that is the point where we need to do a lot of monitoring as well and understand how they're jumping from one species to another and you know, project how, how we can be able to contain when there's a spillover from one species to another so that it doesn't get into the community transmission level where it's human to human, sustained human to human transmission. And the PAN and Resilience Action Network Africa exists to do, to really keep this agenda high up in the political discourses and the policy discourses. Both at the national levels, where a lot of action needs to happen, but also at the regional and global levels, because the global health security is really very interconnected and we have to act in unison because we are only as strong as our weakest link. We are only as safe as our most impoverished neighbor who does not have the tools. So it's in everybody's interest to work in solidarity, to share tools, to share technology, and to mobilize the community who are really the backbone of a resilient health system. Because communities are the ones who we see when there's a deviation in the health presentation of their members. They're the ones who will see that we're seeing a new trend in terms of symptoms of diseases that we've not seen and be able to connect with the formal health system. And that health system should be good enough to have the necessary capacities, like laboratory capabilities to be able to do quick genomic sequencing and know whether we are dealing with a new pathogen or a pathogen that already exists and mobilize tools, you know, in terms of, you know, diagnostics and vaccines and, you know, other measures to contain it before it spirals out of control. So that's what we exist to do. And we work with different members across the continent and also across the globe. Agree.

[B]

Let me interrupt because there is so much to unpack from what you have described. I gotta say, I was very pleased.

To hear you comment about the zoonotic transmission, that whole one health agenda that then fits into the climate, pandemic and conflict conundrum that we face not only in Africa, but the other thing that you pointed to, which I think is so important, and it picks up on what Ejide was saying earlier, is around now the modes of transmission through, one might call it bushmeat, through interaction with animals, and that is particularly affecting kids, particularly affecting pediatric populations. And as we were researching this episode right from the top, from Addis Ababa, the African Union and the cdc, African CDC to Geneva to Washington. What's so interesting and concerning about the current outbreak with what is called Clade 1A is the impact on kids. And.

That seems to be an area where we've been completely taken by surprise. And I'd love the thoughts of all three of you on what we do for a pediatric strategy. But, Ejide, perhaps I could start with you. What are you seeing in Burundi? How is it playing out there?

[C]

Well, thanks for pointing out this, this strain that, that we have of, of the monkeypox now, this all unit, we have the, the new strain of the ballast, the crate I burund. And this was also. That has been also seen in adc. And it's funny because when, when, you know, when we talk about and the, the people who are at risk, we talk men who have sex with men. We have of course healthcare workers and we have sex workers. And we see the, the figures is 51% of people who are infected of MPOX are children.

[B]

So just to emphasize that AGD of. Of all the people you're that have been reported with Mpox in Burundi, 50 over 51.3% of them are children.

[C]

Yeah, yeah. Many are. It's not, it's not a sex worker. It's most adult population which are higher. And we. These numbers are also disaggregated. You can have between five and nine months and between nine. No. So nine years. Nine years, 15 years. But the cumulative.

Is 51. So this is what I was saying, more than 20, 40% of the children are infected. So it's interesting and it's zoonotic disease and the concept of one health and also what.

EG was saying, we cannot say we may have specific integrations with outbreaks for the children because you know, this disease, the impact is not. If you see the mortality rate is not big, but sometimes it can read through to computation. For example, in Burundi we didn't and we haven't reported in any depth resulting to Mpoke, but can lead to complications and also morbidity is very huge and important.

[B]

So to be clear about that.

In kids, in children, are we seeing a much higher mortality rate compared to adults? Because we've always assumed MPOX was a serious disease, but it didn't tend to have the fertility rates that we were seeing in other pandemic outbreaks.

[C]

So you talk about mortality rate globally or in Burundi?

[B]

In Burundi, and particularly in kids, no.

[C]

We don't have any death from MPOX now. We don't have any reports to death. So we don't have, I mean we, I don't know, we don't have official. We don't have, we don't have any documented death without influence. So we have been many people who are infected and who are being monitored, but we don't have any death which can be counted that result from mpox.

[B]

And is that because you think we're not seeing mortality or is there an issue in data collection and monitoring? Do you think surveillance.

[C]

That's a hard question, but I mean from the suspected case, one of Mpoke, there has been much effort to identify. I remember the first case Where I was suspected of mpox, they were.

There, were diagnosed and they send samples to Uganda, I mean to.

Viral laboratory in Uganda so that they can get a confirmation. And then after we have support from partners such as W2 CDC with these biomolecular equipment to detect the virus. And also the UNICEF was also involved to give like equipment to detect. So.

We think contact tracing is working. But again, as Egreg was saying, in my opinion, we don't prepare pandemics. Once in 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, then go to the borders again, ask people to sanitize, wash hands, increase the hygiene. But again, we, as I say, as Agri was saying, have resilience of our system is really low. And yeah, this is what I can say, but I cannot say what it was the key, not getting death. I can say everyone was involved, but I don't say that that's really.

The key.

I mean, there's been a combination of factors and we need to investigate, we need to research, we can be sure and see what ways to know death right now.

[B]

So let's look to the future. And Zodwa, perhaps I could start with you. We talk about the role of communities and the partners of frontline aids, advocating for what is needed, the package of action that you are wanting, you know, global stakeholders, and of course we're recording this just prior to the World Health Summit in Berlin. What is it that you want them to be doing? And I ask that question because an easy mistake to make might be to think, oh, this is a repeat of COVID It's all about vaccine inequity, it's all about private sector greed in the north. Whereas in fact the lack of commodities from awareness, from diagnosis, from availability of vaccines that actually have been around for a while. They're smallpox vaccines that are being used and have been researched for mpox. There's a whole sort of mobilization that needs to take place there. We'll come back to the role of the WHO in a minute. But what are you, from the community perspective, asking, demanding, calling for, from health leaders around the world, we are calling.

[A]

For the involvement of CSOs in contributing to the development and implementation of national response plans related to mbox. They need to have a word, they need to take ownership of the response plans and they need to be part of the decision making.

Also, if they are involved at that level, it is very easy for them to hold the governments Accountable should things not go as planned. So our community organizations need to be involved and also we, we need to the government to provide.

Communities with up to date rapid, up to date data information.

Access to resources and up to date information on any changes and.

Any information that is required to MBOX and then its response in a very rapid manner. Because currently the challenge is that the data is not updated. When they go in to look for the data.

It'S a bit outdated. So it becomes a bit difficult for our CSOs to act and be relevant at that time because of the availability of national data in country. Yeah.

[B]

And when you say cso you mean community service organizations, civil society organizations?

[A]

Yes.

[B]

You see, I had a completely different civil society organizations.

[A]

Sorry, I should have explained. Yes, the civil society organizations. And so if they get involved and contribute to the development and implementation of national plans, that is number one, they need to be part of it and take ownership of the plants. And also they need to have the level at which information and data of MBOX and its response is being updated. It's too slow. 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.

Our funding requests are informed by the data that is available. So it is very important that the data is made available on time for our CSOs.

[B]

So that really gets us then not only from the governments but but to the multilaterals and agra. You're going to be in Berlin, I think during the World Health Summit there were a set of articles written by a really impressive journalist at the New York Times, Stephanie Nolan, around what has been going on regarding the approvals and rollout of a vaccine that could have some effectiveness in Mpoke. And of course after the 2022 outbreak, as you rightly pointed out, as you've all rightly pointed out, we took our feet off the gas, as it were in our response everything went back to normal. But one of the things that Stephanie Nolan said is that the byzantine regulations that WHO have both in terms of setting conditions for a public health emergency of international concern, but also the pre qualification regulations that WHO has to supposedly speed through the availability of products, in this case particularly vaccines, but is also diagnostics that they just haven't worked. And only I think in the last week has UNICEF been able to make its first order of a million vaccines. 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 when the data relating to the effectiveness of this smallpox vaccine for MPOX had been submitted to who. So what would your message be to Tedros and colleagues at who?

[D]

Yeah, thank you very much. I think one important lesson that we keep losing in the different iterations of outbreaks and pandemics is the role of, of global solidarity in really driving an efficient response and the critical role of the multilateral systems, including the WHO in you know, being seized of the responsibility and you know, acting as an enabler of quick equitable response. And I think that's the role WHO really has to play. We have to explore.

You know, how we do business so that we have a system that is ready to plug and play, you know, in events that we have outbreaks. Because even the very stipulation of how pandemics are declared for us, we have seen that as also being part of the problem. Because we should have a faced declaration where you are able to activate global response early enough before it goes to the level where so many countries are now dealing with the challenge. And I think that goes to the approval process because if we have this very delayed process of response that it has to be this number of countries impacted for us to be able to activate, get the emergency approvals, then that's where we are getting a lot of the timings wrong. Because we've seen in the efficiency of responses, time is the most critical. And there have been so many.

Models to show that if we were able to turn around responses within seven days, for example the 717 model, and then there's a hundred day mission which have been really around the time that within 100 day mission if you have a novel pathogen, we should be able to, you know, have put things in motion and used countermeasures to and be ready to deploy them within 100 days. It changes the trajectory, it bends the curve of the transmission.

[B]

But the problem here, agri is the this so called Hundred day action plan applies to new, new, new infused agents.

[D]

Yes.

[B]

And I guess our challenge is, you know, M has been around for a while and.

You know, a bit like subatomic particle physics, it goes in and out of our consciousness depending on the seriousness of the outbreak.

[D]

Yeah, no, that, that's even now, even a more, a more embarrassing scenario that we face because we've had M. Monkeypox previously since 70s, it's endemic in Africa, in a lot of African countries, West and Central Africa. And we have countermeasures from the 2022 when it was declared. Yet we are still struggling with timely approvals and availability of these countermeasures. And this particular outbreak started very much in earnest in around March. It's been more than 100 days, even within a known pathogen that has tools to deal with. So I think what the basic that I would. I would want to pass to the leadership of WHO and other multilateral agencies and the political system, so to speak, is that we don't have the luxury of time and we have to deploy tools as quickly and equitably as possible because the vaccines are stockpiled in countries that do not have outbreaks, they are useless in those countries. And I think somebody in charge of emergency at WHO mentioned, I can't remember her name of it, but she mentioned very clearly keeping. When we hear of outbreaks and we're still holding on to the stockpiles, instead of really getting the stockpiles to the countries that need them, that really needs to change. And if there's an innovation in the pipeline, we need to fast track them with the target of getting it out as quickly as possible. And if the system that we currently have is not helping us do that, then the system is not fit for purpose. It needs to be reviewed as possible. And as we go through the pieces of the international intergovernmental negotiating body process for our pandemic treaty or pandemic agreement, I think these are some of the most important conversations that we must have and really get covered in that agreement so that we, we can work with the intention of really containing outbreaks at the points where they break out before they become pandemics, because that becomes costly, that costs us human beings, and that costs us human resources and unnecessary disruption of our lives. Thank you.

[B]

No, thank you. And I come back to a comment you made earlier that we're only as strong as our weakest link. And that is profoundly true in these instances of infectious disease. I see that we're coming up to the top, top of the hour. Ejida, is there anything that we've missed, anything that you would want to add to this?

[C]

Yeah.

Yeah, it's important. And as Egro was saying.

We need to keep an eye to the government, how is exporting to the outbreaks and how also is building health systems. So we also urge that the government is on us, whether it's UNICEF or debris or not, always to be here to come. We give diagnostic. We need also to be like. So not only dilatory activities to help the Ministry of Health in Africa to prepare to the pandemic that need be prepared in advance. Which is really clear to say that we are now accelerating the rollout of vaccine since there was an outbreak in 2022 and now we are reaching the 2025, whereas we know that it was even heavy endemic cases of MPOX in Central Africa. So we need ourselves to prepare for the pandemics, to know what is coming, to mobilize resources, internal resources, external resources, training healthcare workers. And this is the spirit of the government, also the spirit of the CSOs, as Zoda was saying. Also the civil society organization has been empowered so that it can when, for example, they may become even a vaccine, how many people are ready for the vaccine? So many people, if they are not, we've seen with the COVID 19 people are not prepared the COVID 19 vaccine. And it became a huge problem because it came with all this misinformation with the mass control. Now we know WH is doesn't recommend mass vaccination on Ampox, but no one is informed about that. Tomorrow may see that we have vaccine, but no one is prepared. That is not even targeting is targeting healthcare workers and the people at risk. But no one is really spreading the good news that with this vaccine here we are just giving to people.

Who are at risk. So the concept of epidemiology has to be.

Thought well. And then in all outbreaks management, all pandemic management has to be integrated well and from the bottom to the top so that we manage where the pandemics and the prepared work. And also the whole step with detect, prepare, monitor, intervene, sanction also has to be praying not only during the pandemic, but also after and the before.

[B]

So it goes to your comment Zodway about needing accurate information, needing that shared in a timely manner. What are your final thoughts?

Having heard the conversation? Where do you think we go from here, Ben?

[A]

It is a bit.

Stressful that we are dealing here with a neglected disease.

At the same time, we need to act as quickly as possible to make sure that it doesn't spread and go as far as a point where we will not be able to control it. So what I would just say is that.

The civil society organizations need to form the coalitions. The ones that don't have coalitions and country need to form coalitions. The ones that already have coalitions need to use those coalitions in accessing the resources that are available out there and contextualize them and adapt them into their own context. And use them. These are the resources from world health organizations, from Africa. CDC adapt them to their own setting so that they can be able to act. That way, they can mobilize communities, they can be able to educate and create awareness about the transmission of the disease. That is number one. That is the first way. Because when I say it's a neglected disease, it's neglected in a lot of different ways in the sense that financially, the resources are not there.

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, once it goes down, it's forgotten. It's a forgotten disease. There are no resources in place. There is no access. There's a lot of stigma and discrimination. And which now makes one understand why when the rates go down, people want to quickly forget about it. So what I would like to encourage our CSOs is to leverage on resources and services so that they can immediately act and not wait for funding resources to be made available. By the time they get funding, it might be a bit too late or the pandemic might have died on it. I don't know whether it died on its own or just gets forgotten, just lies low and come back. We need to act while it's still there, active, so that we know we have actually put the red tapes where they are needed for our communities. So I encourage and support the integration of services as well. Tap into the already available resources, support the services that are a burden, but a bit neglected when it comes to the system and the resources themselves. Yeah.

[B]

Thank you, Zotwa. A powerful closing, I think, that wraps all the threads of the conversation that we've had. Thank you very much. And of course, it's entirely appropriate for an organization like Frontline aids, a partnership like Frontline aids, to be so concerned about mpox, given the very close interrelation between the two, between MPOX and hiv. And in fact, the need. And I was speaking to someone from PEPFAR who made this point, the need for frontline services that have been developed in HIV to be mobilized, deployed to help deal with new pandemic threats or old pandemic threats, as we have here.

[A]

Yes.

[B]

Well, with that, let me thank our three guests. Cote d', Ivoire, South Africa, Burundi. We were able to do a truly Pan African and global conversation. So thank you very much indeed.

So it just remains for me.

[C]

Thank you.

[B]

It just remains for me to thank our guests. A particular thanks to our director and producer Eric Aspera from newsdoc Media who helped keep the podcast going and running. Thanks to the staff of Frontline aids, particularly Suzanne Fisher Murray and her team for supporting and helping develop this episode.

Thanks to our production coordinator, our assistant producer in fact Waisha Rafael joining us behind the scenes from Lima, Peru. I do want to just flag up a few thanks in researching this episode, the international HIV and infectious disease activists Emily Bass, the African Union lead on Covid Michel Sidibe and the Infectious Disease Institute's Andrew Kambugu for their thoughts and insights on how we might address this issue because so few people are so with that. I hope you have a great week and a safe week everyone. Don't forget to subscribe. Give us five stars and we'll be back in the next episode with another key topic about how communities built from the HIV response are changing the world and are needed as we face these new pandemic threats.