Nigeria's Readiness Facilitates Receipt of First Mpox Vaccines Donations

The Jynneos (MVA) vaccine, produced by Bavarian Nordic, has been donated by the United States government. This vaccine will be distributed in five states that are experiencing the highest incidence of mpox cases. A two-dose regimen will be provided to 5,000 individuals at the greatest risk of mpox, which includes close contacts of confirmed cases and frontline healthcare professionals. Additionally, there is a plan for reactive vaccination in other states as necessary.

Nigeria, representing only 1% of Africa's confirmed mpox cases, has distinguished itself as the first African nation to receive a vaccine shipment outside of a clinical trial setting.

“We are grateful for this initial donation of the mpox vaccine, which has proven to be both safe and effective,” stated Nigeria’s Minister of Health, Muhammad Ali Pate. “We will persist in enhancing our surveillance efforts and remain vigilant in our fight against mpox.”

Prior to the vaccine's arrival, Dr. Jean Kaseya, Director-General of the Africa CDC, confirmed that Nigeria was one of only two African nations to grant regulatory approval for the vaccine's deployment.

Nigeria's readiness, underscored by a comprehensive vaccination strategy, positioned it as a leader in receiving these doses.

According to the latest epidemic intelligence report from the Africa CDC, nearly 21,000 suspected cases and fewer than 3,400 confirmed cases of mpox have been documented across Africa this year.

While the Democratic Republic of Congo (DRC) accounts for 95% of suspected cases and 90% of confirmed cases, Nigeria has reported only 40 confirmed cases and no fatalities, representing just 1% of the continent's total confirmed cases.

Despite this relatively small figure, Nigerian public health officials have heightened the alert level and bolstered their outbreak preparedness efforts.

Dr. Jide Idris, the head of Nigeria's primary agency for disease prevention and control, the Nigeria Centre for Disease Control (NCDC), has experienced a whirlwind of activity since mpox was designated a public health emergency of international concern (PHEIC) for the second time in two years. 

Following the announcement, Idris was unable to accommodate interviews, as his agenda was filled with preparations and briefings. 

The environment at the NCDC headquarters was charged, reflecting the urgency felt nationwide as teams diligently worked to monitor and coordinate responses to various outbreaks. 

Simultaneously, numerous requests for information regarding Nigeria's mpox preparedness were received. Amidst briefings for the health minister, press conferences, and meetings with health commissioners from all 36 states, he managed to carve out a few moments to speak with Health Policy Watch.

“It is extremely busy,” he remarked. “We do not have Clade 1b in Nigeria. All cases are Clade 2,” Idris stated. 

Clade 1b is the new strain rapidly spreading in the DRC and neighboring regions.

Idris detailed Nigeria's three-pronged strategy for addressing mpox: enhancing surveillance at entry points, increasing laboratory capacity for testing and genomic surveillance, and supplying medical countermeasures (MCM) commodities.

Despite mpox being classified as a PHEIC, the NCDC's most recent situation report indicates a stable outlook for Nigeria: no unexpected changes in case counts, no fatalities, and a consistent trend in states reporting cases. 

Since August 18, there has been no fluctuation in cases, with the cumulative count for 2024 remaining at 40 across 19 states. Only five states reported more than two confirmed cases: Bayelsa (5), Akwa Ibom, Enugu, and Cross River (4 each), and Benue (3).

Bayelsa, which recorded the third highest number of confirmed cases (45) during the 2022 outbreak and ranked second the previous year, has consistently been among the top three states for mpox cases in Nigeria over the past eight years, with the exception of 2020.

As of 2024, children under 10 years old represent 35% of confirmed cases, while adults between the ages of 31 and 40 account for 20%.

"Prior to 2024, the majority of confirmed cases were among young adults aged 10 to 40, with a higher prevalence in males. However, in 2024, more than 33% of confirmed cases are now found in children aged 0 to 10," stated Idris.

Expanding the focus beyond Nigeria and the realm of vaccines

The official announcement states that 10,000 vaccine doses will be distributed in a two-dose regimen to 5,000 individuals who are at the highest risk of mpox, including close contacts of confirmed cases and frontline healthcare professionals. 

The vaccination campaign will focus on the five states that have reported cases, with the possibility of reactive vaccination in other regions as necessary.

Despite the Democratic Republic of the Congo's (DRC) central role in the outbreak, it has not yet received its initial shipment of mpox vaccines, raising concerns about the global health community's ability to prioritize the allocation and distribution of doses effectively.

Gavi's CEO, Sania Nishtar, indicated that in addition to donations from the U.S. government and the vaccine manufacturer, the DRC can request 65,000 doses of mpox vaccine from Gavi as soon as it submits a formal request.

However, Nishtar emphasized that the current supply of mpox vaccines is insufficient to meet the needs of individuals in Nigeria, the DRC, and other affected areas, highlighting the importance of addressing additional regions, particularly in the short term.

“The initial response should focus on enhancing areas such as surveillance, data collection, case management, and community engagement, as these foundational elements are essential for understanding and ultimately controlling the outbreak,” Nishtar stated.

Idris concurs. When asked about Nigeria's unique position to effectively manage the spread of mpox without implementing travel restrictions, he did not reference vaccine donations or medical interventions.

Instead, he pointed to Nigeria's extensive experience in handling various outbreaks, including more lethal ones, and the “surge capacity” it has developed, which includes coordinated response mechanisms, genomic sequencing, and molecular diagnostics.

This expertise is why Nigeria stands out as one of the few African nations reporting cases without a significant disparity between suspected and confirmed cases.