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August 28, 2024 13 mins

The World Health Organization declared the last mpox global emergency over in May 2023. And just over a year later, here we are again.

Since the start of 2024, a deadlier, more transmissible strain of the virus has killed about 575 people in the Democratic Republic of Congo and infected 30 times more. New cases have recently appeared in Europe and Asia. In August, the WHO declared a new mpox global health emergency. 

Bloomberg’s Ashleigh Furlong joins host Sarah Holder to explain why the latest outbreak could have been avoided — and what it will cost to beat it.

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Speaker 1 (00:03):
Bloomberg Audio Studios, podcasts, radio.

Speaker 2 (00:07):
News, Mozart had it. So did Beethoven and George Washington
and Abraham Lincoln. For nearly three thousand years, smallpox wreaked havoc,
killing a third of people who were infected and severely
disfiguring many others.

Speaker 3 (00:24):
Becauesn't hear that most of the fatal cases of smallpox
have occurred.

Speaker 2 (00:28):
Even though a vaccine, the world's first vaccine was created
in seventeen ninety six, it took hundreds of years to
figure out how to get it to enough people.

Speaker 3 (00:37):
The focus, of course, is on Bradford, where tens of
thousands of people have waited their term for vaccination.

Speaker 2 (00:43):
A concentrated effort to vaccinate the world against smallpox started
in nineteen fifty nine. Two decades later it had mostly succeeded.

Speaker 4 (00:52):
In October, the Somaria smallpus Eraducation Program recorded the last
case in Merga Town and is similar to me that
this was the last known case of smallpox in the world.

Speaker 2 (01:09):
By nineteen eighty, health officials announced that smallpox was officially eradicated,
and with that came the end of the vaccination push
that had led to one of the greatest achievements in
public health history. But that achievement also had some unintended consequences.

Speaker 1 (01:27):
We had the smallpox vaccines, and that actually also protected
against empos. When we eradicated smallpox, stop giving people smallpox vaccines,
that's when we started to see empox cases rise in
certain countries in Africa.

Speaker 2 (01:42):
Ashley Furlong is a health reporter for Bloomberg. She says
that empox has been infecting humans in West and Central
Africa with increasing frequency since it was first reported in
a nine month old boy in the Democratic Republic of
Congo in nineteen seventy.

Speaker 1 (01:57):
It's been spreading in Africa for decades. It's called endemic
at the moment because you know, it's sort of constantly there,
it's not sporadic.

Speaker 2 (02:06):
Allowing that spread and not instituting a comprehensive vaccine program
has allowed the empox virus to mutate. Now a dangerous
news strain has been detected in at least six African countries,
and the world is watching.

Speaker 3 (02:21):
The World Health Organization declares an MPO's outbreak in Africa
a global health emergency as it seems to contain the
potentially deadly.

Speaker 2 (02:32):
Virus vaccinations are part of the key to getting this
outbreak under control. But things are different today from when
the world beats smallpox, and public health experts are saying
that the worst part about EMPOS being back on the
map is that it was entirely avoidable.

Speaker 4 (02:49):
This is something that should concern us all.

Speaker 2 (02:56):
Today. On the show Missed Warnings one hundred dollars, vaccines
and red tape, why the latest empox outbreak didn't have
to happen like this and what it will now cost
to beat it. I'm Sarah Holder, and this is the
big tape from Bloomberg News.

Speaker 1 (03:17):
So that epicenter of where we're seeing the spread is
in the Democratic Republic of the Congo. We're seeing it
in neighboring countries as well, and then we see a
couple of cases in European countries. We saw one in Sweden,
and then we also saw one outside of Africa and Thailand.

Speaker 2 (03:32):
Bloomberg's actually Furlong says, the epicenter of this current empox
outbreak is in the country where the virus was first spotted, Congo.
And one thing that's notable about this particular outbreak is
how EMPOKS is spreading.

Speaker 1 (03:47):
So what we've been seeing at the moment is that
it's being transmitted off and through sexual contact, but it
could be through you know, just touching a friend or
you know, sharing bed sheets with someone who has been
infected by the virus.

Speaker 2 (03:58):
And what is an EMPOC case look like? What does
it do to the body.

Speaker 1 (04:02):
A lot of the symptoms are kind of like any
old virus that you might get and could be you know,
confused with another virus. But I think what is quite
significant about empocs are these lesions that you get sort
of small sores, kind of like chicken pox, and that
we've seen a few cases where actually they thought it
could be EMPUCS, but it turned out to be chicken pox.
So I think that the little round lesions that you

(04:24):
see on people with EMPUCS, that's sort of a strong
attribute of empucs. But otherwise it can cause people to
sort of feel unwell, tired, things that you might get
with another kind of virus.

Speaker 2 (04:34):
Historically, EMPOS has shown a limited ability to spread. The
virus has mostly been transmitted from animals to humans, like
from eating bush meat, and amongst humans in very close proximity,
like those who live in the same household or share
the same bedsheets, but that's changed with this latest outbreak,
which began in December with the emergence of a news

(04:56):
strain called clade one.

Speaker 1 (04:58):
Be we're seeing is sort of a change in transmission
and it's spreading from human to human in these long
chains of transmission, and that's what scot scientists really quite worried.

Speaker 2 (05:08):
Can it be fatal?

Speaker 1 (05:10):
It can?

Speaker 2 (05:11):
The key thing to know about this outbreak is that
it's different from the one that happened in twenty twenty two.
That year saw the first ever global outbreak of the virus,
and fresh off the heels of the COVID nineteen crisis,
the US and Western Europe acted fast.

Speaker 1 (05:27):
We saw vaccines rolled out to at risk communities, which
at that time was mainly men who have sex with men,
and we were seeing the transmission within those communities. There
was a lot of public health messaging as well around
safe sex practices about how impos is transmitted, how to
stop it being transmitted.

Speaker 2 (05:44):
That messaging and those resources seem to work in some places,
particularly in the US, which had stockpiled vaccines.

Speaker 1 (05:53):
The US has always been really worried about a smallpox
outbreak potentially, and this vaccine is effective against smallpox, so
that's why they had those contracts and why they had
those stockpiles.

Speaker 2 (06:04):
But Ashley says in Congo and other African countries where
empos is endemic, the response was different.

Speaker 1 (06:10):
In many African countries, empo's case has continued to appear
and vaccines never arrived.

Speaker 2 (06:16):
There.

Speaker 1 (06:17):
You know, public health messaging around stopping empocs. There might
have been that messaging, but there's obviously many other priorities
when you're a country like the DRC, like Congo where
measles kills way more people than empocs does, So there's obviously,
you know, different priorities that governments have when handling health crises.

Speaker 2 (06:34):
Another factor governments have to contend with is the price
of the empo's vaccine. How much do those shots cost.

Speaker 1 (06:42):
So there's several vaccine developers who have empox vaccines, and
the one that is approved in the US and in
Europe is from Bavarian Nordic and we don't have an
exact price because the company hasn't actually revealed how much
they're charging for their shot, but the Africa CDC estimates
that it's about one hundred dollars a dose and you

(07:02):
need two doses to be fully vaccinated against the virus,
so that's quite pricey. Vaccines are normally, you know, quite cheap.

Speaker 2 (07:10):
In mid twenty twenty, the US government was able to
buy COVID nineteen vaccines for about twenty dollars a dose.
So I asked Ashley what makes the EMPOS vaccine five
times as expensive. She said there was one main reason.

Speaker 1 (07:25):
There's not a huge market for them, you know, emparcs.
We might see there's obviously are quite a few cases,
and there's currently a global health emergency around it, but
it's still quite small. So if you a vaccine developer
figuring out how to price your vaccine, you need to
make considerations about you know, you're only producing maybe several
million doses of this vaccine, so you need to still

(07:47):
make a profit. And that's what Bavarian Nordic has said, basically,
is that to be viable, they have to charge the
price that they have set and they don't have that
much flexibility. You know, when you distributing a measles vaccine,
for example, you know, most childhoodization campaigns will include a
measles vaccine. So that's a massive, massive market compared to
the EMPOS vaccines.

Speaker 2 (08:07):
While fewer people might have needed an empox vaccine, Ashley's
sources told her that making sure the vaccine was available
to the people who did need it could have changed
the course of this current outbreak.

Speaker 1 (08:18):
When I spoke to scientists last week, they were rarely
saying that, you know, if vaccines had gotten to the DC,
for example, to Congo in January, we wouldn't be in
the situation.

Speaker 2 (08:31):
But this is the situation we're in. So what will
it take to get the outbreak under control? And what's
at stake if the world fails to act? That's next.
The Africa Centers for Disease Control and Prevention reported Sunday

(08:53):
that empox has killed five hundred and seventy five people
in the Democratic Republic of Congo since the start of
the sea and it's infected thirty times more, and new
cases are now being found in Asia and in Europe.
I asked Bloomberg's Ashley Furlong where efforts to combat the
outbreak currently stand. So our vaccines available now for the

(09:17):
folks around the world who are at most risk.

Speaker 1 (09:21):
No, so Congo doesn't have any doses at the moment,
they said, sort of the next couple of days, but
there's no clear timeline yet.

Speaker 2 (09:30):
How many vaccines are needed.

Speaker 1 (09:32):
The Africa CDC says that about ten million are needed
for the African content. That's quite small, you know, in
the DC in Congo at the population's nearly one hundred million,
so you know, we're talking about a tiny amount of
vaccines rarely that are needed potentially to control the outbreak.
Obviously we would have needed probably less if we were
talking about the several months ago.

Speaker 2 (09:53):
The US is planning to donate fifty thousand doses, but
it has millions more in its stockpiles. Germany will donate
one hundred thousand doses of it's one hundred and seventeen
thousand dos reserve. Almost none of these donations are expected
to get to Congo until September at the earliest.

Speaker 1 (10:11):
That won't get us up to the ten million, so
the rest will probably need to be bought, and countries
like Congo don't have the budgets to buy those vaccines,
so we're going to be looking at who's going to
help pay for those. There's some money being pledged by
several aid organizations and organizations that might administer and roll
out these vaccines, but at the moment it doesn't look

(10:33):
like we have the full amount that's needed.

Speaker 2 (10:37):
But Ashley says containing the outbreak is not just a
matter of getting enough vaccines.

Speaker 1 (10:42):
Rolling it out is going to also require quite a
lot of resources. Healthcare workers campaigns about educating people about
getting the vaccine, because just because you have a vaccine
on the ground, as we saw during COVID, doesn't mean
people will want to take it. And also in some
of these communities there might be quite a lot of
stigma around empuk'svaccines. There might be concern that, oh, if
I get at MPUs vaccine, everyone's going to know that

(11:04):
I'm might be at risk of emparks through my sexual
network or through my sexual contact. So we're going to
have to see how that plays out on the ground.

Speaker 2 (11:13):
Given all these challenges, how likely is it that emparks
will be contained.

Speaker 1 (11:19):
We're seeing quite a strong, finally, you know, response from
sort of the global players in a sense from the US,
from countries like Germany, etc. So we are seeing that reaction.
It might have been a little bit delayed. I think
there's a sense that you know, this is not going
to be the next pandemic, and that there's a strong
desire to stop the outbreak, and you know we're seeing

(11:41):
from the WHO, from the Africa CDC a really strong
message that this needs to be stopped. Now, I suppose
it'll depend on when that point's reached where it's no
longer global threat, then what happens. Are we going to
go back to what happened last year when the global
threat ended? The warld Hoth organized said this is no
longer a global emergency, and then things kind of went

(12:04):
back to the status quo, which basically meant nothing really
happened to stop the spread of mpocs.

Speaker 2 (12:10):
So there's a risk that there could be a false
sense of complacency and that could snowball into a much
bigger problem exactly.

Speaker 1 (12:18):
But I think that we've seen what that risk has
done now, so hopefully some of those lessons might be learned.
But this is a disease that, as we've spoken about,
has been spreading for a very long time. But you know,
there's been a push to end measles for years and
we still haven't reached that, and we're seeing more spread
of measles in high income countries as well. So I

(12:38):
think global health experts don't get their hopes up too much.

Speaker 2 (12:45):
This is the Big Take from Bloomberg News. I'm Sarah Holder.
This episode was produced by Adrianna Tapia and David Fox.
It was mixed by Blake Maples. It was fact checked
by Alex Sugia. Our senior producers are Naomi Shaven and
Kim Gettelson, who also edited this episode with Aaron Edwards
and Tom O'Sullivan. Our executive producer is Nicole Beamster. Bor

(13:07):
Sage Bauman is Bloomberg's head of Podcasts. If you like
this episode, make sure to subscribe and review The Big
Take wherever you listen to podcasts. It helps people find
the show. Thanks for listening. We'll be back tomorrow
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