Six African nations sit on a waiting list for Mpox vaccines that don't exist. Ethiopia, Malawi, Tanzania, Ghana, South Sudan and Guinea have all joined the queue for doses that global suppliers can't immediately provide, exposing a crisis that threatens to derail months of progress against the disease.

This shortage arrives as the continent grapples with an explosion of four major health emergencies – Mpox, cholera, dengue fever and measles.

The Africa Centres for Disease Control and Prevention (CDC) warns that funding shortfalls and manufacturing gaps have left member states dangerously exposed to the threat of public health catastrophes.

"Vaccination is progressing, although we are reaching the point where there won't be enough doses to allocate to countries that need them the most," Dr Yap Boum, deputy incident manager for continental Mpox response at Africa CDC, tells TRT Afrika. "This is a big challenge that we have to solve."

Till the beginning of July, Africa CDC recorded 25,175 suspected Mpox cases and 574 deaths from the viral zoonotic disease across 23 countries on the continent.

While three million vaccine doses have been mobilised, their availability is currently restricted to 11 countries. Of them, only seven are actively vaccinating. The remaining four purportedly lack the resources to distribute doses across territories.

UNICEF needs US $33 million to purchase 500,000 Mpox vaccines for distribution. The shortage of funding to meet this target underscores the deeper vulnerability of Africa's dependence on external medical countermeasures, including vaccines.

"We don't have the continental capacity to manufacture the vaccines and other medical items we need. That's one of the things we need to push for," says Dr Kyeng Mercy, epidemic intelligence unit lead at Africa CDC.

Shot in the arm

Amid the grim data, Uganda has emerged as a success story in Mpox vaccination, utilising 96% of its initial 100,000 doses through targeted campaigns. The country recently received 97,000 additional doses to focus on the remaining disease hotspots.

"The idea was to contain the spread of the disease with the first 100,000 doses and also assess the vaccine response before the next phase," explains Dr Boum.

Sierra Leone, which has recently reported a surge in Mpox infections, started the third phase of its immunisation drive with a target of vaccinating 70,000 people within 10 days.

However, while effective vaccination strategies exist, supplies seem to be unable to keep up with the demand.

“Vaccines are available with manufacturers, but funding to acquire them is a problem. That's what we are missing," says a healthcare official.

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Cholera's rapid spread

As Mpox dominates headlines, cholera has been silently devastating communities across 21 African nations. By the end of June, the continent's disease burden had reached 175,586 suspected cases and 3,553 deaths this year alone.

The Democratic Republic of Congo (DRC), Sudan, South Sudan and Angola have borne the brunt of the cholera outbreak. In the DRC, conflict-ridden South Kivu province has been battling concurrent outbreaks of cholera, Mpox and measles.

"The challenge for South Kivu is a lack of access. There are areas to which we are unable to deliver medical supplies despite having stocks. The other big challenge is a lack of clean water," says an aid official.

The disease has spread to North Kivu, Haut-Katanga, Haut-Lomami and Tanganyika provinces. Kinshasa, the capital, has also reported an alarming number of infections.

Manufacturing hiccups

The pandemic highlighted Africa's vaccine dependence like never before, prompting African leaders to commit themselves to establishing local manufacturing capacity at scale.

At the African Union summit last year, delegates decided to create a pooled procurement mechanism, backed by Afreximbank and the United Nations Economic Commission for Africa, to address vaccine requirements for public health emergencies.

In June 2024, a $1.2 billion African Vaccine Manufacturing Accelerator (AVMA) was launched, providing funding over 10 years to boost commercially viable vaccine production. Afreximbank has pledged an additional $2 billion for the manufacturing of health products.

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Last October, an Africa CDC study identified 25 active vaccine projects across the continent. Five manufacturers now have commercial-scale facilities with technology transfers underway. Another five await technology transfers, while 15 remain in early development stages.

By 2030, installed capacity could reach 1.4 billion doses annually, potentially surging to two billion during emergencies. Between 2025 and 2030, three African manufacturers expect to produce nine different WHO-prequalified vaccines.

While the continent possesses the ambition – and increasingly the means – to achieve vaccine independence, what it lacks is the certainty that when production lines start rolling, buyers will materialise.

Until that equation balances, the uncertainty surrounding vaccine availability when needed could persist.