The MPOX Wake-Up Call: Time to Decolonize Health

It began, as so many outbreaks do, with a sense of déjà vu.

In early 2024, as new cases of MPOX spread through the Democratic Republic of the Congo and neighboring countries, vaccines were already being distributed to Europe and North America. But across much of Africa—the region bearing the heaviest burden—clinicians waited months for doses to arrive. Hospitals ran short on protective gear, children went unvaccinated, and frontline health workers faced yet another epidemic without the tools they needed.

This stark delay wasn’t simply a matter of logistics. It was a window into the unfinished project of achieving health independence—and the urgent need to decolonize the process of making, financing, and distributing vaccines.

The Problem: A Familiar Pattern of Inequity

Between 2022 and 2024, high-income countries secured millions of MPOX vaccine doses while Africa received less than one-third of what was needed. Out of the 20.5 million required doses, only 5.6 million were allocated, leaving a 73 percent shortfall. Even when shipments came, rollout was slow: Nigeria’s first delivery arrived in August 2024; the DRC waited until September for 200,000 doses — months after Europe and North America had stockpiled their supplies

The reasons echo those of the COVID-19 era: limited purchasing power, donor-driven priorities, and dependence on global intermediaries such as the WHO and Gavi. Structural issues—weak supply chains, fragmented regulation, and chronic under-investment—magnified the gap.

The Evidence: What the Review Found

Researchers Adanze Nge Cynthia and Gordon Takop Nchanji reviewed 31 studies published between 2016 and 2024 to map how these inequities persist. Their findings reveal both structural and immediate causes:

• Colonial legacies left Africa reliant on imported pharmaceuticals, with limited local production capacity.
• Regulatory fragmentation across 50+ countries makes emergency approval and cross-border distribution painfully slow.
• Global market asymmetries—such as intellectual-property barriers—keep technology transfer in the hands of a few multinational firms.
• Workforce and infrastructure shortages constrain even well-funded manufacturing projects.

Together, these factors form what the authors call a “dependency loop”: outbreaks demand vaccines → Africa must import them → import delays worsen outbreaks → external donors reassert control.

Bright Spots: A New Architecture Is Emerging

Despite the obstacles, the continent is laying the groundwork for change.

Initiatives like Senegal’s Institut Pasteur, South Africa’s Biovac, and the Partnership for African Vaccine Manufacturing (PAVM) are building local production hubs. The African Union has set a goal for 60 percent of vaccines used in Africa to be produced within Africa by 2040s.

Regulatory capacity is also improving. The African Vaccine Regulatory Forum (AVAREF) now accelerates trial approvals from two years to under 60 days. The new African Medicines Agency (AMA), launched in 2021, coordinates standards across regions. As of 2024, eight countries—including Tanzania, Ghana, Egypt, Nigeria, Rwanda, Senegal, South Africa, and Zimbabwe—had achieved WHO “Maturity Level 3” regulatory status, meaning they can independently oversee vaccine safety and productions.

These institutions are more than bureaucratic milestones—they represent Africa’s growing ability to approve, produce, and distribute its own medical technologies.

Why Decolonizing Health Systems Matters

The authors argue that Africa’s vaccine inequity cannot be solved by technology alone.
Colonial economic structures, designed to extract raw materials rather than build industrial or regulatory capacity, still shape health outcomes today. In the DRC, for example, colonial policies intentionally suppressed local manufacturing. Today 90–95 percent of medicines are imported.

Decolonizing health systems means more than symbolism:

1. Local ownership of production and data
2. South–South partnerships instead of one-way aid
3. Community engagement to counter mistrust and hesitancy
4. Full technology transfer, not just “fill-and-finish” assembly contracts

When paired with strong regulation through AMA and AVAREF, these steps could help Africa transition from dependency to self-reliance — not only for MPOX but also for Ebola, malaria, cholera, and future unknowns.

What This Means in Practice

For governments and public health agencies

• Invest long-term in vaccine R&D, clinical-trial networks, and skilled manufacturing labor.
• Coordinate regional procurement through Africa CDC to pool demand and lower costs.
• Embed emergency-use pathways (like the proposed African Emergency Use Authorization Framework) to cut approval delays from months to weeks.

For international partners

• Support equitable technology transfer rather than donor-driven production.
• Revisit intellectual-property restrictions that limit Africa’s ability to scale.
• Prioritize public-health impact over market exclusivity.

For local communities and civil society

• Integrate traditional health networks into vaccination campaigns.
• Engage trusted messengers to overcome misinformation and hesitancy.
• Monitor equity in distribution to ensure marginalized populations aren’t left behind.

The Stakes: Health and Economics Intertwined

The DRC’s 2024 MPOX response alone cost millions in hospital surges, isolation centers, and supply shortages. Continental dependence on imports drains $4–7 billion each year that could instead fuel local industry. Developing domestic vaccine capacity would not only protect health but also generate high-tech jobs and regional resilience against supply-chain shocks.

Barriers Ahead

Progress remains uneven. Many countries lack sustained financing; donor priorities still dominate; and political will can fade once emergencies end. Market competition from cheap imports may undercut local producers, and quality-assurance systems must be scaled rapidly to meet WHO standards.

Yet, as the authors note, these are not insurmountable barriers—they are policy choices. Choosing to invest in sovereignty means choosing a future where Africa sets its own health agenda.

What’s Next

• The African Vaccine Manufacturing Accelerator (AVMA) has pledged $1 billion to expand production and regulation.
• AMA and AVAREF are piloting continent-wide reliance mechanisms to share regulatory data and speed approvals.
• South-South collaborations with India, Brazil, and Indonesia are creating new blueprints for affordable biotech exchange.

If sustained, these efforts could make MPOX the last epidemic where Africa waits in line for vaccines it helped test.

Reflection: Turning Dependency into Power

The authors conclude with a provocation:

“MPOX should serve not only as a warning but as a turning point toward health sovereignty.”

Public health leaders have the data and the momentum. The question is whether they have the political will to act.

Discussion Questions

• How might your organization support local manufacturing or data-sharing initiatives?
• What incentives could make regional procurement sustainable beyond emergencies?
• Does your funding or policy framework still reinforce dependency—or help dismantle it?