Mobilizing Municipalities Against Mpox in East Africa Hubs

Context

The spread of mpox – recently designated as both a Public Health Emergency of Continental Security and a Public Health Emergency of International Concern – demands urgent and coordinated action.

Key transit hubs and port cities within the East African Community (EAC) ¹ are on the front lines of this growing threat. Municipalities and cities across Kenya, Burundi, DRC, Rwanda, Uganda and Tanzania are currently at acute risk of mpox transmission.

These municipalities are crucial in the region’s trade and transportation networks, as high-traffic intersections through which goods and people flow. They are host to high-risk populations, including long-haul truck drivers, farm workers and sex workers.

The extensive mobility and close contact inherent in these professions puts workers and surrounding communities at significant risk. The disease is spread through close contact with an infected person and is known for causing painful, pus-filled lesions, severe illness or, in some cases, death.

The Africa CDC and WHO launched a joint continental response plan for Africa. Given the strategic importance of these municipalities in EAC, their proactive participation is critical to operationalizing and supporting this strategy.

Crucially, with 367 confirmed mpox cases, including 3 deaths, reported across Southern and Eastern Africa ² in September, the time for action is now.

At-Risk Communities

The EAC has an estimated 500,000 long-haul truck drivers who regularly travel between key transit hubs across the region, with many spending over 14 days on the road from Kinshasa to Dar es Salaam.

The municipalities through which these workers travel are also home to large numbers of farm workers and sex workers, who are at higher risk of transmission due to the close contact inherent in their work. Truck stops, farms and urban centers where sex work is prevalent pose opportunities for mpox to spread, whilst contaminated objects like towels, clothing and personal hygiene items can also carry the virus. Aside from vaccines and other medical countermeasures, this underscores the importance of safe WASH practices.

Call To Action

As the threat of mpox grows, key transit municipalities do not have the luxury of waiting for the full implementation of the strategies being developed by Africa CDC and WHO. These workers and surrounding communities are facing a perfect storm, with high-mobility and close contact professions putting them at increased risk. Immediate, proactive action is needed to protect communities and the region at large.

We are calling on municipal leaders — particularly those of key transit cities and towns ³ — to convene joint emergency meetings with key stakeholders to mobilize funding and resources to begin rolling out critical interventions. Stakeholders include relevant private sector actors and trade unions and East African philanthropy, as well as regional organizations.

By pooling resources, sharing costs and engaging the private sector, municipalities can ensure that the necessary medical countermeasures and community-based interventions are in place to combat mpox effectively. This coordinated approach not only mitigates the immediate threat and helps prevent the uncontrolled spread of mpox, it also strengthens the overall resilience of the region’s public health infrastructure, safeguarding both the health and economic stability of the East African Community.

Immediate Steps

Municipalities must ensure availability and deployment of effective medical countermeasures to tackle transmission and spread, including:

PPE and WASH supplies

Personal protective equipment (PPE) includes gloves, masks and face shields which could cost approximately $0.60 per mask and $1 per pair of gloves when procured in bulk. Distribution must prioritize frontline health workers and high-risk groups.

WASH supplies must include hand sanitizers, soap and water purification tablets. Mpox can also be spread through shared personal items such as towels, clothing and toothbrushes, so care packages should include these items. Setting up a mobile handwashing station costs around $500 per unit and individual hygiene kits could cost $10 to $15 per kit.

Condoms

Building on successful HIV prevention strategies, municipalities should ensure the widespread availability of condoms, which are vital in reducing the risk of mpox transmission. Condoms also limit the spread of other STIs whose interaction with mpox could aggravate complexity in treating the disease. The cost of condoms, when procured in bulk, can be as low as $0.03 per unit.

Care Packages

Care packages should contain PPE, WASH supplies and condoms, as well as educational materials about mpox. Care package costs an estimated $20.

Municipalities must strengthen community health worker (CHW) networks by:

Immediate Training and Deployment of CHWs

CHWs are essential in reaching high-risk populations. Investment in training them on mpox prevention, symptom recognition and case reporting is crucial. Training costs can be estimated at $100 per CHW.

The deployment of CHWs, including their transport and daily allowances, might require an estimated $20 per day per worker.

CHW-Led Community Engagement

Regular visits to truck stops, farms and areas where sex workers operate should be conducted by CHWs. These visits are essential for distributing care packages and providing education. A small-scale engagement initiative could start with $5,000 per municipality.

Municipalities must enhance community-based surveillance and reporting through:

Digital Surveillance Tools

Investments is needed in digital tools that enable CHWs to report suspected mpox cases in real-time. These tools can be integrated with national health databases to ensure timely responses to outbreaks. Tools ready to be deployed for truckers include the RECDTS App. Others may exist for CHWs.

CHWs must be trained on using digital tools to collect data on symptoms, report cases and monitor the health status of individuals in high-risk groups.

Community Reporting Networks

Network of CHWs must be leveraged to establish community reporting networks where individuals can report symptoms or concerns anonymously. This approach has been effective in previous health crises, allowing for early detection and containment of outbreaks.

Cross-municipality cooperation is needed to implement pooled procurement and cost-sharing. Municipalities must collectively establish:

Pooled Procurement Mechanism for Medical Countermeasures

Measures must include PPE, WASH supplies and condoms, allowing municipalities to benefit from economies of scale to reduce costs overall.

Municipalities across the EAC should contribute to a central procurement fund managed by the EAC Secretariat. This fund would handle the bulk purchasing of supplies, ensuring that all participating municipalities receive a fair allocation based on their population size and risk level.

Cost-Sharing Arrangements

Cost-sharing arrangements must be predicated on wealthier municipalities or those with more robust budgets contributing more to the procurement fund, subsidizing the costs for smaller or less financially capable municipalities. This ensures equitable access to essential supplies across the region.

Municipalities can also explore public-private partnerships (PPPs) to fund the procurement and distribution of supplies, involving local businesses and multinational corporations operating in the region.

The private sector can play a role in financing municipality led prevention and protection strategies. Municipalities should make use of:

Private Sector Partnerships:

Invitations to private sector organizations should include prominent businesses like the Mo Dewji Foundation and MeTL Group.

Organizations can provide financial support, donate supplies or offer logistical assistance for distributing medical countermeasures.

Companies involved in logistics and transport, such as those managing truck fleets, can play a critical role by ensuring that their drivers are educated on mpox prevention and are equipped with care packages.

Corporate Social Responsibility (CSR) Initiatives:

Encourage businesses operating in key transit municipalities to integrate mpox prevention into their CSR initiatives. This could involve sponsoring public health campaigns, funding CHW training or providing mobile health clinics at truck stops and farms.

Involve the private sector in the pooled procurement process by offering them opportunities to supply goods and services. This will boost local economies while addressing public health needs.

Committees and Policy Instruments Available

The EAC has established several policy instruments and committees that provide a framework for coordinated action among municipalities. These include:

The Urban Development and Human Settlements Sectoral Committee:
This committee focuses on urban development, housing and municipal management. It is well-positioned to support municipalities in implementing health-related urban planning and infrastructure projects, especially those aimed at preventing and controlling disease outbreaks like mpox.

The East African Local Governments Association (EALGA):
EALGA serves as a coordinating body for local governments within the EAC, facilitating cooperation and capacity building. Municipalities can leverage EALGA to share best practices, pool resources and ensure a unified approach to public health emergencies.

Cross-Border Health Collaboration Protocols

These protocols are designed to facilitate seamless cooperation between municipalities and national governments, particularly in managing cross-border health risks. Municipalities can activate these protocols to enhance their surveillance and response efforts against mpox.

These policy instruments may prove useful for the design of coherent response efforts, ensuring that they are aligned with regional strategies and best practices.

Conclusion

Key transit municipalities in EAC are home to workers and communities facing an acute risk of mpox transmission. There is an immediate and critical need to protect these people from the risk mpox poses as well as safeguarding the region as a whole. Mpox has already shown its capacity to spread across borders and continents, making it a significant threat to public health and economic stability in the EAC region and beyond.

In order to prevent the uncontrolled spread of mpox and safeguard the health and stability of the region, key transit municipalities must take immediate, proactive steps to protect their communities and the region at large.

The time for action is now.

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References

1. The East African Community – is a regional intergovernmental organization comprising of eight partners States, including the Republic of Burundi, Democratic Republic of Congo, Republic of Kenya, Republic of Rwanda, Federal Republic of Somalia, Republic of South Sudan, Republic of Uganda and United Republic of Tanzania.
2. In Southern and Eastern Africa, about 367 confirmed mpox cases, including 3 deaths, have been reported in 5 countries, including Burundi (328), South Africa (24), Uganda (7), Rwanda (4) and Kenya (4) as of 2 September. Experts estimate the actual numbers could be higher.  Source: https://reliefweb.int/report/burundi/southern-and-eastern-africa-mpox-situation-snapshot-3-september-2024
3. Municipalities include Lubumbashi, Bukavu and Goma (DRC), Bujumbura (Burundi), Kigali (Rwanda), Kampala and Jinja (Uganda), Malaba/Busia Town (Kenya-Uganda border) and Arusha, Tabora and Dodoma (Tanzania). Port cities include Mombasa (Kenya) and Dar es Salaam (Tanzania).