The current mpox outbreak in South Africa, our second since 2022, is more than just a health crisis; it’s a stark indicator of deeper systemic failures. Despite over days passing since the second outbreak began, and an unbelievable days since the first—when most world governments acted swiftly to make vaccines available and introduced routine vaccinations—our government has yet to implement a vaccination strategy, let alone secure the vaccines needed to protect our citizens. This delay isn’t just an administrative oversight; it’s a critical failure that puts lives at risk and undermines the public’s trust in our healthcare system.
The Constitution guarantees the right to access healthcare services, yet here we are, in the midst of a preventable outbreak, with no clear path forward. This situation is symptomatic of a broader, more troubling pattern. As climate change accelerates, the frequency and severity of outbreaks like this one are only going to increase. If we can’t manage a relatively small outbreak like this, how will we cope with the larger, more complex challenges that lie ahead?
According to the Professor Helen Rees, co-chair of the Incident Management Team, we need 40 000 vaccines to tackle the current outbreak — so far we have 0.
This website documents my ongoing efforts to obtain information and accountability from those responsible for safeguarding our health. The lack of meaningful responses highlights the urgent need for a coordinated, proactive approach to public health. The lessons we fail to learn today could have dire consequences tomorrow.
Update, 10 April 2025
Gauteng residents have been urged to take precautionary measures to protect themselves from the Mpox virus.
The province has reported seven (7) cases, of a more severe variant, after six (6) months of not reporting any new cases. All the cases are from the Ekurhuleni District in Brakpan, Vosloorus and Katlehong. Of the 7 cases, three (3) are females and four (4) were males including a 14-year-old teenager.
Unlike the previous outbreaks that happened in 2022 and 2024 where the circulating clade was clade II which has a lower mortality rate and less virulence, the recent cases reported in the province all tested positive for clade I which is highly infectious with a mortality rate of 10%.
This variant has spread widely in African regions such as the DRC, Rwanda and Kenya.
Update, 13 September 2024
On 11 September 2024, the National Department of Health (the Department) responded to my Promotion of Access to Information Request (a PAIA request). PAIA gives effect to the constitutional right of access to any information held by the Stat. In my request, I asked for “minutes, meeting notes, reports, emails, notices and related records relating to mpox and the mpox vaccine”. In fulfilling my request, the Department sent me a press release - a single press release, and not even the latest.
It’s difficult to determine if the Department is just being arrogantly dismissive of my application, or if they are riddled with incompetence. My suspicion is that it is both. The Department has no plan, has no policy, and has no idea what they are doing. If they cannot take a constitutional obligation to provide access to simple information seriously, how can we expect them to take the Constitutional Right to Health seriously?
The press release from 9 September 2024 announcing the 25th case for this latest outbreak described the patient as having had “no recent international travel history nor contact with a suspected or confirmed mpox case”. I don’t think the Department had fully applied their mind to the implications of making such a statement, which suggests that mpox just randomly appears out of the air.
But this is not surprising. The current belief amongst health experts is that the Department had simply hoped that the current outbreak would fizzle out without anything needing to be done. But the level and socioeconomic class of patients has completely thrown their “thoughts and prayers” approach to health care into a tailspin.
How are we to believe that the Department has this outbreak actually under control? What is simmering below the surface? What does Helen Rees know that the Department is not telling us? How can there be “only” 25 cases, yet we need 40 000 vaccines? Even if the 40 000 is a drastic over estimate, the National Department of Health wants to take over the health care needs of 63 000 000 South Africans and is wholly incapable of procuring just 40 000 vaccines.
Why should we make such a fuss over a handful of cases, for a relatively nonfatal disease? Because this is the same National Department of Health that wants to roll out National Health Insurance. If a National department cannot handle a localised infection that is near 95% treatable with a common and routine vaccination for a handful of people, how is this same Department expected to handle a National health insurance plan?
Nearly 4 thousand people a week are searching for information on a mpox vaccine in South Africa. Every single one of those individuals is being failed by their Government.
Update, 3 October 2024
On 30 September 2024, the South African Health Products Regulatory Authority (SAHPRA) responded to my PAIA application for information they have on the mpox vaccine:
SAHPRA has considered your request, but unfortunately, SAHPRA is unable to provide information for the following reasons:
- no records of Section21 applications for the Mpox vaccine
- no records of a registration number for the Mpox vaccine
Why is this important? Before any medicine can be sold in South Africa, it must be approved by SAHPRA, which ensures that the medicine is safe, of good quality, and effective. Without this approval, a medicine cannot be legally sold. However, in exceptional cases, SAHPRA allows access to unregistered medicines under a process known as a "section 21 application".
Section 21 applications are typically used in situations where there is no registered version of a medicine in South Africa, but access is urgently needed to address serious health issues. One example is the use of a section 21 application at the beginning of the COVID-19 pandemic in South Africa, when health care workers were granted access to initial vaccinations before they were fully registered. This process allows for potentially life-saving treatment when standard approval processes may take too long.
The fact that there has been no section 21 application for an mpox vaccine is a serious concern. It highlights that not only is there no registered treatment for mpox in South Africa, but there hasn’t even been an attempt to secure access to one.
Demand Accountability Now! The government claims there’s no demand for vaccines. Click below to prove them wrong and make your voice heard.
Demand action from Minister MotsoalediThe below are all the emails I have sent, along with the responses.
Hi All,
Thank you for your mails over the last couple of months. Some of you have been incredibly helpful, and most of you have not.
Going forward, I do not see the point in engaging with the Government. It is a futile effort. 791 days since mpox first landed in South Africa (when most governments started implementing routine vaccinations still available to this day) and 104 days since the second outbreak, my Government does not yet even have a vaccination strategy, never mind actual vaccines.
I do not know how this will end, but I can be assured, that even 6 months from now, there will not be vaccines.
Despite mpox being endemic on the continent, and despite climate change only going to accelerate the frequency of outbreaks, here we are.
The handling of this small outbreak is a symptomatic of the much larger failings with the National Department of Health.
To quote the late Chief Justice Arthur Chaskalson:
“We live in a society in which there are great disparities in wealth. Millions of people are living in deplorable conditions and in great poverty. There is a high level of unemployment, inadequate social security, and many do not have access to clean water or to adequate health services. These conditions already existed when the Constitution was adopted, and a commitment to address them, and to transform our society into one in which there will be human dignity, freedom and equality, lies at the heart of our new constitutional order. For as long as these conditions continue to exist that aspiration will have a hollow ring.”
Nearly 30 years later, the hollow ring is deafening.
Rest assured, I will continue to wash my hands and eat beetroot, hoping for the best.
In the meantime, I have started documenting our conversations here: mpoxupdates.co.za
Please may I get an update on the below PAIA application.
Kindly find attached, the latest statistics on mpox in the country, as requested.
I am not well placed to answer the questions; we are currently awaiting information from the National Incident Management Team (IMT) on the procurement of the vaccine and the vaccination strategy. I am copying in ----- from the National Department of Health who might be able to respond.
We will announce once vaccine is available, how the vaccination programme will unfold. That decision will be informed by data at our disposal.
Please be assured that this issue is being addressed. We are currently working with partner organisations to secure access to mpox vaccines. If we do get access to the vaccines, and bearing in mind that there is a limited supply in South Africa, we would likely first target the most high-risk individuals, particularly those who are immune compromised. We will update the community and our clients as soon as we have any news.
Given the ever increasing reported cases on mpox on the continent, I am mailing to ask if the peace keepers that we deployed across the continent have been or are going to be vaccinated against mpox?
Has the National department of health also dragged their feet for the SANDF, or is this an ordinary citizen problem?
I have been struggling to get any information of out the National Department of Health regarding mpox.
I wonder if you have any advice on how I may proceed?
Despite reaching out to the TAC and Section27, they have not made any contact.
I have come to learn that the National Department of Health has secured vaccines for mpox.
Have there been any contact by NDoH and yourselves? Have you made any contact with NDoH regarding the mpox vaccine?
I have been struggling to get information out of the national department of health, and wonder if there has been any communication, planning etc between National and Provincial health departments with regards to mpox?
Apparently National has secured vaccines, has there been any plans to allow people to be vaccinated?
I'm not clear on where the lines lie, so any guidance would be greatly appreciated.
I have come to learn that the National Department of Health has secured vaccines for mpox.
Have there been any contact by NDoH and yourselves? Have you made any contact with NDoH regarding the mpox vaccine?
Trust you are well.
I see the Africa CDC has declared "the ongoing Mpox outbreak a Public Health Emergency of Continental security".
Again I reiterate that I am glad you have vaccines and ask:
What steps do I need to follow in order to get the vaccine?
It may be worthwhile pointing out that a vaccine, according to the World Health Organisation, "is a simple, safe, and effective way of protecting you against harmful diseases, BEFORE you come into contact with them". Note that I added the emphasis because I'm starting to feel like the Department is Health doesn't quite understand how preventative health care works.
If you are unprepared or incapable of answering my question, could you at least have the courtesy to say so and direct me to someone who can.
Let me also remind you I have a constitutional right to health care services, and that the state has an obligation to take reasonable legislative and other measures to progressively realise the right of access to health care services. Given the demographics of the cases that have been reported on thus far, I'm starting to wonder if there is purposeful feet dragging. Let us remember that there is also the right not to be discriminated against on the basis of sexual orientation.
Finally, I asked over a month ago if vaccination sites have been identified. Given they have not been, I do not buy the argument that you are concerned about demand - as there is currently no where to even register to request a vaccination and thus indicate demand.
Please see the attached PAIA application.
I'm so glad that you have vaccines.
Please detail the steps I need to follow in order to get a vaccine.
Please note that the current supply in terms of vaccines matches the current demands in terms of the rate of transmission or positive cases of mpox, we have vaccines, unless you know patients who were diagnosed and were not put on treatment. Our response efforts are informed by epidemiological surveillance data. We will always try to avoid what we experience with COVID-19 when we secured more vaccines to safe lives, but the appetite was very low amongst the citizens.
Unfortunately, there is no documentation to provide.
I hope the response is sufficient, but feel free to make a follow if you need clarity.
Could I please get an update on any of the below questions, and perhaps an update on when vaccines will be available.
Trust you and team are well.
May I please get an update on how far along the process is for securing mpox vaccines?
Could I ask for a follow up on my mail below with regards to help with a PAIA application?
Could I get a follow up on my request below.
I strongly suspect that the NDoH has been dithering because mpox affects a minority group, and your response would be greatly appreciated for a future SAHRC complaint.
Could I get a follow up on my request.
I strongly suspect that the NDoH has been dithering because mpox affects a minority group, and your response would be greatly appreciated for a future SAHRC complaint.
Thank you so much for your response.
It puts me much at ease to know that work is happening on securing mpox vaccines.
If you don't mind, I think I shall check back with you in a couple weeks to find out how far along we are.
Hope you are well.
Please could I get a response to my question below.
I understand that there has been engagements with SAHPRA, which gives some relief. But I would imagine that that is one of many steps, and that those other steps lie directly with the health department.
Answers, with supporting documentation, would be greatly appreciated.
Thank you for your correspondence regarding the possible registration/Section 21 authorisation of Mpox vaccines.
The National Department of Health’s (NDoH) strategy to manage the outbreak is with supportive treatment and handling of complications. The NDoH will also procure the Mpox vaccine. It is currently working with SAHPRA to ensure that a safe, efficacious and quality-compliant vaccine is made available. These stakeholders are working together to ensure that an evaluation is conducted before the vaccine is authorised or registered. This is in preparedness for an increase in the number of confirmed cases of Mpox.
I am currently attempting to engage with the National Department of Health to understand when, or even if, they will be procuring mpox vaccinations.
I am emailing to ask for guidance or assistance to draft a PAIA application to the department requesting minutes, notes and briefings related to the departments planning and discussions of mpox.
I've never made a PAIA application before, and I'm not too sure of what exactly I can ask for, and what the right words are. Hence my reaching out to you.
Any guidance would be greatly appreciated. I would understand if this is not something that you can assist with.
I wish to know if the national department of health and SAHPRA have had any engagements about the registration or procurement of mpox vaccines? My very poor understanding is that there is a Section 21 involved, and that SAHPRA would be involved in that.
I am not to sure if I am emailing the right person, and if not, your assistance with the correct details would be greatly appreciated.
Thank you so much for your response. I'm glad to hear that lessons were learned, and the department is taking this latest outbreak relatively seriously.
I do think though that my original questions went unanswered.
If securing vaccines "simply means considering procuring", then when is the department going to stop considering and actually procure? I get the feeling that you are either waiting for this to get worse, or simply go away.
So again, if you're waiting for it to get worse, then how many people have to die before it fits the criteria of "worse"? If you are hoping it just goes away, then say so.
When is a decision to procure actually going to be made? I understand that there are regulatory processes that need to be complied with, so has any of this actually started? Have any potential vaccination sites been identified? Of the organisations I have spoken to, there has been no outreach from the department. Has the department made any attempt to ascertain demand?
I think in essence my question is: When will vaccines be available in the Republic so that I can go to either my primary care provider or local sexual health organisation to actually get vaccinated? There is no need for the department to plan a mass vaccination campaign to make this happen.
If you do not know when, then can you at least say that the process has started (and what this process is), and that the department is not just dithering and hoping for the best.
Finally, I'm glad the department is ensuring that funeral services don't become superspreader events, but, and I don't know if you know this, there are numerous spaces, both private, public, and online, that are dedicated to MSM physically touching each other in large numbers - which can become super spreader events far more readily than funerals. I know your first reaction will be to want to shut these places down - as we, the public, also learned lessons from Covid-19 - but that is futile, and vaccinations are the only sustainable solution.
It is my understanding that the National Department of Health is considering procuring mpox vaccines.
Have you had any contact with the department? Either them to you, or you to them, with regards to mpox vaccines?
It is my understanding that the National Department of Health is considering procuring mpox vaccines.
Have you had any contact with the department? Either them to you, or you to them.
Please note that as part of pandemic preparedness, the country like other countries has to prepare for the worst scenario and Covid-19 taught us a lesson. We need to prepare for prevention and infection control of diseases during the outbreak, we need to guide on the proper the handling of human remains of those who passed on due to infectious diseases because funerals services have potential to become super spreader events.
Our decisions are scientifically based, meaning that the number of treatment and vaccines to be procured is informed by the level of local transmission and severity of the diseases. Also, the implementation of vaccination programme is informed by the level of risk amongst the populations, as we did during Covid-19.
Lastly, securing vaccines simply means considering procuring vaccines which is very limited around the world because mpox is not endemic in most parts of the world. However, once a decision is made to procure, we will only procure limited doses for a number of reasons and see an uptake.
I hope this answers your questions.
Feel free to seek clarity when you don't understand.
Please may ask for an update on the questions below.
Further to that, I reference the media statement issued on 25 June 2024, where "The department, working with provinces and other stakeholders in the sector, has embarked on health education with funeral parlours on how to handle the human remains of demised due to suspected and confirmed mpox."
Given you are preparing for more deaths, my second question on the maximum number of numbers the department is happy to allow before there is a need for vaccines becomes even more pertinent.
In a Media Statement from Thursday, 20 June 2024, the Department indicated that "The process to secure more treatment including vaccine is underway in case the need arises."
May I humbly ask the following questions:
1. What does it mean for a "process" to be started? Are there any timelines for when this process will actually yield results, or is it currently just thoughts and prayers?
2. What does it mean to secure vaccines "in case the need arises"? I and many others want to be vaccinated against MPox, does that not indicate a need? Or is there some maximum number of MSM the department is happy to let die of an entirely preventable a disease before there is a need? If so, please may you let me know what that number is.
I understand that this has been an issue for nearly three years, so will have taken then department by surprise, but I am eagerly looking forward to your reply.
The table below shows the number days since the relevant member of parliament, government department, or organisation replied to an email. In many instances, there has never been a response.
+Has never responded to an email
*Member of the National Assembly Portfolio Committee on Health
**Member of the National Assembly Portfolio Committee on Defence and Military Veterans
hello@mpoxupdates.co.za