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Speaker 1: Bloomberg Audio Studios, podcasts, radio.

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Speaker 2: News, Mozart had it. So did Beethoven and George Washington

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Speaker 2: and Abraham Lincoln. For nearly three thousand years, smallpox wreaked havoc,

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Speaker 2: killing a third of people who were infected and severely

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Speaker 2: disfiguring many others.

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Speaker 3: Becauesn't hear that most of the fatal cases of smallpox

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Speaker 3: have occurred.

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Speaker 2: Even though a vaccine, the world's first vaccine was created

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Speaker 2: in seventeen ninety six, it took hundreds of years to

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Speaker 2: figure out how to get it to enough people.

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Speaker 3: The focus, of course, is on Bradford, where tens of

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Speaker 3: thousands of people have waited their term for vaccination.

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Speaker 2: A concentrated effort to vaccinate the world against smallpox started

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Speaker 2: in nineteen fifty nine. Two decades later it had mostly succeeded.

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Speaker 4: In October, the Somaria smallpus Eraducation Program recorded the last

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Speaker 4: case in Merga Town and is similar to me that

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Speaker 4: this was the last known case of smallpox in the world.

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Speaker 2: By nineteen eighty, health officials announced that smallpox was officially eradicated,

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Speaker 2: and with that came the end of the vaccination push

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Speaker 2: that had led to one of the greatest achievements in

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Speaker 2: public health history. But that achievement also had some unintended consequences.

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Speaker 1: We had the smallpox vaccines, and that actually also protected

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Speaker 1: against empos. When we eradicated smallpox, stop giving people smallpox vaccines,

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Speaker 1: that's when we started to see empox cases rise in

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Speaker 1: certain countries in Africa.

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Speaker 2: Ashley Furlong is a health reporter for Bloomberg. She says

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Speaker 2: that empox has been infecting humans in West and Central

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Speaker 2: Africa with increasing frequency since it was first reported in

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Speaker 2: a nine month old boy in the Democratic Republic of

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Speaker 2: Congo in nineteen seventy.

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Speaker 1: It's been spreading in Africa for decades. It's called endemic

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Speaker 1: at the moment because you know, it's sort of constantly there,

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Speaker 1: it's not sporadic.

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Speaker 2: Allowing that spread and not instituting a comprehensive vaccine program

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Speaker 2: has allowed the empox virus to mutate. Now a dangerous

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Speaker 2: news strain has been detected in at least six African countries,

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Speaker 2: and the world is watching.

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Speaker 3: The World Health Organization declares an MPO's outbreak in Africa

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Speaker 3: a global health emergency as it seems to contain the

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Speaker 3: potentially deadly.

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Speaker 2: Virus vaccinations are part of the key to getting this

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Speaker 2: outbreak under control. But things are different today from when

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Speaker 2: the world beats smallpox, and public health experts are saying

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Speaker 2: that the worst part about EMPOS being back on the

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Speaker 2: map is that it was entirely avoidable.

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Speaker 4: This is something that should concern us all.

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Speaker 2: Today. On the show Missed Warnings one hundred dollars, vaccines

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Speaker 2: and red tape, why the latest empox outbreak didn't have

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Speaker 2: to happen like this and what it will now cost

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Speaker 2: to beat it. I'm Sarah Holder, and this is the

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Speaker 2: big tape from Bloomberg News.

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Speaker 1: So that epicenter of where we're seeing the spread is

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Speaker 1: in the Democratic Republic of the Congo. We're seeing it

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Speaker 1: in neighboring countries as well, and then we see a

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Speaker 1: couple of cases in European countries. We saw one in Sweden,

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Speaker 1: and then we also saw one outside of Africa and Thailand.

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Speaker 2: Bloomberg's actually Furlong says, the epicenter of this current empox

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Speaker 2: outbreak is in the country where the virus was first spotted, Congo.

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Speaker 2: And one thing that's notable about this particular outbreak is

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Speaker 2: how EMPOKS is spreading.

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Speaker 1: So what we've been seeing at the moment is that

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Speaker 1: it's being transmitted off and through sexual contact, but it

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Speaker 1: could be through you know, just touching a friend or

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Speaker 1: you know, sharing bed sheets with someone who has been

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Speaker 1: infected by the virus.

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Speaker 2: And what is an EMPOC case look like? What does

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Speaker 2: it do to the body.

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Speaker 1: A lot of the symptoms are kind of like any

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Speaker 1: old virus that you might get and could be you know,

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Speaker 1: confused with another virus. But I think what is quite

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Speaker 1: significant about empocs are these lesions that you get sort

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Speaker 1: of small sores, kind of like chicken pox, and that

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Speaker 1: we've seen a few cases where actually they thought it

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Speaker 1: could be EMPUCS, but it turned out to be chicken pox.

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Speaker 1: So I think that the little round lesions that you

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Speaker 1: see on people with EMPUCS, that's sort of a strong

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Speaker 1: attribute of empucs. But otherwise it can cause people to

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Speaker 1: sort of feel unwell, tired, things that you might get

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Speaker 1: with another kind of virus.

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Speaker 2: Historically, EMPOS has shown a limited ability to spread. The

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Speaker 2: virus has mostly been transmitted from animals to humans, like

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Speaker 2: from eating bush meat, and amongst humans in very close proximity,

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Speaker 2: like those who live in the same household or share

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Speaker 2: the same bedsheets, but that's changed with this latest outbreak,

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Speaker 2: which began in December with the emergence of a news

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Speaker 2: strain called clade one.

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Speaker 1: Be we're seeing is sort of a change in transmission

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Speaker 1: and it's spreading from human to human in these long

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Speaker 1: chains of transmission, and that's what scot scientists really quite worried.

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Speaker 2: Can it be fatal?

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Speaker 1: It can?

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Speaker 2: The key thing to know about this outbreak is that

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Speaker 2: it's different from the one that happened in twenty twenty two.

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Speaker 2: That year saw the first ever global outbreak of the virus,

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Speaker 2: and fresh off the heels of the COVID nineteen crisis,

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Speaker 2: the US and Western Europe acted fast.

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Speaker 1: We saw vaccines rolled out to at risk communities, which

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Speaker 1: at that time was mainly men who have sex with men,

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Speaker 1: and we were seeing the transmission within those communities. There

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Speaker 1: was a lot of public health messaging as well around

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Speaker 1: safe sex practices about how impos is transmitted, how to

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Speaker 1: stop it being transmitted.

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Speaker 2: That messaging and those resources seem to work in some places,

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Speaker 2: particularly in the US, which had stockpiled vaccines.

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Speaker 1: The US has always been really worried about a smallpox

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Speaker 1: outbreak potentially, and this vaccine is effective against smallpox, so

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Speaker 1: that's why they had those contracts and why they had

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Speaker 1: those stockpiles.

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Speaker 2: But Ashley says in Congo and other African countries where

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Speaker 2: empos is endemic, the response was different.

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Speaker 1: In many African countries, empo's case has continued to appear

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Speaker 1: and vaccines never arrived.

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Speaker 2: There.

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Speaker 1: You know, public health messaging around stopping empocs. There might

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Speaker 1: have been that messaging, but there's obviously many other priorities

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Speaker 1: when you're a country like the DRC, like Congo where

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Speaker 1: measles kills way more people than empocs does, So there's obviously,

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Speaker 1: you know, different priorities that governments have when handling health crises.

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Speaker 2: Another factor governments have to contend with is the price

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Speaker 2: of the empo's vaccine. How much do those shots cost.

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Speaker 1: So there's several vaccine developers who have empox vaccines, and

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Speaker 1: the one that is approved in the US and in

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Speaker 1: Europe is from Bavarian Nordic and we don't have an

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Speaker 1: exact price because the company hasn't actually revealed how much

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Speaker 1: they're charging for their shot, but the Africa CDC estimates

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Speaker 1: that it's about one hundred dollars a dose and you

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Speaker 1: need two doses to be fully vaccinated against the virus,

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Speaker 1: so that's quite pricey. Vaccines are normally, you know, quite cheap.

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Speaker 2: In mid twenty twenty, the US government was able to

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Speaker 2: buy COVID nineteen vaccines for about twenty dollars a dose.

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Speaker 2: So I asked Ashley what makes the EMPOS vaccine five

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Speaker 2: times as expensive. She said there was one main reason.

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Speaker 1: There's not a huge market for them, you know, emparcs.

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Speaker 1: We might see there's obviously are quite a few cases,

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Speaker 1: and there's currently a global health emergency around it, but

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Speaker 1: it's still quite small. So if you a vaccine developer

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Speaker 1: figuring out how to price your vaccine, you need to

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Speaker 1: make considerations about you know, you're only producing maybe several

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Speaker 1: million doses of this vaccine, so you need to still

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Speaker 1: make a profit. And that's what Bavarian Nordic has said, basically,

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Speaker 1: is that to be viable, they have to charge the

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Speaker 1: price that they have set and they don't have that

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Speaker 1: much flexibility. You know, when you distributing a measles vaccine,

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Speaker 1: for example, you know, most childhoodization campaigns will include a

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Speaker 1: measles vaccine. So that's a massive, massive market compared to

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Speaker 1: the EMPOS vaccines.

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Speaker 2: While fewer people might have needed an empox vaccine, Ashley's

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Speaker 2: sources told her that making sure the vaccine was available

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Speaker 2: to the people who did need it could have changed

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Speaker 2: the course of this current outbreak.

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Speaker 1: When I spoke to scientists last week, they were rarely

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Speaker 1: saying that, you know, if vaccines had gotten to the DC,

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Speaker 1: for example, to Congo in January, we wouldn't be in

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Speaker 1: the situation.

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Speaker 2: But this is the situation we're in. So what will

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Speaker 2: it take to get the outbreak under control? And what's

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Speaker 2: at stake if the world fails to act? That's next.

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Speaker 2: The Africa Centers for Disease Control and Prevention reported Sunday

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Speaker 2: that empox has killed five hundred and seventy five people

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Speaker 2: in the Democratic Republic of Congo since the start of

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Speaker 2: the sea and it's infected thirty times more, and new

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Speaker 2: cases are now being found in Asia and in Europe.

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Speaker 2: I asked Bloomberg's Ashley Furlong where efforts to combat the

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Speaker 2: outbreak currently stand. So our vaccines available now for the

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Speaker 2: folks around the world who are at most risk.

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Speaker 1: No, so Congo doesn't have any doses at the moment,

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Speaker 1: they said, sort of the next couple of days, but

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Speaker 1: there's no clear timeline yet.

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Speaker 2: How many vaccines are needed.

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Speaker 1: The Africa CDC says that about ten million are needed

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Speaker 1: for the African content. That's quite small, you know, in

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Speaker 1: the DC in Congo at the population's nearly one hundred million,

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Speaker 1: so you know, we're talking about a tiny amount of

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Speaker 1: vaccines rarely that are needed potentially to control the outbreak.

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Speaker 1: Obviously we would have needed probably less if we were

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Speaker 1: talking about the several months ago.

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Speaker 2: The US is planning to donate fifty thousand doses, but

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Speaker 2: it has millions more in its stockpiles. Germany will donate

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Speaker 2: one hundred thousand doses of it's one hundred and seventeen

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Speaker 2: thousand dos reserve. Almost none of these donations are expected

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Speaker 2: to get to Congo until September at the earliest.

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Speaker 1: That won't get us up to the ten million, so

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Speaker 1: the rest will probably need to be bought, and countries

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Speaker 1: like Congo don't have the budgets to buy those vaccines,

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Speaker 1: so we're going to be looking at who's going to

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Speaker 1: help pay for those. There's some money being pledged by

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Speaker 1: several aid organizations and organizations that might administer and roll

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Speaker 1: out these vaccines, but at the moment it doesn't look

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Speaker 1: like we have the full amount that's needed.

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Speaker 2: But Ashley says containing the outbreak is not just a

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Speaker 2: matter of getting enough vaccines.

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Speaker 1: Rolling it out is going to also require quite a

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Speaker 1: lot of resources. Healthcare workers campaigns about educating people about

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Speaker 1: getting the vaccine, because just because you have a vaccine

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Speaker 1: on the ground, as we saw during COVID, doesn't mean

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Speaker 1: people will want to take it. And also in some

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Speaker 1: of these communities there might be quite a lot of

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Speaker 1: stigma around empuk'svaccines. There might be concern that, oh, if

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Speaker 1: I get at MPUs vaccine, everyone's going to know that

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Speaker 1: I'm might be at risk of emparks through my sexual

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Speaker 1: network or through my sexual contact. So we're going to

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Speaker 1: have to see how that plays out on the ground.

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Speaker 2: Given all these challenges, how likely is it that emparks

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Speaker 2: will be contained.

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Speaker 1: We're seeing quite a strong, finally, you know, response from

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Speaker 1: sort of the global players in a sense from the US,

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Speaker 1: from countries like Germany, etc. So we are seeing that reaction.

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Speaker 1: It might have been a little bit delayed. I think

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Speaker 1: there's a sense that you know, this is not going

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Speaker 1: to be the next pandemic, and that there's a strong

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Speaker 1: desire to stop the outbreak, and you know we're seeing

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Speaker 1: from the WHO, from the Africa CDC a really strong

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Speaker 1: message that this needs to be stopped. Now, I suppose

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Speaker 1: it'll depend on when that point's reached where it's no

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Speaker 1: longer global threat, then what happens. Are we going to

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Speaker 1: go back to what happened last year when the global

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Speaker 1: threat ended? The warld Hoth organized said this is no

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Speaker 1: longer a global emergency, and then things kind of went

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Speaker 1: back to the status quo, which basically meant nothing really

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Speaker 1: happened to stop the spread of mpocs.

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Speaker 2: So there's a risk that there could be a false

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Speaker 2: sense of complacency and that could snowball into a much

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Speaker 2: bigger problem exactly.

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Speaker 1: But I think that we've seen what that risk has

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Speaker 1: done now, so hopefully some of those lessons might be learned.

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Speaker 1: But this is a disease that, as we've spoken about,

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Speaker 1: has been spreading for a very long time. But you know,

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Speaker 1: there's been a push to end measles for years and

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Speaker 1: we still haven't reached that, and we're seeing more spread

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Speaker 1: of measles in high income countries as well. So I

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Speaker 1: think global health experts don't get their hopes up too much.

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Speaker 2: This is the Big Take from Bloomberg News. I'm Sarah Holder.

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Speaker 2: This episode was produced by Adrianna Tapia and David Fox.

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Speaker 2: It was mixed by Blake Maples. It was fact checked

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Speaker 2: by Alex Sugia. Our senior producers are Naomi Shaven and

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Speaker 2: Kim Gettelson, who also edited this episode with Aaron Edwards

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Speaker 2: and Tom O'Sullivan. Our executive producer is Nicole Beamster. Bor

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Speaker 2: Sage Bauman is Bloomberg's head of Podcasts. If you like

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