Rich countries have several hundred million doses of vaccines that could help fight an mpox outbreak in Africa, where donated shots fall far short of what is needed, according to a Reuters tally of public statements, documents and estimates from non-governmental organizations.

The shots have been stockpiled for years by countries such as Japan, the United States and Canada in case smallpox, an eradicated disease that is the more dangerous cousin of mpox, ever makes a comeback. Some of the vaccines were used outside of Africa in 2022 when mpox spread globally.

A small fraction of those doses could help curb what is now the biggest mpox outbreak on record in the Democratic Republic of Congo and neighbouring countries, disease experts say.

Fewer than 4 million doses have been pledged for donation out of an estimated 18 million to 22 million that are needed to vaccinate 10 million people in the next six months, depending on the vaccine, Africa’s Centers for Disease Control and Prevention said in a statement.

“It’s not a technical question, it’s a political one,” Maria Van Kerkhove, acting head of pandemic and epidemic prevention at the World Health Organization, told Reuters. She is lobbying for more donations alongside Africa’s CDC and other health authorities.

“Vaccines are useless on shelves,” Van Kerkhove said. “Why wouldn’t we get them to the people who need them right now?”

The current outbreak began in early 2023 in Congo, which accounts for most of the 37,500 infections and 1,451 deaths. It has spread to 14 African countries, according to Africa’s CDC. A first inoculation campaign using 265,000 donated shots is due to begin in Congo in early October.

“If we’d had more doses earlier, we could have planned a large-scale campaign and reduced transmission,” said Cris Kacita, head of Congo’s mpox response.

Health officials are concerned about a new strain, known as clade Ib, which was first identified in Congo and appears to spread more easily by close contact. Children are particularly vulnerable to mpox, as well as people with immune system conditions like HIV. The risk outside of Africa appears low at this time.

“Children are the main victims of this epidemic. The first emergency is not really being treated,” Kacita said.

Other factors have held back the mpox response, including slow regulatory procedures at WHO and in Congo, high vaccine prices and competing health crises exacerbated by conflict in the country.

Mpox shots alone are not a magic bullet and affected countries also need access to testing and awareness-raising to tackle outbreaks effectively, disease experts say.

But the stark divide on vaccine access shows governments are still not prepared to stamp out viral threats where they begin and before they spread.

“The disinterest in mpox and other viral threats where they emerge is a significant danger to people the world over,” said Peter Maybarduk, access to medicines director at the U.S. consumer group Public Citizen.

WHERE ARE THE DOSES?

Three vaccines recommended by the WHO are held in stockpiles worldwide: Bavarian Nordic’s BAVA.CO Jynneos (Imvanex or Imvamune outside the United States); KM Biologics’ LC16; and Emergent BioSolutions’ EBS.N ACAM2000.

They are all being considered for purchase and donation in Africa, said a spokesperson for Gavi, the Vaccine Alliance, a global group that helps lower-income countries buy vaccines. The group has up to US$500 million available for the mpox response. Many wealthy countries declined to say how much vaccine they have, citing national security reasons.

Japan has around 200 million doses of LC16, according to a WHO document from 2022. Unlike rival shots, LC16 can be used for children, although it is not available outside of Japan and requires special needles to administer.

Kacita said Congo is in discussions for up to 3.5 million LC16 doses from Japan.

KM Biologics declined to comment. A Japanese health official said Congo had asked for 3.05 million doses, but would not confirm the timing of the delivery. He said the WHO’s 200 million figure was not correct but would not confirm the size of the national stockpile.

Canada may have up to 2 million doses from Bavarian Nordic in its stockpile, said Adam Houston, medical policy and advocacy adviser for Medecins Sans Frontieres Canada, based on previous years’ announcements from the company. This shot was used to curb the 2022 mpox outbreak outside of Africa. This week, the Canadian government said it would donate up to 200,000 doses(opens in a new tab).

U.S. officials declined to disclose how much vaccine is in its stockpile, but two senior Biden administration officials said it is enough to protect its population.

That includes around 100 million doses of Emergent’s vaccine, according to Maybarduk, as well as an unspecified number of Jynneos shots, which experts say have fewer side effects. The U.S. has donated 60,000 Jynneos doses to the current outbreak.

Spain is among the largest confirmed donors, pledging in August 20 per cent of its mpox vaccine stockpile, or 500,000 doses. The country has urged all European Union member states do the same.

The European Commission has a joint procurement contract with Bavarian Nordic to buy vaccines for donations, and has sent 215,000 doses to Congo.

“Some of the vaccines could cost around US$150 for a person to be fully vaccinated, a price that is unaffordable to most African countries,” a spokesperson for the Africa CDC team in DRC said. “So donated vaccines from countries is all the more important.”

On social media, health-related misinformation pops up as relentlessly as furry heads in a game of whack-a-mole. In recent years, posts have claimed that ginger can be “10,000 (times) more effective(opens in a new tab)” at killing cancer than chemotherapy, that fluoridated water provides “no benefits, only risks(opens in a new tab),” and that the measles vaccine is “more dangerous(opens in a new tab) than becoming infected with measles.”

A national survey released in January by Abacus Data and the Canadian Medical Association (CMA)(opens in a new tab) found that false health claims can have a direct impact on patient care. Encountering health misinformation led 35 per cent of respondents to delay seeking appropriate medical care and 29 per cent to avoid effective treatments.

But the sheer volume of social media posts published on a daily basis means health experts hoping to set the record straight face a near impossible challenge – how do you know which claims will sputter out, which ones will gain momentum, and the best way to counteract false messaging?

These are some of the questions researchers at the University of Waterloo in Ontario hope to answer with a tool used to identify health misinformation on social media.

Named U-MAS, short for UbiLab Misinformation Analysis System, the University of Waterloo research tool is able to track health misinformation patterns before they become potential catastrophes. While the project launched in 2022, development is ongoing. The tool has been used to explore false claims about the war between Russia and Ukraine(opens in a new tab), and its current focus is on vaccine hesitancy and misinformation related to fluoride, heatwaves and diet.

A 2022 study conducted by the World Health Organization(opens in a new tab) identified misinformation in about 60 per cent of social media posts related to pandemics (29 per cent specifically on COVID-19) and more than 50 per cent on vaccines. Social media posts came from platforms such as X (formerly known as Twitter) and Instagram.

In addition to monitoring which posts gain traction, U-MAS researchers can identify sometimes overlooked factors that may fuel misinformation. Their work on vaccine hesitancy, for instance, found that while many of the concerns during the COVID-19 pandemic revolved around the safety of vaccinating young children, adults were also concerned about the safety of seniors, a worry that may have caused some to discourage their parents from getting vaccinated.

For now, only Waterloo researchers and their colleagues at other institutions can access the tool. But the development team — Zakir Hussain, development lead Dr. Jasleen Kaur and principal investigator Prof. Plinio P Morita — is aiming to make it accessible to a broader audience.

Misinformation a ‘very bad public health outcome’: expert

As part of one study published in 2022(opens in a new tab), the tool examined 500 Instagram posts that contained the term “fluoride-free,” a keyword often used by social media users who oppose fluoridation.

Common concerns emerged among users — many messages suggested fluoride use was inconsistent with a healthy lifestyle, while others took issue with governments mandating its addition to water supplies. But noticeable differences appeared when the tool examined the likes, comments and retweets these messages received.

While posts about lifestyle concerns were liked and shared, messages characterized as political, which represented about 16 per cent of the data set, spread more widely. Posts that saw high amounts of engagement often suggested governments were deliberately overlooking dangerous side-effects.

The analysis also showed that anti-fluoride messaging became more prevalent with the onset of the COVID-19 pandemic, a period when government conspiracy theories thrived(opens in a new tab).

Community water fluoridation has been endorsed by major public health bodies including the World Health Organization, the Canadian Dental Association and the Public Health Agency of Canada, according to a 2022 report published by the Office of the Chief Dental Officer of Canada(opens in a new tab). Studies cited by the U.S. Centers for Disease Control and Prevention(opens in a new tab) also show fluoridated drinking water is associated with a 25 per cent reduction in tooth decay among children and adults.

Still, since 2017, more than a dozen communities in Canada(opens in a new tab) have discontinued water fluoridation programs. The reasons vary, but include concerns about “putative health effects” of fluoride, the report noted. Research conducted throughout the years has shown that in Canada, much of the documented risk associated with community water fluoridation involves dental fluorosis, caused by exposure to too much fluoride during tooth development. The most common form of dental fluorosis is considered mild, according to the 2022 report(opens in a new tab).

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Misinformation about the risks of public health initiatives poses a threat not only to individuals, but to the broader population, says Irfhana Zakir Hussain, a PhD student in the University of Waterloo’s School of Public Health Sciences, who served as core designer and developer for the misinformation project.

If left unchecked, false claims can spread quickly and widely, with negative consequences, says Zakir. “If (they are) shared and become an infodemic, that becomes a very bad public health outcome,” she says.

A case in point involves a water department official in Richmond, Vermont, who in 2022, admitted to quietly lowering the levels of fluoride(opens in a new tab) being added to local water supplies. He expressed concerns about the quality of fluoride being sourced from China and also stated that he didn’t believe the level of fluoridation recommended by the state was warranted.

“To err on the side of caution is not a bad position to be in,” he told the city’s Water and Sewer Commission.

This led community residents to express concerns around their children’s dental health and overall government transparency.

How can false health claims be addressed?

Armed with his knowledge, health experts could develop a campaign directly targeting misinformation, Zakir Hussain says.

“Ideally, you’d be using the system for a variety of use cases and monitor them over time to see what needs to be spoken about and what does not,” she says.

Dr. Joss Reimer, CMA’s current president and the medical lead for Manitoba’s COVID-19 Vaccine Implementation Taskforce, says new support to combat misinformation is critical to Canadians’ well-being.

“During the pandemic, I saw first-hand how misinformation becomes literally a life-or-death issue,” she says.

The Council of Canadian Academies, a not-for-profit that examines evidence on various scientific topics, published a report suggesting the belief that COVID-19 was a “hoax” or an exaggerated threat(opens in a new tab) contributed to more than 2,800 deaths in 2021. COVID-19 misinformation also led millions of Canadians to delay getting vaccinated, the report noted.

“In Manitoba, there were people struggling to breathe, but still denying COVID was real. We had pregnant patients who believed the lies about the vaccine, got sick and gave birth prematurely, leading to lifelong health problems for those infants,” Reimer says.

Those without COVID-19 vaccinations faced increased risk of severe symptoms(opens in a new tab), hospitalization and death – and the dangers didn’t disappear once they got over their initial infections, a 2023 study found. Published in the Nature Medicine journal(opens in a new tab), the U.S. study discovered these patients were at higher risk of developing a host of health complications, including blood clots and heart problems, for up to two years after recovering. Pregnant women who weren’t vaccinated risked worse COVID-19 symptoms and a higher possibility of losing their baby, according to a separate study published in the Nature journal in 2022(opens in a new tab).

Timothy Caulfield, an outspoken expert on health misinformation and a Canada Research Chair on health law and policy, says the U-MAS system is part of a growing international movement taking aim at health misinformation. In the past, he says, some experts may have ignored false claims, assuming that science-based information would prevail, “but now there’s growing recognition that action is required.”

Practitioners can play a key role in encouraging this action, says Reimer, referencing some of the results of the national survey by Abacus Data and the CMA(opens in a new tab) released earlier this year.

“We found that physicians are the most trusted source of health information for Canadians, closely followed by nurses and pharmacists,” says Reimer. “That privilege gives us the opportunity to address false health claims head-on.”

In addition to direct conversations with health providers, Caulfield says curbing the spread of health misinformation requires tactics such as regulatory interventions by different levels of government, an educational curriculum that emphasizes critical thinking skills among students, and “pre-bunking” messaging that anticipates concerns about a particular health issue and addresses them before they become rampant.

Resources like U-MAS can inform all of these strategies, he says, by identifying the false messaging most likely to gain traction.

Along with making the tool accessible to more users, the development team hopes to expand their analysis, which draws on posts from X and Instagram, to include material from YouTube, Facebook and other platforms.

“Tools like this that take a big-data approach are desperately needed,” says Caulfield. “They’re helping build resilience against misinformation.”

Primary and acute care providers, highly trained professionals who are adept at using up-to-date technology to help look after patients, still rely heavily on a distinctly 20th-century device: the fax machine.

“It’s 2024. We’re digitally connected in pretty much all other aspects of our lives. Why not for something as important as our health and wellness?” said Dr. Rashaad Bhyat, a Brampton, Ont.-based family physician and clinical leader with Canada Health Infoway(opens in a new tab), a digital health non-profit organization.

While 93 per cent of primary care physicians across Canada use electronic medical records (EMR), less than 40 per cent of those providers are able to digitally share clinical updates, according to the Commonwealth Fund’s 2022 International Health Policy Survey of Primary Care Physicians.

The lack of interoperability — the ability to share information securely across different systems — is one of the biggest factors that has kept the fax machine humming well into the smartphone age, said Bhyat. For the most part, even email is off the table, because many general practitioners have not integrated secure messaging into their clinic management systems.

With overburdened health-care systems across the country, there is an urgent need to provide doctors and patients with the ability to digitally access and share data, he said. According to a report published by Infoway last year, a modernized system of connected care(opens in a new tab) has the potential to eliminate more than two million unnecessary primary care visits and 500,000 trips to the emergency room, saving nearly $700 million per year. Enhanced connectivity will also lead to more hassle-free referrals, faster test results and more comprehensive consultations, the report states.

But to widely implement digital access will require improving infrastructure across the board to ensure patients’ data remains in their own hands — and not in the clutches of cybercriminals.

Piecing together the puzzle of digital health care

When it comes to digitally connected health-care systems, Canada is playing catch-up. Denmark established its national patient portal(opens in a new tab) in 2003, while more than 40 per cent of those living in Sweden had signed up to access their electronic health records by 2017, a level of buy-in that Canada has not yet achieved.

In the U.K., the National Health Service (NHS) app grants patients access to general practitioner records, and while the United States does not yet have a national portal, the country implemented the 21st Century Cures Act in 2016, federal legislation that established standards for data collection and sharing. For its part, Canada’s federal government has only just taken initial steps to improve connected care, tabling Bill C-72(opens in a new tab), which would ensure common approved standards this past June.

Abhi Kalra, executive vice-president of Infoway’s connected care program, said seamless nationwide connectivity is lagging, in part, because of the complexity of Canada’s federal and provincial systems. Each province and territory runs its own unique health system, and each of those 13 systems reflects the issues that seem most urgent to that region.

Interoperability isn’t always at the top of the list of priorities, he said. “Each jurisdiction knows its own pain points, so there are bound to be different priorities,” Kalra said. “One province might want to focus its resources on reducing wait times or hiring more specialists, and then come back to digital access and data infrastructure modernization two years later.” Change is slowly coming, he said, adding that provinces are now recognizing interoperability “is needed to advance an effective, connected care health system.”

Some provinces, such as Quebec, Nova Scotia and Prince Edward Island, have established portals that allow patients to check lab results, track hospital visits, and keep up with prescriptions and appointments. Other provinces, however, are still working to develop similar tools. ConnectingOntario(opens in a new tab), for example, provides patient summaries that can only be accessed by health-care providers. Additionally, networks of linked hospitals, such as the University Health Network (UHN) and Unity Health, allow patients to access information from clinics that are part of their self-contained systems.

Kalra said Infoway has been working with federal, provincial and territorial governments to develop a 10-year plan for a national EMR platform. Not quite two years in, Infoway’s pan-Canadian roadmap has established standards for data collection and exchange between different health-care providers, to ensure medical records are kept safe while allowing patients to access this data more easily.

Bill C-72, once passed, would require that these standards are upheld by all IT companies that provide health-care delivery systems in Canada if a province or territory does not have its own similar requirement.

Innovation to access information

The shift toward giving patients access to their own information is as much cultural as it is technological, said Rishi Nayyar, co-founder and CEO of PocketHealth(opens in a new tab), a startup that has developed a cloud-based medical image–sharing system.

“I think the industry used to feel it was in patients’ best interests to be left in the dark,” said Nayyar. “The worry was that they’d learn they had a diagnosis without a doctor to comfort them, or they’d take it the wrong way and do something dramatic.”

The startup began with a minor injury. In 2013, Nayyar’s brother, Harsh, who was a Google software engineer in the San Francisco Bay Area at the time, twisted his ankle playing tennis. After X-rays and an MRI, the radiologist gave him two CD-ROMs.

“(My brother) called me and said, ‘What am I supposed to do with these? I have a MacBook Air,’” said Nayyar.

PocketHealth co-founder Rishi Nayyar (Supplied)

In 2016, the brothers saw their chance and founded PocketHealth. In addition to cloud-based image-hosting and sharing capabilities, the platform includes features such as Report Reader, which helps explain medical terms, and Ask My Doctor, which offers patients personalized questions to ask their physicians. PocketHealth is able to instantly upload and share medical imaging and patient results with care providers, streamlining communication between patients and doctors, Nayyar said.

Eight years later, close to 2 million people and 800 hospitals and imaging centres across North America have set up accounts with the Toronto-based startup.

Security worries and potential protections

According to experts, access is one of two buzzwords in eHealth, which involves the use of digital technology to provide health-care services — the other is security. Last fall’s ransomware attack(opens in a new tab) on five southwestern Ontario hospitals, during which more than 325,000 patient files were stolen, was just one of many examples of the threats targeting health-care systems around the world.

Patient records can easily be exploited by bad actors for identity fraud purposes, said Jennifer Quaid, executive director of the Canadian Cyber Threat Exchange (Getty Images / Viorika)

Ransomware attacks in the global health sector nearly doubled from 2022 to 2023. Because they collect sensitive personal data and require constant access to that information, health-care facilities can be particularly lucrative targets for cybercriminals, said Jennifer Quaid, executive director of the Canadian Cyber Threat Exchange (CCTX(opens in a new tab)), a cybersecurity collaboration forum with 180 private-sector members.

In May, hackers shut down Ascension(opens in a new tab), a U.S. non-profit that oversees 140 hospitals and 40 senior living facilities, and June’s attack on U.K.’s Synnovis, a provider of pathology services, delayed medical procedures in several major London hospitals.

Cybergangs such as Black Basta, the Russia-based ransomware group that debilitated Ascension, have started to practise double extortion — they demand money to decrypt the data and again to not release the data.

Some groups are also starting to demand ransom directly from patients by threatening to publicize their sensitive data on the dark web, said Quaid. “EMRs are a goldmine for cybercriminals,” she said. “These files have OHIP (Ontario Health Insurance Plan) numbers, social insurance numbers, credit card info.”

Patients are not always aware that their details are being tracked by third parties. A 2023 investigation by Toronto-based cybersecurity company Feroot Security(opens in a new tab) found that as many as 86 per cent of the health-care and tele-health sites that they analyzed were transferring data to Big Tech without user consent.

Bad actors can easily exploit these details for identity fraud purposes, said Quaid, who describes EMRs as “a very tempting target.”

There are some relatively easy steps health-care organizations can take, however, to prevent attacks and safeguard patient information, she said. First, it’s important to identify what information is critical to operate and protect that accordingly, ensuring systems are up to date and that people are using multi-factor authentication, she said. As well, staff should be trained to recognize phishing attempts. And organizations should have a plan in place in case the worst happens and there is a breach.

PocketHealth’s Nayyar said he believes the benefits of data ownership can help offset the vulnerability of large health-care organizations. When Windsor Regional Hospital, one of the five southwestern Ontario health facilities hacked last fall, was forced offline, most procedures and treatments had to be delayed.

For patients who had previously signed up with PocketHealth, however, their care was able to proceed with few disruptions. That’s because those users had access to their own data and were quickly able to share it with their doctors, said Nayyar: “It shows we’re really in the era of the empowered patient.”

Healthy patients, healthy doctors

Connected care can also help reduce doctor burnout, said Bhyat. Many family physicians see up to 50 patients a day, which means every minute counts. But according to a report from the Canadian Federation of Independent Business, doctors in this country collectively spend up to 18.5 million hours per year(opens in a new tab) on unnecessary administrative tasks, the equivalent of 55.6 million patient visits annually.

Bhyat said empowering patients can also be a boon to doctors’ own well-being. He sees many individuals with chronic problems, such as diabetes, chronic obstructive pulmonary disease or cancer, that require ongoing and complex care.

“Co-ordinating that care shouldn’t require filling out duplicate forms and going through multiple logins,” he said. “It’s very frustrating to have to go through a billion clicks just to write a good referral and send it.”

Bhyat said this frustration can lead to fatigue and stress, forcing some to reduce clinical hours or switch to a different specialty. A survey from the Ontario College of Family Physician last year found that two-thirds of physicians in the province are planning to make a change or leave the profession in the next five years. But with Canada in need of more family doctors, modernizing the country’s EMR system may be exactly the prescription providers need to take on the most important — and rewarding — part of their jobs, he said.

As Bhyat put it, “Ask any doctor and they’d tell you they’d rather spend more time with their patients and less time trying to track down a missing fax.”

Saskatchewan’s overdose crisis is tragically on par with last year’s record breaking total, with more than 200 people having lost their lives to accidental overdoses in the first seven months of the year.

From Jan. 1 to July 31, 229 people have died as a result of drug toxicity in Saskatchewan. Of those, 104 have been conclusively proven to be accidental, while five were found to be a result of suicide. One case is still classified as undetermined.

In addition, suspected drug toxicity deaths total 119 in the same period, resulting in a total of 229.

Including both confirmed and suspected deaths – 2023 saw 460 people lose their lives to drug toxicity.

“Drug toxicity is getting much, much worse. We’re seeing combinations of drugs where people still don’t know there’s fentanyl in it,” explained Kayla Demong, executive director of Prairie Harm Reduction.

The Saskatoon-based non-profit does offer drug testing services out of its drop-in and safe consumption site. While information is power in these circumstances, it alone isn’t stopping the wave of tragedy that surrounds drug toxicity across the province.

“We’re seeing multiple overdoses a day, and we’re losing people at this point every couple days,” Demong said. “It has become one of the most tragic things I’ve ever seen working in this field, because we have so many people who are so desperate for proper support who aren’t getting it.”

According to Moms Stop the Harm, 2,900 people have died due to due to drug related harms in Saskatchewan since 2010.

Drug Toxicity Deaths

•  2024 – 229 (as of July 31)
•  2023 – 460
•  2022 – 368
•  2021 – 406
•  2020 – 325

Source: Saskatchewan Coroners Service

Demong says the province’s current approach of solely focusing on treatment is bound to ineffective – due to it not taking into account all the necessary steps on the road to recovery.

“Right now, it’s treatment or nothing, or it’s harm reduction or nothing, and it’s just become this ongoing clash without actually looking at the research and the facts and the reality of substance use to really make a proper plan that will save people’s lives,” she said.

According to Prairie Harm Reduction, housing supports are absolutely key to begin the process.

“With the community that we’re working in. We need housing first. We need basic needs met. People need to be provided enough on income assistance to actually be able to meet their basic needs, and then treatment is an option,” Demong explained.

“But right now, we have people who are using and overdosing, sleeping in alleys. You can’t send somebody to treatment and release them back into an alley and expect that there’s going to be success and more than anything, we need a continuum of care.”

The province touted its new action plan for mental health and addictions in the leadup to International Overdose Awareness Day on Aug. 31 – highlighting its commitment to doubling treatment capacity by adding 500 treatment beds across the province.

So far, 231 beds have been added.

“By helping people overcome addictions and by supporting recovery, we can save lives, heal families and strengthen our communities,” Mental Health and Addictions Minister Tim McLeod said in the release.

With September now well underway and the province traveling headlong into fall – Demong highlighted the changing dangers for those at-risk of overdosing.

Demong says regardless of the season, there’s always environmental hazards.

“When people are dehydrated and it’s really hot and they’re overheated, that increases risk of overdose, because you’re already dealing with other factors,” she said. “With winter, it’s freezing. If you’re overdosing in an alley and nobody sees you and it’s -30 [degrees], the chance of living is very minimal.”

In 2023, the province activated its cold weather strategy on Nov. 1 as temperatures dipped across the province.

Demong says discussions around a strategy for the coming winter have not happened yet.

“Every year, they [say], ‘Well we’re going to start planning in the spring,’” she said.

“Well, we still don’t have a plan.”

Another aspect of its overdose strategy the province highlighted were its free Take Home Naloxone kits.

The kits are available free of charge at more than 430 locations across Saskatchewan.

Since its introduction in 2015, the province says 44,000 people have been trained to use them and 12,000 overdoses have been reversed by members of the public.

While more access to life-saving resources like Naxolone is always a good thing, Demong noted that it acts as a band-aid – not a solution.

“It definitely has helped raise awareness. We give away thousands of kits a year … but it’s not solving the overdose crisis. Nothing that’s happening right now is solving the overdose crisis.”