Sikhulile Moyo, virologist: ‘With mpox, I’m concerned about the selfishness of some countries. It seems that we haven’t learned’

In November 2021, the team led by virologist Sikhulile Moyo (Zimbabwe, 1973), researcher and director of the Botswana-Harvard HIV Institute (BHP) laboratory in Gaborone, was the first to identify the omicron variant of the coronavirus, together with a Brazilian bioinformatician working in South Africa, earning him a multitude of awards and recognitions. The following year, Times magazine included him in its list of the 100 most influential people in the world.. The specialist then believed that the planet had learned a lesson: viruses have no borders. Now he doubts this after witnessing the international response to the serious health emergency unleashed by mpox — also known as monkeypox — in the Democratic Republic of the Congo.

In the laboratory he runs in the capital of Botswana, he talks about this new virus causing concern in some African nations and that high-income countries are looking askance at, but also about how climate change can accelerate the emergence of new epidemics, especially in Africa, and the reasons that make the continent more vulnerable to this type of disease. He also discusses how Botswana, a middle-income state, has made significant progress in health matters. In 2021, for example, it became the first country in the world with a high HIV burden — those in which more than 2% of pregnant women live with the virus — to eliminate mother-to-child transmission of the AIDS virus.

Question: It’s been three years since your laboratory sequenced the omicron variant of the coronavirus. There was a lot of talk back then about how many things had to change in Africa to ensure that new epidemics would not catch countries on the continent off guard again. Has that been the case?

Answer. One of the things that the world discovered with the omicron variant is that viruses have no passports or borders. They move with people because we are a global village. We also realized that the effort to control pandemics cannot be that of one country alone. There are now several coalitions, both national and international, working to ensure that, in the future, we can deal with these kinds of problems together. In addition, we have learned how to communicate to communities the existence and dangers of a new virus. Even though we scientists do our job, we must be able to make people understand what is happening. People are part of the solution. Finally, I think that African countries are realizing that they can now issue their own diagnostics.

Q. However, we have recently witnessed an outbreak of mpox, the largest known to date in Africa, and it seems that the same problems have been repeated: higher-income countries have withheld vaccines that could have alleviated the situation.

A. What we see is that some lessons we thought we had learned have come back to us. Countries like the Democratic Republic of the Congo or Burundi are dealing with an aggressive disease while the rest of the world is just watching them do it. One of the things that worries me the most is the selfishness of some countries. And as I said, viruses do not respect borders. In 24 hours they can move from one end of the world to the other. We have seen that there are nations and organizations that have mobilized to bring vaccines and donate material. It is not enough, but those are the kinds of actions that we need.

If you protect your neighbor, you are protecting yourself. And, in the case of mpox, this is not happening. No action is taken until you see your own house on fire”

Q. Do you think Western nations should become more involved in health emergencies such as this new outbreak of mpox?

A. The world is a global village, so these kinds of cases need an international response. If you protect your neighbor, you are protecting yourself. And, in the case of mpox, this is not happening. No action is taken until you see your own house on fire. But I also think that the African continent needs to wake up and be able to produce its own test kits, its own vaccines. It is the only way to stop complaining that no one is helping us.

Q. In 2021, countries in southern Africa were hit by the omicron variant. Now, the Democratic Republic of the Congo is battling mpox. In 2022, there was an aggressive outbreak of Ebola in Uganda, although not as bad as the one in Sierra Leone in 2014. In addition, every so often, countries like Zimbabwe or Zambia deal with severe cases of cholera. Why do these diseases seem to hit Africa more severely than other regions?

A. Africa is more vulnerable for several reasons. Firstly, many of the health systems in African countries are still those of colonial times. Secondly, this is where the largest interface between humans and animals is found, and more than 70% of these infections we are talking about are zoonotic. In addition, prevention systems are still developing. I also have to say that climate change could accentuate some of these problems. And the countries that cause it the most are not precisely those that are suffering its most devastating consequences.

Climate change causes animals and humans to come into closer contact, and these microorganisms become more adaptable and more capable of infecting new hosts”

Q. Can climate change cause pandemics or epidemics in Africa?

A. It can amplify diseases and epidemics. It changes temperatures and habitats and causes floods that bring with them massive movements of organisms. Climate change causes animals and humans to come into closer contact, and these microorganisms become more adaptable and more capable of infecting new hosts. Ultimately, it can cause viruses whose main victims are animals to also affect humans. You can see this with mosquitoes that carry malaria; changes in temperature, for example, allow these bad mosquitoes, so to speak, to displace the good mosquitoes. It also happens with those that transmit dengue, chikungunya, and other diseases.

Q. There are countries in Africa, such as Botswana, that are models in terms of health. For example, in 2021 the country became the first with a high HIV burden to eliminate mother-to-child transmission. How can these achievements be enhanced?

A. Firstly, with committed public policies. Here, the government has taken this issue very seriously for the last 25 years or more. Significant resources have been allocated to combat HIV. Botswana was the country with the largest proportion of people living with the AIDS virus, and it was the first nation in Africa to offer free treatment to all its citizens. It did so in 2002. It was a great show of commitment that attracted many partners, including this institution. Secondly, Botswana has always been open to working with international organizations in the response to HIV. Donors are vital, but allocating a significant amount of your budget to health is even more vital.

Q. Is it easy for everyone to benefit from these advances? How do you combat, for example, the stigma that this disease often carries?

A. Primary care was promoted a lot here to ensure that services reached everyone and all sectors of the population. We have to make sure that no one is left behind. Access to healthcare cannot be a matter for the rich, and that is something that is being done very well in Botswana. All inhabitants have access to healthcare for free or at a very low cost. In addition, Botswana society has managed to make it very natural to talk about HIV. Before, some people who were infected felt ashamed, they lowered their heads... Now none of that happens any more.

Q. Botswana, however, has fewer than three million inhabitants. Is it easier to achieve such progress here than in other countries, or even in African cities, with much larger populations?

We have to make sure that no one is left behind. Access to healthcare cannot be a matter for the rich, and that is something that is being done very well in Botswana”

A. Not necessarily. It is true that having a small population can be an advantage, but here we have had to face a challenge due to the very low population density — two-thirds of the country’s territory is desert. This makes it difficult for medicine to reach everyone. In terms of means of production, for example, other nations may have many more options.

Q. What other diseases are of concern to the Botswana or African population in general today?

A. We are now focusing on non-communicable diseases such as diabetes, hypertension, etc. That is what concerns us now. These are problems that also affect high-income countries. In addition, we are facing an increasing number of cancer cases.

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